年龄、临近死亡时间和老年人医疗费用——关于“红鲱鱼”假说的验证  

Age,Time to Death and Health Care Expenditure for Older Adults:Testing of Red Herring Hypothesis

作　　者：刘晓婷[1] 赵琦 LIU Xiao-ting;ZHAO Qi(School of Public Affairs,Zhejiang University,Hangzhou 310058,China)

机构地区：[1]浙江大学公共管理学院,浙江杭州310058

出　　处：《人口与发展》2022年第1期2-15,共14页Population and Development

基　　金：国家社会科学基金重大项目《人口老龄化与长寿风险管理的理论和政策研究》(13&ZD163);国家自然科学基金青年项目“基于认知能力对身体功能影响的失能老年人长期照护需求评估模型研究”(72004201)的阶段性研究成果。

摘　　要：年龄的增长是否必然带来医疗费用的增长?以往的实证研究仍存在争议。使用CLHLS数据,区分不同人群,采用两部模型研究年龄和临近死亡时间与老年人医疗费用的关系。研究发现:虽然在低龄群体中医疗费用随年龄增长而提高,但高龄群体随着年龄的增长医疗费用显著下降;在死亡样本中医疗费用随年龄的增长而下降,而存活样本中并未发现年龄的显著影响。然而,临近死亡时间越短则医疗费用越高,这一规律在各群体中保持稳健。临近死亡时间并未显著影响失能老年人的医疗费用,却显著提高了一年内死亡样本的照料费用。研究表明,寿命的延长并未导致医疗费用的增长,而是推迟了医疗费用高峰期的到来。为此有必要发展和完善临终关怀服务和长期照护保障制度,以降低老年人生命末期的医疗费用并提高生命质量。Will population aging inevitably lead to an increase in health care expenditures(HCE)The results of empirical studies have been rather mixed,while the evidence from low-and middle-income countries is scarce.Based on the Chinese Longitudinal Healthy Longevity Survey(CLHLS),this study examines the effect of age and time to death(TTD)on HCE among older adults in China.The results indicate that the effect of age on HCE varies while the effect of TTD stays consistent in subsamples.Specifically,HCE increases as a function of age in older adults aged below 80;while it declines with age in the oldest-old group.In addition,age has a negative effect on HCE among the deceased elderly;while it fails to affect HCE among the survivors.On the contrary,TTD has a significant impact on HCE during the terminal years as HCE increases with the closeness of TTD.This result remains robust in subsamples.Furthermore,we find that TTD fails to affect HCE but increases the cost of long-term care for deceased older adults with disability.This study suggests that the extension of lifespan may not lead to an increase in HCE but could delay the arrival of its peak period.These results provide policy implications in terms of HCE and long-term care for the analysis of the aging population in China.

关 键 词：年龄 临近死亡时间 医疗费用 “红鲱鱼”假说 老年人 

分 类 号：C913[经济管理]