基于模糊断点回归的退休对老年男性医疗服务利用影响研究  

Impact of Retirement on the Utilization of Medical Service for Elderly in China

作　　者：曾雁冰[1,2] 罗贝 方亚[1,2] Zeng Yanbing;Luo Bei;Fang Ya(Center for Aging and Health Research,Center for Health Economics and Policy,School of Public Health,Xiamen University(361102),Xiamen)

机构地区：[1]厦门大学公共卫生学院卫生经济与政策研究中心,361102 [2]厦门大学公共卫生学院老年健康研究中心

出　　处：《中国卫生统计》2022年第1期19-24,共6页Chinese Journal of Health Statistics

基　　金：国家自然科学基金项目(71874147,81973144)。

摘　　要：目的了解退休对老年人医疗服务利用的影响。方法基于模糊断点回归模型,利用中国健康与养老追踪调查(CHARLS)2013年、2015年数据,使用两阶段最小二乘法(2SLS)分析退休对门诊服务、住院服务、自我治疗以及医疗服务满意度的影响,并分析退休对老年人的健康、健康行为、收入和时间成本的影响机制。结果本研究共纳入2044个男性老年人样本,退休率在60岁出现了明显跳跃。门诊服务利用方面,退休减少了14%的门诊放弃率,看医生的次数每月增加0.3次以上,门诊就诊率提高14%,门诊自付费用占总费用的比重增加42.3%。住院服务利用方面,退休使得放弃住院率增加13.4%。自我治疗方面,退休后男性老年人自我治疗总费用和自付费用显著增加。医疗服务满意度方面,退休后的老年人降低了对本地医疗服务的质量、成本和方便程度的满意度。从影响机制上看,退休后个体生理健康、心理健康、自评健康均呈下降趋势,其中退休后其认知功能、日常生活能力、生活满意度明显下降,患慢性病病种数量增加9.8%、患抑郁的风险增加9.1%、自评健康下降49.8%。退休后社交参与率和吸烟概率显著上升。退休后随着时间成本变化私营部门员工门诊放弃率、住院放弃率相较于公共部门显著下降。结论退休后男性老年人医疗服务利用呈上升趋势。退休通过对健康和健康行为产生负面影响,降低就医时间成本来促使个体提升医疗服务利用。相关部门应采取措施提高就医服务的便捷性、可及性以及满意度,进一步完善社会保障体系,并关注劳动者和退休人员身心健康,保障不同部门职工休息休假的权利,加强健康教育以促进健康行为,为推动健康老龄化、保障老年人医疗服务利用提供重要基础。Objective To study the utilization of medical service for elderly.Methods This study used data from the China Health and Retirement Longitudinal Study(CHARLS)in 2015 and 2013.Based on a fuzzy regression discontinuity model,we applied 2 SLS to analyze the impact of retirement on outpatient services,inpatient services,self-treatment and medical service satisfaction,and the impact mechanism of retirement on the health,health behavior,income and time cost of the elderly.Results This study included 2044 samples,and the retirement rate jumped significantly at the age of 60.Regarding the outpatient service utilization,the outpatient abandonment rate decreased by 14%,the number of doctor visits increased more than 0.3 times a month,the outpatient rate increased by 14%,The proportion of outpatient out-of-pocket expenses increased by 42.3%.In terms of the utilization of hospitalization services,the probability of giving up hospitalization after retirement increased by 13.4%.In terms of self-treatment,the total cost of self-treatment and out-of-pocket expenses for the elderly increased significantly after retirement.As for medical service satisfaction,the retired older people′s satisfaction with medical services decline.Furthermore,we found the physical health,mental health and self-assessment health of individuals after retirement all declined.Meanwhile,the cognitive function,daily life ability and life satisfaction of the elderly after retirement dropped significantly,and the number of individuals suffering from chronic diseases increased by 9.8%,the risk of depression increased by 9.1%,and self-rated health decreased by 49.8%.The social participation rate and smoking probability increased significantly after retirement.With the changed opportunity cost of time after retirement,the incidence of forgone outpatient and forgone inpatient among private sector employees decreased significantly compared with the public sector employees.Conclusion After retirement,elderly increased the utilization of medical services,mainly du

关 键 词：退休 医疗服务利用 老年人 模糊断点回归 

分 类 号：R195.1[医药卫生—卫生统计学]