失能风险对老年人医疗消费的影响——长期护理服务模式的中介作用  

The Impact of Disability Risk on Medical Consumption of the Elderly:The Mediating Role of Long-term Care Service

作　　者：刘欢 LIU Huan

机构地区：[1]苏州大学社会学院

出　　处：《中央财经大学学报》2023年第11期52-63,共12页Journal of Central University of Finance & Economics

基　　金：浙江省哲学社会科学基金“目标治理视域下浙江省长期护理保险试点政策评估与优化研究”(项目编号:23NDJC218YB);教育部人文社会科学重点基地重大项目“弱有所扶:困难群体就业援助的政策体系研究”(项目编号:22JJD630015)。

摘　　要：在人口老龄化背景下,医疗服务与长期护理服务保障的重要性日益凸显,而剖析失能风险对老年人医疗消费行为的影响有利于医疗控费政策的精细化,并有助于推动医疗保障与长期护理保障的制度协同。因此,笔者基于CLHLS三期追踪数据,利用多水平模型和结构方程模型,探讨失能风险对老年人医疗消费的影响。研究结果显示:失能风险对老年人年度医疗总消费、门诊消费、门诊自付、住院消费及住院自付有显著正向影响,其效应分别为0.2852、0.3079、0.1788、0.1101和0.1503;相较于基础性日常生活自理能力,工具性日常生活自理能力对老年人医疗消费影响更显著且效应更高,其效应分别是0.3093、0.3721、0.1688、0.1311和0.1370。以上结果在家庭经济状况、子女数及性别上表现出群体异质性。此外,长期护理服务模式发挥了重要的中介作用,如其显著降低了失能风险所造成的老年人医疗总消费增加,中介效应占比(RIT)达到了22.60%,而其对门诊消费的RIT达到了最高的40.70%。整体而言,长期护理服务模式对门诊消费行为的综合中介效应更高,其累计中介效应也高于住院消费。基于此,笔者提出加快长期护理保险制度建设、完善长期护理服务供给等建议。Based on the CLHLS three phase tracking data,we use a multilevel statistical models and structural equation modelling(SEM)to explore the impact of disability risk on the medical consumption of the elderly.The results have shown that disability risk has a significant positive impact on the annual total medical expenses,outpatient expenses,outpatient self payment,inpatient expenses,and inpatient self payment of the elderly,with effects of 0.2852,0.3079,0.1788,0.1101,and 0.1503,respectively.Compared to BADL,IADL has a more significant and higher impact on elderly medical consumption.In addition,the long-term care service model plays an important intermediary role.If it significantly reduces the increase in the total medical consumption of the elderly caused by disability risk,the proportion of mediating effect(RIT)has reached 22.60%,and its RIT on outpatient consumption has reached the highest 40.70%.Based on this,it is proposed to accelerate the construction of long-term care insurance system and improve the supply of long-term care services.

关 键 词：失能 长期护理服务 老年人 医疗消费 日常生活自理能力 

分 类 号：F84[经济管理—保险] C913.7[社会学]