居家社区医养结合服务对老年人医疗费用的影响:效应测度与机制分析  

The Impact of the Integrated Medical and Nursing Care Services in Home and Community on the Elderly Medical Expenses:Effect Measure and Mechanism Analysis

作　　者：孙菊[1,2] 韩文晶 SUN Ju;HAN Wen-jing(Wuhan University,Wuhan 430072,China)

机构地区：[1]武汉大学政治与公共管理学院,湖北武汉430072 [2]武汉大学健康治理研究中心,湖北武汉430072

出　　处：《江西财经大学学报》2023年第5期51-64,共14页Journal of Jiangxi University of Finance and Economics

基　　金：国家社会科学基金项目“基于SD的城乡居民医疗保险基金风险动态评估与管控机制仿真研究”(16BGL150)。

摘　　要：基于CHARLS(2018)数据,借助HECKMAN样本选择模型、两部模型、处理效应模型以及因果中介效应分析方法,系统考察居家社区医养结合服务对老年人医疗费用的影响效应、作用路径及其异质性。研究发现:医养结合服务具有显著的经济绩效,能促进门诊服务利用、降低住院概率,每增加1单位医养结合服务,住院总费用减少约2145元;同时存在显著健康效应和服务替代效应,即通过提升老年人健康水平、改善健康保健行为以及医疗服务利用行为,进而抑制老年人医疗费用支出。另外,居家社区医养结合服务对居住在农村地区、非高龄、健康状况较差、有配偶同住的老年群体作用更显著。因此,要进一步提升医养结合服务供给能力与质量;加强服务对象的健康动态监测与行为管理;瞄准农村地区和弱势群体,制定服务供方激励机制与需方待遇倾斜政策。Based on the data of CHARLS(2018)and with the help of the Heckman sample selection model,two-part model,treatment effect model and the causal mediation effect analysis method,this paper systematically investigates the effect,action path and heterogeneity of the integratedmedical and nursing care services in home and community on the elderly medical expenses.The results show that the integrated medical and nursing care services has significant economic performance,that is,promoting the utilization of outpatient services and reducing the probability of hospitalization.For every one unit increase in the integrated medical and nursing care services,the total hospitalization cost is reduced by about 2145 yuan.And there are significant health effects and service substitution effects,mainly through the improvement of the health level of the elderly,improving health care?behavior and medical service utilization behavior,thereby restraining the elderly medical expenditure.At the same time,theintegrated medical and nursing care services at home and in community has a more significant effect on the elderly groups who are living in rural areas,with the age not too old,with poor health,and living with spouses.Therefore,it is necessary to further improve the supply capacity and quality of the integrated medical and nursing care services,strengthen the dynamic health monitoring and behavior management of the service objects,and formulate the incentive mechanism forthe service suppliers and the preferential treatment policy for the demand side by aiming at the rural areas and the vulnerable groups.

关 键 词：居家社区医养结合服务 医疗费用支出 健康效应 服务替代效应 

分 类 号：D669.6[政治法律—政治学]