推动医防融合:老年人免费健康体检的经济绩效和健康绩效  

Promoting the Integration of Health Care and Prevention:The Economic and Health Performance of the Health Checkups

作　　者：苏敏[1] 张天娇 刘银喜 李东旭 SU Min;LIU Yinxi;LI Dongxu;ZHANG Tianjiao

机构地区：[1]内蒙古大学公共管理学院 [2]南开大学周恩来政府管理学院 [3]济宁医学院公共卫生学院

出　　处：《公共管理与政策评论》2024年第6期101-118,共18页Public Administration and Policy Review

基　　金：国家自然科学基金项目《家庭医生“以患者为中心”的健康服务模式优化机制及实证研究》(72204128);国家自然科学基金项目《边疆民族地区基层医疗机构肺结核“电子药盒+手机APP”诊疗管理模式实施效果及优化机制研究》(72164031)。

摘　　要：在人口老龄化进程加快、医疗费用不断攀升的背景下,如何兼顾合理控制医疗费用并改善老年人健康水平,实现“医防融合”是中国新一轮医改面临的难题。本文利用中国健康与养老追踪调查2013年和2015年两期面板数据,采用粗糙化精确匹配和长差分策略对老年人健康体检的经济绩效和健康绩效进行评估。根据释放效应理论,本文发现在短期内老年人健康体检会释放健康需求,其自付-收入比、灾难性卫生支出发生率及医疗费用显著增加,并且这种释放效应在65岁及以上老年人中更加明显。其次,健康体检对老年人门诊服务利用存在显著的释放效应,并且这种释放效应在60—64岁老年人中更加明显。最后,在短期内,健康体检对老年人健康相关生命质量的影响并不显著。建议完善老年人免费健康体检的内容和流程,增强获得感;积极推进“区块链+健康”服务模式的发展,加强对健康数据的使用;提升居民健康素养,构建“全民参与健康共同体”治理格局。In the context of accelerating population aging and rising health costs,it raises public awareness that how to control the health costs and maintain the health status of the elderly people simultaneously in the new round of Chinese health reform.This study uses the panel data from the China Health and Retirement Longitudinal Study(CHARLS)2013 and 2015 to evaluate the economic and health performance of health checkups for the elderly under the coarsened exact matching and difference-in-difference framework.The results indicate that health checkups improved inpatient service utilization,reduced outpatient service utilization,and significantly improved health-related quality of life without significantly increase in health care burden.However,the economic and health performance had significant age and urban-rural heterogeneity.It is recommended to improve the content and process of free health checkups for the elderly to enhance the sense of gain;actively promote the development of the"Block-chain+Health"service model and strengthen the use of health data;improve the health literacy of the population and build a governance pattern of"universal participation in the health community".

关 键 词：医防融合 老年人 免费健康体检 经济绩效 健康绩效 

分 类 号：R197.1[医药卫生—卫生事业管理] F719[医药卫生—公共卫生与预防医学] D669.6[经济管理—产业经济]