基层医疗卫生服务供给的长期福利效应——来自中国“赤脚医生”历史实践的经验证据  

Long⁃term Effects of Primary Healthcare Provision:Historical Evidence from China's Barefoot Doctors

作　　者：胡志安[1] 朱可桐 张川川 Hu Zhian;Zhu Ketong;Zhang Chuanchuan(School of Economics,Central University of Finance and Economics;School of Advanced Agricultural Sciences,Peking University;School of Economics,Zhejiang University)

机构地区：[1]中央财经大学经济学院 [2]北京大学现代农学院 [3]浙江大学经济学院

出　　处：《经济科学》2024年第6期218-240,共23页Economic Science

基　　金：国家自然科学基金项目“新中国早期人力资本积累:演化特征、政策影响与经济效应”(项目编号:72303262);国家自然科学基金项目“对我国城镇职工基本医疗保险中道德风险问题的再考察和医保待遇优化”(项目编号:72273124);教育部人文社会科学规划基金项目“社会经济变迁、生育政策调整与家庭生育行为研究”(项目编号:22YJA790083)的阶段性成果。

摘　　要：本文基于我国20世纪六七十年代农村赤脚医生队伍建设的历史实践,考察了基层医疗卫生队伍建设对居民健康和社会经济状况的长期影响。实证结果显示,个体幼年时期(0—5岁)所在村庄的赤脚医生队伍建设能够显著改善其在青少年和中老年时期的自评健康状况,并显著降低其在中老年时期患有慢性病的概率。进一步研究显示,个体幼年时期所在村庄的赤脚医生队伍建设能够显著降低其在成年时期由于健康原因停止工作的概率和家庭负债率,提高其在成年时期的家庭收入、财富水平和个体生活满意度。本文的研究揭示了中华人民共和国成立后的前三十年农村医疗卫生事业发展的长期成效,同时也在一定程度上表明现阶段“加强基层医疗卫生服务体系和全科医生队伍建设”是一项低成本、高收益的健康促进手段。Based on the historical practice of the barefoot doctor initiative in rural China during the 1960s and 1970s,this paper examines the long⁃term effects of grassroots healthcare workforce development on individual health and socioeconomic outcomes.The empirical findings indicate that exposure to the barefoot doctors during early childhood(ages 0—5)significantly improves individual self⁃reported health in adolescence and later life and reduces the likelihood of being diagnosed with chronic diseases in middle and older age.Moreover,exposure to barefoot doctors during early childhood lowers the probability of health⁃related work cessation and household debt in adulthood,while increasing household income,wealth levels,and individual life satisfaction.This study highlights the lasting effectiveness of rural healthcare development in the first three decades of the People's Republic of China,suggesting that the strategy of strengthening primary healthcare provision and general practitioner workforce development is cost⁃effective.

关 键 词：基层医疗 赤脚医生 健康 福利效应 

分 类 号：F061.3[经济管理—政治经济学]