老有所医与老有所依:医养结合政策的代际经济支持效应  

Medical Care for the Elderly and Support for the Elderly:The Intergenerational Economic Support Effect of the Medical and Nursing Care Integration Policy

作　　者：张磊[1] 邓紫琪 Zhang Lei;Deng Ziqi

机构地区：[1]湘潭大学商学院 [2]暨南大学经济学院

出　　处：《中国人口科学》2025年第1期76-93,共18页Chinese Journal of Population Science

基　　金：国家社会科学基金一般项目“中国消费现代化的理论逻辑、动态趋势及政策路径研究”(编号:24BJL004);湖南省社会科学基金重大项目“湖南公共消费发展的现状问题、经验借鉴及优化建议”(编号:24ZWA48)的阶段性成果。

摘　　要：医养结合政策对于缓解中国人口老龄化背景下的养老问题具有重要意义。文章以2016年实施的国家级医养结合试点为政策冲击,基于CHARLS2013年、2018年和2020年的老年人面板数据,系统检验医养结合试点政策对子女向父母提供经济支持的总效应及其机制。研究发现:医养结合政策对代际经济支持的“挤入效应”强于“挤出效应”,使试点地区子女对父母的代际经济支持显著增加,同时实现“老有所医”和“老有所依”,但重大突发公共卫生冲击会使得政策效应暂时丧失;机制分析表明,医养结合政策可以促进子女就业收入增加,形成代际经济支持的“挤入效应”,同时医养结合政策促进老人健康收益提升、医疗消费减少,形成代际经济支持的“挤出效应”;异质性分析表明,医养结合试点政策在受儒家文化影响较大的地区作用相对更强,且对家户收入水平较高、与子女同住、女性、生活自理困难程度较高和高寿老人的影响更为显著。文章为理解医养结合政策对代际经济支持的“挤入效应”提供了可靠证据,为进一步优化医养结合政策、缓解老年人口养老难题提供了有益启示。The integrated medical and elderly care policy is crucial for addressing the challenges posed by China's aging population.Using panel data from the China Health and Retirement Longitudinal Study(CHARLS)for 2013,2018,and2020,this article systematically examines the total effects and mechanisms of the pilot policy on intergenerational economic support from children to parents.The findings indicate that the policy's"crowding-in effect"on intergenerational support outweighs the"crowding-out effect",leading to a significant increase in intergenerational economic support in the pilot areas.It enhances both the availability of medical care and dependency support for the elderly,although major public health crises may temporarily undermine the policy's effectiveness.Mechanism analysis shows that the policy boosts adult children's employment income,thereby strengthening the"crowding-in effect",while also improving elderly health outcomes and reducing medical spending,which contributes to the"crowding-out effect".eterogeneity analysis reveals stronger effects in areas influenced by Confucian culture,with more pronounced impacts on households with higher income levels,those living with children,females,individuals with greater self-care difficulties,and the elderly living to advanced ages.This study provides valuable insights for optimizing integrated medical and elderly care policies to address the challenges of an aging population.

关 键 词：医养结合 家庭养老模式 代际经济支持 人口老龄化 养老服务 

分 类 号：F27[经济管理—企业管理]