人口老龄化背景下的城乡居民医疗卫生支出问题研究

发布时间：2018-05-08 08:34

本文选题：人口老龄化 + 医疗保险　；参考：《湘潭大学》2016年博士论文

【摘要】：随着预期寿命的延长,加之计划生育政策的长期约束,被视作“银发浪潮”的人口老龄化问题在中国将变得愈发严重。据预测,中国60岁及以上老年人将从2014年的2.12亿上升至2025年的3.08亿,从相对数来看,老年人口占中国总人口的比重将从2014年的15.5%上升至2025年的21.1%。在人口老龄化和高龄化日益严峻的背景下,老年人问题逐渐提上日程,且受到了人民群众的密切关注。而在影响老年人生活质量的诸多因素中,健康因素始终扮演着十分重要的角色。随着中国人口的迅速老化,医疗保健服务压力将不断加大。出于预防目的的健康老年人、或者出于治病目的的带病老年人均对医疗卫生服务有了更高的渴求。在可预计的未来,中国将迎来老年人高负担期,医疗卫生支出这一重要的民生问题势必会更加凸显。“看病贵、看病难”一直是困扰城乡居民切身利益的突出难题,也是中国社会建设方面的薄弱环节。本文以人口老龄化背景下的城乡居民医疗卫生支出作为切入点,为实现在宏观层面,医疗卫生制度的总体安排以满足居民合理的医疗需求;在微观层面,医疗费用报销比例的提高、老年健康行为的宣传以更好的控制个人医疗卫生费用支出的上涨。接下来将主要从这两个层面来探讨人口老龄化背景下的城乡居民医疗卫生支出问题。从宏观数据的实证结果来看:城乡居民收入水平对其医疗卫生支出具有重要影响,少年人口抚养比的下降,促使更多的中国家庭人口生产偏好由之前的“人口数量”向更重视人力资本投资的“人口质量”转变,进而通过增加医疗卫生支出促进了人口的“少生、优生”,而不断演化的老龄化进程也显著增加了居民的医疗卫生支出。就城乡间医疗卫生支出的差异比较来看,由于农村地区的老龄化更为严重,且收入水平更低,因此医疗卫生支出面临的压力更大。而伴随着中国人口老龄化大潮的来临,未来中国人口总抚养比与医疗卫生支出将表现为明显的正相关性。从中国老年健康影响因素跟踪调查(CLHLS)微观数据的实证结果来看:社会医疗保险虽然在一定程度上减轻了参保人的医疗支出负担,但是医疗保险却扭曲了医疗服务质量,并通过各种机制影响患者的医疗需求行为,可能导致道德风险的产生。更高的医疗保险保障水平将增加医疗服务的需求,意味着医疗保障中存在道德风险。根据倾向得分匹配(PSM)方法控制除保险以外的其他因素以观察是否参加医疗保险对老年人医疗支出的影响。结果发现参与医疗保险在一定程度上降低了老年人的自付医疗支出,但是医疗保险并没有降低老年人的总医疗支出,反而增加了老年人的总医疗支出,说明医疗保险使得老年人支出的多、报销的也多,验证了医疗保险中道德风险的存在。同时,基本药物政策并未降低老年人医疗支出,反而增加了老年人医疗支出。基本药物政策对没有参与医疗保险以及农村的老年人的影响作用更加显著。基本药物政策并未解决“看病贵”这一难题。从人口老龄化背景下的城乡居民医疗卫生支出问题研究的对策建议来看:首先,积极促进城乡居民收入持续增长,努力进入经济发展高水平阶段,同时向着更加公平的方向发展,这是中国应对老龄化的核心战略。由于医疗保健消费是一种更高层次的消费,而家庭收入水平也是影响居民医疗保健消费支出的重要因素,因此居民医疗保健消费水平与其家庭的收入水平密切相关。同时城乡间收入水平的差异在一定程度上能够造成城乡居民的健康不平等,这也使得城乡间居民医疗卫生支出(需求)存在差异成为必然。收入差距的拉大也影响到低收入居民家庭在医疗保健方面的进一步消费。因此,在人口老龄化背景下,城乡居民医疗卫生支出的增加,需要以收入水平的持续增长和公平为前提。其次,在城市化加速的背景下,农村老龄问题应受到更多的关注。因此有必要广泛开展老年健康教育,促使其医疗保健观念逐步由“治病型”转向防患于未然的“保健型”。同时,城乡间财政医疗卫生资源分配不平衡特征,使得农村居民医疗保健投入过度依赖家庭,导致家庭消费其他方面的需求不足,因此需要强化农村医疗卫生投入的政府责任。最后,现代社会的医学模式应由重事后治疗转向重事前预防,医疗服务的需求也应从低层次的“疾病需求”向高层次的“健康需求”演进。健康的实现既依赖于医疗保障制度的安排,也得益于个人的自觉努力。随着疾病模式的转变,健康与疾病的界限越来越模糊,我们往往强调对收益性较好的医疗的供给而忽视了公共性较强的预防服务的供给,随着老龄人口的增加,针对治疗老龄人口多发疾病的医疗服务需要加强,针对老年人养老的预防保健服务也将是未来发展的一个方向。
[Abstract]:With the prolongation of life expectancy and the long-term constraints of the family planning policy, the problem of population aging, regarded as the "wave of silver hair", will become more serious in China. It is predicted that the age of 60 and older in China will rise from 212 million in 2014 to 308 million in 2025. From the logarithmic point of view, the proportion of the elderly population is the proportion of the total population of China. From the 15.5% rise of 2014 to the 2025 21.1%. in the background of the aging and aging of the population, the problem of the elderly is gradually put on the agenda and is closely concerned with the people. Among the factors affecting the quality of life of the elderly, the health factors have always played a very important role. The pressure of health care service will increase rapidly. The health care service for the elderly, or the elderly for the purpose of prevention, is higher. In the expected future, China will have a high burden of the elderly, and the important livelihood problem of medical health expenditure is bound to be more serious. It is a prominent problem that puzzles the vital interests of urban and rural residents, and is also a weak link in the construction of Chinese society. This article takes the medical and health expenditure of urban and rural residents as a breakthrough point under the background of population aging, and the overall arrangement of the medical and health system to meet the residents reasonable at the macro level. Medical needs; at the micro level, the increase in the proportion of medical expense reimbursement and the promotion of the health behavior of the elderly in order to better control the increase of personal medical and health expenditure. The following will be mainly from the two levels to explore the problem of medical and health support for urban and rural residents under the background of population aging. The income level of the rural residents has an important impact on its medical and health expenditure, and the decline of the child support ratio has prompted more Chinese family population production preferences to change from the previous "population" to the "population quality" which pays more attention to human capital investment, and thus promotes the population "less living and eugenics" by increasing medical treatment and health expenditure. And the continuous evolution of the aging process also significantly increased the health expenditure of residents. Compared to the differences in urban and rural medical and health expenditure, the aging of rural areas is more serious, and the income level is lower, so the pressure of medical and health expenditure is greater. China's total population dependency ratio and medical and health expenditure will be positively correlated. From the empirical results of the CLHLS micro data, the social medical insurance reduces the burden of medical expenditure to the insured, but it distorts the quality of medical services. And the effects of various mechanisms on the patient's medical needs may lead to moral hazard. Higher health insurance levels will increase the demand for medical services and mean moral hazard in medical care. The PSM method controls other factors other than insurance to observe whether to participate in medical insurance. The result shows that the participation of medical insurance in medical insurance reduces the self paid medical expenditure of the elderly to some extent, but the medical insurance does not reduce the total medical expenditure of the elderly, but increases the total medical expenditure of the elderly. It shows that medical insurance makes the old people spend more, and the reimbursement is much more. The existence of moral hazard in medical insurance. At the same time, the basic drug policy did not reduce the medical expenditure of the elderly, but increased the medical expenditure of the elderly. The basic drug policy has a more significant impact on the lack of participation in medical insurance and the elderly in the rural areas. The countermeasures and suggestions on medical and health expenditure of urban and rural residents under the background of aging are: first, actively promote the continuous growth of urban and rural residents' income, strive to enter the high level of economic development, and develop in a more equitable direction. This is the core strategy for China to deal with aging. High level of consumption, and family income level is also an important factor affecting residents' health care expenditure, so the level of health care consumption of residents is closely related to the income level of their families. At the same time, the difference of income level between urban and rural areas can cause the health inequality of urban and rural residents to a certain extent, which also makes urban residents. The widening of medical and health expenditure (demand) is inevitable. The widening of the income gap also affects the further consumption of low-income households in health care. Therefore, in the context of the aging population, the increase of medical and health expenditure in urban and rural residents should be based on the continuous growth and equity of income level. Secondly, the urbanization is added to the urbanization. In the rapid context, the problem of aging in rural areas should be paid more attention. Therefore, it is necessary to develop health education for the elderly so that the concept of health care is gradually shifted from "cure type" to "health care". Meanwhile, the distribution of medical and health resources in urban and rural areas is not equal, so that rural residents' health care has been put into health care. Depending on the family, the demand for other aspects of household consumption is insufficient, so it is necessary to strengthen the government responsibility of rural medical and health investment. Finally, the medical model of modern society should turn from heavy post treatment to pre prevention, and the demand of medical service should also evolve from low level "disease demand" to high level "health demand". The realization of health depends not only on the arrangement of the medical security system but also by the self-conscious effort of individuals. With the change of the disease pattern, the boundary between health and disease is becoming more and more blurred. We often emphasize the supply of better benefit medical care and neglect the supply of strong public preventive services, with the increase of the aging population. Medical services for the treatment of elderly patients with multiple diseases need to be strengthened. Preventive health care services for the elderly will also be a direction for future development.

【学位授予单位】：湘潭大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R197.1;F126.1

【参考文献】