推进长期护理保险制度建设是积极应对人口老龄化带来的护理需求压力的重要方式。本文基于中国健康与养老追踪调查数据库,采用双重差分法实证检验长期护理保险政策对中老年人健康水平的影响。结果发现：第一,受长期护理保险政策影响,相比于对照组,实验组自评健康水平显著提升了7.83%。在引入一系列控制变量,并控制了个体和时间固定效应后,政策效应为6.94%（P<0.01）,具有显著的健康效应。第二,长期护理保险的健康效应表现出丰富的异质性,相对于中等收入家庭而言,长期护理保险显著提升了低收入家庭的健康水平。本文的实证结果对扩大长期护理保险试点范围与完善待遇设计等内容具有一定现实意义。
Abstract
Establishing the long-term care insurance system is crucial to address the growing nursing demands associated with population aging. This study utilizes the China Health and Retirement Longitudinal Study (CHARLS) as a foundation for empirical research on the effects of long-term care insurance policies on the health status of middle-aged and elderly populations, employing the differences-in-differences method. The results indicated that the experimental group experienced a 7.83% enhancement in health status compared to the control group after implementing the long-term care insurance policies. After introducing a series of control variables and controlling for individual and time fixed effects, the policy effect was 6.94% (P<0.01), showing a significant health effect. Additionally, the health advantages of long-term care insurance vary significantly, with low-income households experiencing more pronounced improvements relative to their middle-income counterparts. These empirical findings have practical implications for expanding the long-term care insurance pilots and improving the benefit design.
关键词
长期护理保险 /
健康水平 /
双重差分法 /
CHARLS
Key words
long-term care insurance /
health /
differences-in-differences /
CHARLS
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 宋全成,文庆英.我国单独二胎人口政策实施的意义、现状与问题[J].南通大学学报(社会科学版),2015,31(01):122-129.
[2] 王增文,刘庆,胡国恒.政府医疗投入与居民医疗负担——基于“补供方”与“补需方”的路径分析[J].财经研究,2022,48(02):123-137.
[3] 吴宦熙. 典型发达国家应对人口老龄化的制度设计[J].人民论坛,2021(35):62-64.
[4] 王贞,封进.长期护理保险对医疗费用的替代效应及不同补偿模式的比较[J].经济学(季刊),2021,21(02):557-576.
[5] LEE T W, YIM E S, CHOI H S, et al.Day care vs home care: Effects on functional health outcomes among long‐term care beneficiaries with dementia in Korea[J]. International journal of geriatric psychiatry, 2019, 34(1): 97-105.
[6] HUGHES S L, CONRAD K J, MANHEIM L M, et al.Impact of long-term home care on mortality, functional status, and unmet needs[J]. Health Services Research, 1988, 23(2): 269.
[7] CHOI J, JOUNG E.The association between the utilization of long-term care services and mortality in elderly Koreans[J]. Archives of Gerontology and Geriatrics, 2016, 65: 122-127.
[8] RICE J B, KASPER J D, PEZZIN L E.A comparative analysis of Medicaid long‐term care policies and their effects on elderly dual enrollees[J]. Health economics, 2009, 18(3): 275-290.
[9] STABILE M, LAPORTE A, COYTE P C.Household responses to public home care programs[J]. Journal of health economics, 2006, 25(4): 674-701.
[10] 王泽嘉毓,李怡栎,陈浩斌,等.广州市长期护理保险定点服务机构空间分布特征及可达性研究[J].中国医疗保险,2023,173(02):106-112.
[11] 尹海燕. 可持续的公共长期护理保险筹资机制:国外经验与中国方案[J].宏观经济研究,2020(05):166-175.
[12] 武亦文. 统合视角下我国长期护理保险给付的规则形塑与制度建构[J].法学评论,2023,41(02):81-94.
[13] GARCíA-GóMEZ P, HERNáNDEZ-QUEVEDO C, JIMéNEZ-RUBIO D, et al. Inequity in long-term care use and unmet need: Two sides of the same coin[J]. Journal of health economics, 2015, 39: 147-158.
[14] ILINCA S, RODRIGUES R, SCHMIDT A E.Fairness and eligibility to long-term care: an analysis of the factors driving inequality and inequity in the use of home care for older Europeans[J]. International journal of environmental research and public health, 2017, 14(10): 1224.
[15] SOHN M, O'CAMPO P, MUNTANER C, et al. Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level[J]. Social Science & Medicine, 2020, 247: 112812.
[16] WRIGHT B, GRUMAN C, ALECXIH L, et al.Health Insurance for All Long-Term Care Workers: Estimated Costs and Coverage Impacts in Minnesota and Recommendations for States[J]. Journal of Aging & Social Policy, 2012, 24(1): 46-61.
[17] JEON B, KWON S.Health and long-term care systems for older people in the republic of Korea: policy challenges and lessons[J]. Health Systems & Reform, 2017, 3(3): 214-223.
[18] 张郁杨,袁微.养老金能否降低农村老人的健康风险?——兼论社区养老服务的协同作用[J].财经研究,2022,48(11):49-63.
[19] 姚兴安,苏群,朱萌君,等.银色浪潮下的智慧养老与老人健康[J].社会发展研究,2021,8(04):181-195+242-243.
[20] 黄乾,方守林.养老保险制度对老年人健康的影响:来自中国城镇居民的证据[J].经济问题,2022(08):29-38.
[21] 潘泽瀚,吴连霞,卓冲,等.2010—2020年中国老年人口健康水平空间格局演变及其影响因素[J].地理学报,2022,77(12):3072-3089.
[22] 唐代盛,陈蓉,卜涛.父母居住安排对子女心理健康的影响研究——基于CHARLS数据的经验证据[J].人口与发展,2022,28(03):141-155+30.
[23] BECK T, LEVINE R, LEVKOV A.Big bad banks? The winners and losers from bank deregulation in the United States[J]. The Journal of Finance, 2010, 65(5): 1637-1667.
[24] WANG J.The economic impact of special economic zones: Evidence from Chinese municipalities[J]. Journal of development economics, 2013, 101: 133-147.
[25] MCKNIGHT R.Home care reimbursement, long-term care utilization, and health outcomes[J]. Journal of Public Economics, 2006, 90(1-2): 293-323.
[26] HUANG F, GAN L.The impacts of China's urban employee basic medical insurance on healthcare expenditures and health outcomes[J]. Health economics, 2017, 26(2): 149-163.
[27] 李远慧,陈蓉蓉.基于企业研发投入视角的增值税税率下调派生效应研究[J].税务研究,2022(02):124-131.
[28] 于新亮,黄俊铭,康琢,等.老年照护保障与女性劳动参与——基于中国农村长期护理保险试点的政策效果评估[J].中国农村经济,2021(11):125-144.
[29] 孙晓华,张竣喃,郑辉.“营改增”促进了制造业与服务业融合发展吗[J].中国工业经济,2020(08):5-23.
[30] 李运华,姜腊.地方长期护理保险试点政策分析——基于政策工具视角[J].云南民族大学学报(哲学社会科学版),2022,39(01):122-133.
[31] 杨帆,曹艳春,刘玲.我国老年长期护理服务质量评价指标体系构建与评估——基于AHP方法对顾客感知服务质量模型的修正[J].社会保障研究,2019(04):78-86.
基金
教育部人文社会科学青年基金项目“我国长期护理社会保险不同模式政策仿真与优选研究”（18YJCZH123）
