目的: 评估长期护理保险制度对失能老年人健康水平的政策效应及其作用机制。方法: 基于中国健康与养老追踪调查（CHARLS）2013、2015、2018和2020年四期面板数据,选取自评健康、慢性病数量、认知能力（MMSE）及抑郁程度（CES-D）作为健康指标,运用双重差分模型进行实证分析。结果: 长期护理保险显著改善了试点地区失能老人的整体健康水平,其影响存在群体异质性。男性、高教育水平失能老人在自评健康、慢性病管理与认知能力方面的改善更为明显;女性、低教育水平失能老人则在心理抑郁缓解方面获益更多。机制分析表明,政策通过提升生活满意度和降低医疗负担两条路径发挥作用。结论: 长护险制度具有积极的健康促进效果。未来应构建精准化、差异化的服务供给与匹配机制,以推动制度全国统筹,提升保障质量。
Abstract
Objective: The paper attempts to evaluate the policy effect of the long-term care insurance (LTCI) system on the health level of disabled older adults and its underlying mechanisms. Methods: Using four-period panel data (2013, 2015, 2018, and 2020) from the China Health and Retirement Longitudinal Study (CHARLS), we selected self-rated health, number of chronic diseases, cognitive ability (MMSE), and depression level (CES-D) as health indicators and employed a Difference-in-Differences (DID) model for empirical analysis. Results: The LTCI significantly improved the overall health level of disabled older adults in pilot regions, with notable group heterogeneity. Improvements in self-rated health, chronic disease management, and cognitive ability were more pronounced among male and highly educated older adults, while female and less educated older adults benefited more from alleviation of psychological depression. Mechanism analysis indicates that the policy operates through enhancing life satisfaction and reducing medical financial burden. Conclusion: The LTCI system has a positive health-promoting effect. Future policies should develop more precise and differentiated service provision and matching mechanisms to promote national coordination of the system and improve the quality of safeguards.
关键词
长期护理保险 /
失能老年人 /
健康水平 /
双重差分模型
Key words
long-term care insurance /
disabled older adults /
health level /
difference-in-differences model
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 国家统计局.中华人民共和国2023年国民经济和社会发展统计公报[EB/OL].[2025-10-10].https://www.stats.gov.cn/xxgk/sjfb/tjgb2020/202402/t20240229_1947923.html.
[2] 国务院. 中共中央关于制定国民经济和社会发展第十五个五年规划的建议[EB/OL].[2025-12-22].https://www.gov.cn/zhengce/202510/content_7046050.htm.
[3] BECKER G S.Human capital: a theoretical and empirical analysis with special reference to education, third edition[J].NBER Books, 1994, 18(1):556.
[4] GROSSMAN M.On the concept of health capital and the demand for health[J]. Journal of political economy, 1972, 80(2): 223-255.
[5] 杨清红. 老年人健康保障的群体差异及政策启示——基于中国老年健康影响因素跟踪调查和30位老人的深度访谈[J].社会保障研究,2020,72(05):70-78.
[6] 齐小静,杨鸽鸽.社会参与——子女照料对老年人健康的影响——基于CHARLS 2015数据的实证研究[J].经济研究导刊,2022,530(36):59-61.
[7] 杨仕鹏,鄢洪涛.参加医疗保险对农村居民健康的影响——基于CHARLS 2015数据的实证分析[J].福建农林大学学报(哲学社会科学版),2021,24(02):70-79.
[8] 王新峰,欧阳伟,王延赏.童年时期亲子关系对中老年人健康的影响——基于CHARLS数据的实证分析[J].南方人口,2022,37(06):52-65.
[9] 陈惠婷,高培旺,陈玲菊.基于CHARLS数据的我国老年人健康影响因素实证分析[J].闽江学院学报,2021,42(05):8-15.
[10] IHME-CHAIN Collaborators.Effects of education on adult mortality: a global systematic review and meta-analysis[J]. Lancet public health, 2024,9(3):155-165.
[11] KOLANOWSKI A, LITAKER M, BUETTNER L, et al.A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents[J]. Journal of the American Geriatrics Society, 2011, 59(6):1032-41.
[12] LONG C, YANG W, GLASER K.Can long-term care insurance reduce catastrophic health and long-term care expenditures among older adults? a quasi-experimental study in China[J]. European journal of aging, 2025,22(1):25.
[13] 张冲,张丹.城市老年人社会活动参与对其健康的影响——基于CHARLS2011年数据[J].人口与经济,2016(5):55-63.
[14] 李礼,路苗苗.长期护理保险对中老年人生活满意度的影响——基于CHARLS数据的实证分析[J].南方人口,2022,37(05):26-37.
[15] GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021BD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440):2100-2132.
基金
2022年度教育部人文社会科学研究青年基金项目“可持续性视角下长期照护保险筹资机制的效果比较与优化研究”（22YJC840042）
