养老金与照护支出“以养节医”的经济绩效研究
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摘要
使用CLHL2014年数据测评养老金与照护支出的"以养节医"经济绩效,路径模型估计结果显示,养老金与自付医疗支出呈倒U型关系,养老金低于拐点值时,自付医疗支出随养老金增加而增加,超过拐点值之后,自付医疗支出趋于下降;养老金还显著增加了老人的照护支出,照护支出则与自付医疗支出呈U型关系,在老人身体状况较好时,自付医疗支出随照护支出的增加而减少,但当老人身体状况较差时,照护支出对降低自付医疗支出的作用有限。这说明养老金水平要尽量高,照护的介入则要尽量早,才能取得更优的"以养节医"经济绩效。使用2011、2014两期数据的多组比较显示,养老金、照护支出对自付医疗支出的影响作用具有稳健性。建议遵循养、护、医影响健康的内在机理和传导路径,从"治病"转向"治未病";并建议养老金支付方式从递增型生存年金改为递减型生存年金。
Based on the CLHL data of 2014,we measured the economic performance of "aged care to reduce medical expense" with respect to pension and nursing expense. Path model estimation showed that there was an inverted U-shaped relationship between old-age pension and self-paid medical expense. When the old-age pension was below the inflection point,the self-paid medical expense increased with the rise in the old-age pension; when the old-age pension was above the inflection point,the self-paid medical expense tended to decrease. Moreover,the old-age pension caused a significant increase in the nursing expenses of older people,and there was a U-shaped relationship between nursing expenses and self-paid medical expenses. When older people were in good physical condition,self-paid medical expenses decreased with the increase in nursing expenses; when older people were in poor physical condition,nursing expenses could only reduce the self-paid medical expense to a limited extent. Therefore,the old-age pension level should be as high as possible,and older people should receive nursing care as early as possible,so as to attain higher economic performance through " aged care to reduce medical expense". According to the multi-group comparison based on the data of 2011 and 2014,the old-age pension and nursing expenses had a robust effect on the self-paid medical expenses.Therefore,we offer the following suggestions: 1) considering the internal mechanisms and transmission path by which health is affected by care,nursing,and medical treatment,the treatment of diseases should be transformed into the prevention of diseases; 2) old-age pensions should be paid in the form of decreasing life annuities rather than increasing life annuities.
Based on the CLHL data of 2014,we measured the economic performance of "aged care to reduce medical expense" with respect to pension and nursing expense. Path model estimation showed that there was an inverted U-shaped relationship between old-age pension and self-paid medical expense. When the old-age pension was below the inflection point,the self-paid medical expense increased with the rise in the old-age pension; when the old-age pension was above the inflection point,the self-paid medical expense tended to decrease. Moreover,the old-age pension caused a significant increase in the nursing expenses of older people,and there was a U-shaped relationship between nursing expenses and self-paid medical expenses. When older people were in good physical condition,self-paid medical expenses decreased with the increase in nursing expenses; when older people were in poor physical condition,nursing expenses could only reduce the self-paid medical expense to a limited extent. Therefore,the old-age pension level should be as high as possible,and older people should receive nursing care as early as possible,so as to attain higher economic performance through " aged care to reduce medical expense". According to the multi-group comparison based on the data of 2011 and 2014,the old-age pension and nursing expenses had a robust effect on the self-paid medical expenses.Therefore,we offer the following suggestions: 1) considering the internal mechanisms and transmission path by which health is affected by care,nursing,and medical treatment,the treatment of diseases should be transformed into the prevention of diseases; 2) old-age pensions should be paid in the form of decreasing life annuities rather than increasing life annuities.
引文
[1]闫萍.中国老年人的医疗费用分担问题分析[J].兰州学刊,2014(1).
[2]刘军强.专栏导语:新医改是否降低了医疗负担?[J].公共行政评论,2015(5).
[3]郭科,顾昕.过度医疗的解决之道:管制价格、强化竞争还是改革付费?[J].广东社会科学,2017(5).
[4]朱铭来,宋占军.大病保险对家庭灾难性医疗支出的风险分散机制分析[J].中国卫生政策研究,2012(12).
[5]姜德超,吴少龙,魏予辰.新医改缓解了看病贵吗?[J].党政视野,2016(1).
[6]Yip W.,and Hsiao W.,2014. Harnessing the Privatisation of China’s Fragmented Health-care Delivery.The Lancet,384(9945),805-818.
[7]王宏禹,王啸宇.养护医三位一体:智慧社区居家精细化养老服务体系研究[J].武汉大学学报(哲学社会科学版),2018(4).
[8]程令国,张晔.“新农合”:经济绩效还是健康绩效?[J].经济研究,2012(1).
[9]Manning G.,Joseph P.,Newhouse,Naihua Duan,Emmett B.,Keeler and Arleen,1987. Health Insurance and the Demand for Medical Care:Evidence from a Randomized Experiment. American Economic Review,Vol. 77,No. 3:251-277.
[10]Wagstaff A.,and Lindelow M.,2008. Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China. Journal of Health Economics,Vol. 27,No. 4:990-1005.
[11]Yip W.,and Hsiao W.,2009. China's Health Care Reform:A Tentative Assessment. China Economic Review,Vol. 20,No. 4:613-619.
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[13]Gu E.,2009. Towards Universal Coverage:China's New Healthcare Insurance Reforms. China's Reforms at30:Challenges and Prospects(edited by Dali:Yang and Litao Zhao),117-135,World Scientific Publishing,Singapore.
[14]刘军强,刘凯,曾益.医疗费用持续增长机制——基于历史数据和田野资料的分析[J].中国社会科学,2015(8).
[15]王新军,郑超.医疗保险对老年人医疗支出与健康的影响[J].财经研究,2014(12).
[16]黄枫,甘犁.过度需求还是有效需求?——城镇老人健康与医疗保险的实证分析[J].经济研究,2010(6).
[17]胡宏伟,张澜,李佳怿,杜雅轩,王静茹.城镇居民基本医疗保险会加重老年人医疗负担吗?——基于家庭医疗负担的制度评价[J].老龄科学研究,2015(4).
[18]朱铭来,史晓晨.医疗保险对流动人口灾难性医疗支出的影响[J].中国人口科学,2016(6).
[19]Case A.,2001. Does Money Protect Health Status? Evidence from South African Pensions. NBER Working Paper.
[20]刘宏,高松,王俊.养老模式对健康的影响[J].经济研究,2011(4).
[21]李实,杨穗.养老金与收入不平等对老年人健康的影响[J].中国人口科学. 2011(3).
[22]阳义南.照护还是医疗:老年人健康支出的产出效率比较[J].统计研究,2016(7).
[23]朱铭来,于新亮,王美娇,熊先军.中国家庭灾难性医疗支出与大病保险补偿模式评价研究[J].经济研究,2017(9).
(1)数据来源:国家统计局《2018年国民经济和社会发展统计公报》。
(1)保留缺失值极大似然估计(maximum likelihood with missing values,MLMV)是一种完全信息(full information)估计方法,不会删除有缺失的样本观测值,能使用全部样本观测值的各阶矩信息。而传统的OLS、2SLS、ML等估计方法都会删除有缺失的样本观测值,导致损失较多样本信息。
[2]刘军强.专栏导语:新医改是否降低了医疗负担?[J].公共行政评论,2015(5).
[3]郭科,顾昕.过度医疗的解决之道:管制价格、强化竞争还是改革付费?[J].广东社会科学,2017(5).
[4]朱铭来,宋占军.大病保险对家庭灾难性医疗支出的风险分散机制分析[J].中国卫生政策研究,2012(12).
[5]姜德超,吴少龙,魏予辰.新医改缓解了看病贵吗?[J].党政视野,2016(1).
[6]Yip W.,and Hsiao W.,2014. Harnessing the Privatisation of China’s Fragmented Health-care Delivery.The Lancet,384(9945),805-818.
[7]王宏禹,王啸宇.养护医三位一体:智慧社区居家精细化养老服务体系研究[J].武汉大学学报(哲学社会科学版),2018(4).
[8]程令国,张晔.“新农合”:经济绩效还是健康绩效?[J].经济研究,2012(1).
[9]Manning G.,Joseph P.,Newhouse,Naihua Duan,Emmett B.,Keeler and Arleen,1987. Health Insurance and the Demand for Medical Care:Evidence from a Randomized Experiment. American Economic Review,Vol. 77,No. 3:251-277.
[10]Wagstaff A.,and Lindelow M.,2008. Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China. Journal of Health Economics,Vol. 27,No. 4:990-1005.
[11]Yip W.,and Hsiao W.,2009. China's Health Care Reform:A Tentative Assessment. China Economic Review,Vol. 20,No. 4:613-619.
[12]Wagstaff A.,Yip W.,Lindelow M.,and Hsiao W.,2009. China's Health System and its Reform:A Review of Recent Studies. Health Economics,Vol. 18,No. 52:7-23.
[13]Gu E.,2009. Towards Universal Coverage:China's New Healthcare Insurance Reforms. China's Reforms at30:Challenges and Prospects(edited by Dali:Yang and Litao Zhao),117-135,World Scientific Publishing,Singapore.
[14]刘军强,刘凯,曾益.医疗费用持续增长机制——基于历史数据和田野资料的分析[J].中国社会科学,2015(8).
[15]王新军,郑超.医疗保险对老年人医疗支出与健康的影响[J].财经研究,2014(12).
[16]黄枫,甘犁.过度需求还是有效需求?——城镇老人健康与医疗保险的实证分析[J].经济研究,2010(6).
[17]胡宏伟,张澜,李佳怿,杜雅轩,王静茹.城镇居民基本医疗保险会加重老年人医疗负担吗?——基于家庭医疗负担的制度评价[J].老龄科学研究,2015(4).
[18]朱铭来,史晓晨.医疗保险对流动人口灾难性医疗支出的影响[J].中国人口科学,2016(6).
[19]Case A.,2001. Does Money Protect Health Status? Evidence from South African Pensions. NBER Working Paper.
[20]刘宏,高松,王俊.养老模式对健康的影响[J].经济研究,2011(4).
[21]李实,杨穗.养老金与收入不平等对老年人健康的影响[J].中国人口科学. 2011(3).
[22]阳义南.照护还是医疗:老年人健康支出的产出效率比较[J].统计研究,2016(7).
[23]朱铭来,于新亮,王美娇,熊先军.中国家庭灾难性医疗支出与大病保险补偿模式评价研究[J].经济研究,2017(9).
(1)数据来源:国家统计局《2018年国民经济和社会发展统计公报》。
(1)保留缺失值极大似然估计(maximum likelihood with missing values,MLMV)是一种完全信息(full information)估计方法,不会删除有缺失的样本观测值,能使用全部样本观测值的各阶矩信息。而传统的OLS、2SLS、ML等估计方法都会删除有缺失的样本观测值,导致损失较多样本信息。