摘要
为应对日益增大的老年人照料压力,我国各地试点通过政府补助或社会保险支付的方式满足老人的照料需求。基于2002-2014年CLHLS死亡人口追踪数据,文章用两部分模型、Heckman选择模型和结构方程模型,分析了政府补助、保险支付对老年临终照料直接成本和总成本的影响及其中介机制。研究发现,老年临终照料服务由保险支付的直接成本和总成本都比家庭支付明显更高,政府补助的直接成本比家庭支付更高,保险支付的直接成本比政府补助更高。保险支付和政府补助对照料成本影响的机制存在差异,保险支付主要通过收入效应对照料成本产生显著影响,但替代效应也发挥了中介作用,政府补助则主要通过替代效应对照料成本产生显著影响。文章的研究结论具有重要的政策含义。我国发展长期护理保险,应合理界定政府、市场、社会和家庭对老年人的照料责任,并明确长期护理保险的有限责任,尽量降低可能的收入效应和替代效应对照料成本的影响。
In response to the increasing pressure of care for the elderly,pilot programs have been conducted in China to meet the care needs of the elderly by means of government subsidies or social insurance support. This paper explored thoroughly the effects of government subsidies and social insurance support on the direct and total care costs at the end of life and their mediation mechanisms using Tw o-Part M odel,Heckman Sample Selection M odel and Structural Equation M odel based on the deceased older adults＇ data of 2002-2014 w aves of Chinese Longitudinal Healthy Longevity Survey. The main conclusions are as follow s： 1） The care cost of the elderly at the end of life in China is relatively high. 2） Government subsidies and social insurance have a significant impact on the direct and total care costs. Compared w ith payment by the family,the direct and total costs by w ay of social insurance support w ere significantly higher by 62. 74% and 43. 91%,respectively. The direct costs by w ay of government subsidies w ere significantly higher by 15. 84%. And the direct costs by w ay of social insurance support w ere significantly higher than government subsidies by 40. 47%. 3） The income effect and substitution effect played the mediating roles betw een social insurance support and care costs. 4） The substitution effect played the mediating role betw een government subsidies and care costs. The differenceof impact mechanism betw een government subsidies and social insurance support on the care costs may be related to their payment systems. Government subsidies generally provide targeted formal support services based on the assessment of the elderly ＇s self-care ability,care needs and family care ability,to alleviate the family care pressure. Such limited service support avoids possible income effects. Social insurance support is usually based on the expenses of care services and reimburse the care costs in a certain proportion,mainly to reduce the out of pocket care costs. When the out of pocket care cost is
作者
龚秀全
周薇
Gong Xiuquan;Zhou Wei
出处
《南方经济》
CSSCI
北大核心
2018年第9期68-85,共18页
South China Journal of Economics
基金
国家社会科学基金课题“人口老龄化高龄化背景下老年医疗服务保障网络优化研究”(13CGL139)资助
关键词
政府补助
保险支付
临终照料成本
收入效应
替代效应
Government Subsidies
Social Insurance Support
Care Cost at the End of Life
IncomeEffect
Substitution Effect.
