摘要
推进门诊统筹是深化医疗保障制度改革、巩固全面脱贫攻坚成果的内在要求。文章基于2018年中国老年健康影响因素跟踪调查数据(CLHLS),利用倾向得分匹配(PSM)和中介效应模型,从相对贫困发生率和贫困脆弱性两个维度探究门诊统筹对老年人相对贫困的影响及其作用渠道。以家庭人均年收入中位数50%作为相对贫困线的测算结果表明,门诊统筹使老年人的相对贫困发生率和贫困脆弱性分别降低4.3个百分点、2.2个百分点。影响机制分析表明,门诊统筹通过提高生理健康绩效和心理健康绩效缓解了老年人的相对贫困。异质性分析表明,门诊统筹在更大程度上缓解了农村、女性老年人的相对贫困发生率和贫困脆弱性,且缓解了不健康老年人的相对贫困发生率和健康老年人的贫困脆弱性。研究建议应从拓宽基本医保筹资渠道、优化门诊慢特病政策、发挥医保支付杠杆作用、提升老年人健康素养四个方面助力门诊统筹减贫效应的实现。
Implementing the policy of co-payment for outpatient is an inherent requirement for China to deepen the reform of the medical security system and consolidate the achievements of complete poverty alleviation.The propensity score matching(PSM)approach and mediating effect model are used to explore the impact and mechanism of co-payment for outpatient on the relative poverty among the old population from two dimensions of relative poverty incidence and poverty vulnerability based on the data of Chinese Longitudinal Healthy Longevity Survey(CLHLS)from 2018.The relative poverty line is calculated by 50%of the median per capita household income and the results show that co-payment for outpatient reduces the relative poverty and poverty vulnerability among older adults by 4.3%and 2.2%,respectively.Mechanism analysis show that co-payment for outpatient alleviates the relative poverty by improving physical and mental health performance.Moreover,co-payment for outpatient can alleviate relative poverty and poverty vulnerability to a greater extent among the rural and the female older adults,can alleviate the relative poverty among the unhealthy groups,and can alleviate the poverty vulnerability among the healthy groups.The efforts should be made to in the following four aspects to achieve the poverty reduction effect of co-payment for outpatient among the elderly:broaden the funding channels for basic medical insurance,optimize the outpatient policies on chronic and special diseases,play the leverage role of medical insurance payment and enhance the health literacy of older adults.
作者
陈薇
张心洁
CHEN Wei;ZHANG Xin-jie(School of Government,Nanjing University,Nanjing 210023;School of Management,Jiangsu University,Zhenjiang 212013)
出处
《南方人口》
CSSCI
2024年第5期13-29,共17页
South China Population
基金
国家自然科学基金面上项目“基于激励相容的城乡居民门诊大病保障支付模式研究”(72174078)
国家自然科学基金青年项目“健康治理视域下社会、心理资本对农村重大疾病患者健康的影响研究”(71804061)
江苏高校“青蓝工程”资助(2022)。
关键词
门诊统筹
相对贫困
贫困脆弱性
健康绩效
Co-payment for outpatient
Relative poverty
Poverty vulnerability
Health performance
