人口老龄化、临近死亡时间与医疗费用支出——基于中国老年人健康影响因素跟踪调查的实证分析

关于人口老龄化与医疗费用支出的关系,学界存在两种不同的观点:一种观点认为人口老龄化会导致医疗费用支出的增加;另一种观点认为:人口老龄化并不一定会带来医疗费用支出的急剧增加,临近死亡时间才是影响医疗费用支出的主要因素。基于2011—2014年“中国老年人健康影响因素跟踪调查”数据,分别采用样本选择模型和两部模型,对这两种观点进行实证检验。研究发现:(1)年龄增加并不一定导致医疗费用支出的增长,临近死亡时间是老年人医疗费用增长的重要原因。尤其是临近死亡1年对医疗费用支出的影响较大;(2)临终前的医疗费用支出大多是无效的,产生健康效果很小。政策启示在于,人口老龄化背景下,预期寿命的延长会推迟医疗费用高峰期的到来,未必会直接导致医疗费用的急剧增长。应对人口老龄化,通过加快建立长期护理保险制度的步伐,进而减少医疗资源在无效领域的配置。

Population aging, imminent death time and medical expenses: An empirical analysis based on CLHLS

Main ideas towards the relationship between population aging and increasing medical expenditure dig deep into two different views in the world of academic researches. One of the voices believed that population aging accounts for the increase inmedical expenditure,while another exclaimed that the aging of population does not necessarily lead to a sharp increase in medical expenditure. However, our respondents believed that the imminent death time was responsible for the sharp increase in healthcare expenditure.Based on the Chinese Longitudinal Health Longevity Survey (CLHLS) data, this paper examined these two perspectives mentioned above by using the Sample Selection model and Two-part model respectively. The results showed that, firstly, to the increasing age does not necessarily lead to an increase in medical expenditure, and the imminent death time, especially 1 year to death and 2 years to death, has the most obvious effect on expenses increase,with the year before death having the greatest impact on medical expenditure. Secondly, medical expensesmade during the period closer to death are ineffective and impose very small effect on individual''s health. According to the results, policy enlightenment is that in the context of increasing aging population, the extension of life expectancy will delay the peak period of medical expenses,and may not directly lead to a slight increase inmedical expenses. Accelerating the establishment of a long-term healthcare insurance system should be taken as the key strategy to cope with the population aging and thereby relievethe low efficiency of medical resource allocation.