医养结合与老年人健康养老

《财经研究》 2022年48卷第4期 页码：124 - 138  online：2022年3月31日

医养结合与老年人健康养老

Integrated Medical Care Services and Health Care for the Elderly

作者（中）：高鹏, 杨翠迎, 周彩

作者（英）：Gao Peng, Yang Cuiying, Zhou Cai

作者单位：1.上海财经大学 公共经济与管理学院, 上海 200433

摘要：医养结合是我国社会养老服务体系的核心内容之一，也是实现养老服务高质量发展的重要内容。文章利用CHARLS2015和2018两期数据，以2016年确立国家级医养结合服务试点作为准自然实验，运用双重差分法实证检验了社区居家医养结合服务对于老年人健康养老的影响。研究发现：（1）社区居家医养结合服务提高了老年人的健康自评，优化了老年人医疗服务利用水平，并显著促进了慢性病管理与门诊就诊随访概率，但对老年人身体机能和精神健康层面的改善并不明显。（2）服务效果受到老年人的个体因素（年龄、性别、收入、婚姻状况等）与代际因素（居住区域、子女个数、是否有子女照料、子女受教育程度等）的异质性影响。（3）机制检验方面，体检、日间照料、上门巡诊、娱乐活动服务等显著提高了老年人的健康自评，优化了慢性病管理和老年人的医疗服务利用水平，提升了老年人的精神健康水平。文章研究认为，社区居家医养结合服务应当重新梳理其主体行为逻辑，逐步优化顶层设计，完善关联制度衔接，构建医养结合服务模式、机制与需求多维度衔接的动态调整机制，弄清不同层次人群在医养结合服务中的现实需求，打破制度壁垒，提高资源与政策制度的衔接能力。文章的研究为进一步形成医养结合的基本制度，推动医养结合服务高质量发展提供了参考和依据。

关键词：医养结合; 人口老龄化; 养老服务; 健康养老; 社区居家养老

Summary: “Providing for the elderly and medical care for the elderly” is not only people’s beautiful longing for the life of the elderly, but also an important goal to accelerate the construction of care service system for the elderly and promote the high-quality development of care services for the elderly. With the gradual deepening of China’s population aging, China will continue to face greater pressure in the future. Integrated medical care services are one of the core contents of China’s social care service system for the elderly, and also an important content to realize the high-quality development of care services for the elderly. Its concept is to combine care services for the elderly with medical and health service resources to provide residents with a comprehensive “Five-in-One” service of “Care – Medicine – Health – Care – Hospice Care”. Based on the review of China’s integrated medical care service policy and theoretical mechanism, using the data of CHARLS 2015 and 2018, and taking the national integrated medical care service pilot established in 2016 as a quasi-natural experiment, this paper empirically tests the impact of community home-based care services on the health care of the elderly by using the DID method. The study finds that community home-based care services improve the health self-assessment of the elderly, optimize the utilization of medical services for the elderly, and significantly promote the chronic disease management and outpatient visit and follow-up probability, but there is no significant improvement in the physical function and mental health of the elderly. This conclusion is still significant after considering a series of robustness tests such as changing sample identification strategy, policy spillover and placebo test. The service effect is affected by the individual factors (age, gender, income, marital status) and intergenerational factors (residential area, number of children, whether there is child care, education level of children) of the elderly. In terms of the mechanism test, physical examination, daytime care, door-to-door visit and entertainment services significantly improve the health self-assessment of the elderly, promote chronic disease management, optimize the utilization of medical services for the elderly, and improve the mental health level of the elderly. This paper believes that integrated medical care services should resort out the main behavior logic, gradually optimize the top-level design, improve the connection of related systems, and build a dynamic adjustment mechanism for the multi-dimensional connection between integrated medical care service mode, service mechanism and service demand; clarify the actual needs of people at different levels in integrated medical care services, break down institutional barriers, improve the connection ability between resources and policies and systems, and further summarize the pilot experience on this basis. This paper provides a reference and basis for further summarizing the practical experience of pilot areas, forming the basic system of integrated medical care services, further accelerating the summary and promotion of the pilot scope and practical experience of integrated medical care services, and comprehensively improving the high-quality development of integrated medical care services.

Key words: integrated medical care services; population aging; care services for the elderly; health care for the elderly; community home-based care services

DOI：10.16538/j.cnki.jfe.20211216.401

收稿日期：2021-9-8

基金项目：国家社科基金重大项目（20&ZD114）；上海财经大学研究生科研创新项目（CXJJ-2020-324）

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