健全养老服务体系：社区养老支持与老龄健康

Improving the Elderly-care Service System: Community Care Support and Health of the Elderly

《财经研究》2023年49卷第2期 页码：49 - 63 online：2023年2月3日

作者

中：陈飞1，2 , 陈琳2

英：Chen Fei1，2, Chen Lin2

作者单位：1. 东北财经大学 经济与社会发展研究院，辽宁 大连 116025; 2. 东北财经大学 经济学院，辽宁 大连 116025

摘要及关键词

摘要：在我国人口老龄化进程加快和政府不断完善养老服务体系的背景下，已有文献从多个视角讨论了社区在老年人养老生活中的重要作用，但较少有研究文献关注社区养老支持对老龄健康影响的内在作用机制。然而，社区养老如何更好地发挥对家庭养老的补充作用以及如何有效增加老年群体的健康福利显得愈加重要。文章利用CFPS2010、CFPS2014和CHARLS2018数据从社区层面和个体层面定量分析了社区养老支持对老年人身体健康和心理健康的影响及其作用机制。研究发现：（1）使用工具变量和稳健性检验后的估计结果表明，社区养老支持对老年人的身体健康和心理健康均具有显著的改善作用。（2）机制分析表明，社区养老支持通过促进老年人参与体育锻炼、提高生活独立性的方式改善了身体健康，通过保护老年人认知功能、促进社会交往的方式改善了心理健康。（3）异质性分析发现，社区养老支持对未与子女同住的老年群体的健康改善作用更强，其发挥了对传统家庭养老的部分替代作用。但贫困社区的老年人从中获得的健康福利较少，社区养老支持可能存在“马太效应”。文章结论认为，在健全我国养老服务体系过程中，应更加关注社区支持在影响老龄健康方面的重要作用，提高不同老年群体对社区养老服务及设施的利用水平。

关键词：社区支持；老年人健康；人口老龄化；养老服务

Summary: Nowadays, the proportion of the elderly population and the elderly dependency ratio are accelerating year by year in China. The existing literature has discussed the important role of community in the elderly-care life from many perspectives, but little focuses on the internal mechanism of the impact of community care support on health. In the future, how to better play the role of community care as a supplement and upgrade to family care, and how to effectively improve health benefits of the elderly will become increasingly important. Based on the data of CFPS2010, 2014 and CHARLS2018, this paper quantitatively analyzes the impact of community care support on the physical and mental health of the elderly and its mechanism from the community level and the individual level. The results show that: (1) Community care support has a significant effect on improving the physical and mental health of the elderly. (2) Community care support can improve physical health by participating in sports and improving life independence, and improve mental health by protecting cognitive function and promoting social interaction. Different mechanism factors play different roles in the impact of community care support on health. (3) Community care support plays a stronger role in improving the health of the elderly who do not live with their children, which shows that community care support plays a role in replacing family care. However, the elderly in poor communities get less health benefits, and there is a “Matthew effect”. (4) Regular physical examination, onsite visits, community nursing, health management and entertainment are more significant to improve health, which also have a higher utilization rate. The marginal contributions are as follows: (1) This paper explains the relationship between community care support and health of the elderly from the interdisciplinary perspective of economics and sociology, and combs and tests the possible channel in combination with the social production function theory and social support theory, which marginally supplements the relevant literature at the level of mechanism analysis. (2) For the measurement of community care support, this paper investigates from both the community level and the individual level. Compared with the existing literature, it changes from a general single measure to a more specific multi-dimensional measure. (3) This paper attempts to use “the number of members of the village or neighborhood committee” as the instrumental variable to deal with endogenous problems, which enriches the discussion on finding suitable instrumental variables for community care. (4) The policy recommendations are of practical significance. Although community care support can promote physical and mental health, its coverage and actual utilization rate are still low. In the future, we should explore various models of the community in integrating medical and nursing resources, and improve the utilization level of community care services and facilities by different elderly groups.

Key words:community support; health of the elderly; population aging; elderly-care services

其他信息

DOI：10.16538/j.cnki.jfe.20221116.402

收稿日期：2022-08-27

基金项目：国家社会科学基金重大项目（21ZDA099）；国家自然科学基金面上项目（72273108）；教育部人文社会科学研究项目（22YJA790005）

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