医疗保险制度对老年群体死亡风险的影响——基于CLHLS的生存分析

目的:探讨医疗保险制度对老年群体死亡风险的影响,为我国医疗保障制度的改革与完善提供参考依据。方法:基于中国老年健康影响因素跟踪调查(CLHLS)2011—2014年的追踪数据,以添加脆弱因子的Weibull模型与Gompertz模型进行生存分析,并且分年龄组进行异质性分析。结果:相对于无医保的老人,有医保老人的死亡风险随医保制度的不同而发生不同程度的变化,具体而言,新农合、城镇居民基本医疗保险以及城镇职工基本医疗保险分别降低了约20%、25%以及31%的死亡风险。通过分年龄组进一步分析发现,医疗保险对高龄组老人死亡风险有显著影响,而对低龄组老人的死亡风险的影响不显著。结论:医疗保险制度有助于降低老年群体的死亡风险,但影响程度各异,表现为城镇职工医疗保险最高,城镇居民医疗保险次之,新农合最低。基于此,我国医疗保险制度改革的重点方向在于继续扩大医保覆盖面,并弥合不同医保之间的待遇差异,在统筹城乡居民医疗保险的基础上,进一步推进城镇职工医疗保险与居民医疗保险的整合,最终实现城乡医疗保险制度的一体化发展。

Impact of medical insurance system on the mortality risk of the elderly: A survival status analysis based on CLHLS data

Objective:To explore the impact of medical insurance system on the mortality risk of the elderly in order toprovide reference for the reform and improvement of China''s medical security system.Methods:Based on the data of China''s Longitudinal Health Longevity Survey (CLHLS) of 2011-2014, survival status analysis was performed by Weibull Model and Gompertz Model with added vulnerability factors and heterogeneity was analyzed by age groups.Results:Compared to the uninsured elderly, the mortality risk of insured elderly varies from different medical insurance systems; especially the new rural cooperative medical insurance, basic medical insurance for urban residents and basic medical insurance for urban employees separately reduced the elderly mortality risk by about 20%, 25% and 31%, respectively. Through further analysis by age groups, it was found that medical insurance significantly affects the mortality risk of elderly in the oldest age group, while no significant impact on mortality riskwas observed with the younger age group. Conclusions:The medical insurance system helps to reduce the mortality risk of the elderly, but the impact degree is quite different among different systems and age groups of which medical insurance for urban workers was the highest, followed by that of urban residents and the new rural cooperative medical insurance was the lowest. Based on this, the key reform policy of China''s medical insurance system is to effectively expand medical insurance coverage and bridge the treatment gaps among different medical insurance programs.On the basis of overall planning, the integration of basic medical insurance through conforming the residents'' and workers'' medical insurance should be promoted so as to finally realize an integrated development of urban and rural medical insurance system.