居住安排与社会支持对老年人医疗服务利用的影响研究——以上海为例

文章在对上海市静安区老年人进行随机抽样调查的基础上,采用tobit模型分析了居住安排与社会支持对老年人治疗性医疗服务利用的影响,采用logit模型分析了居住安排与社会支持对老年人预防性医疗服务利用的影响。研究发现,居住安排与社会支持对老年人医疗服务利用具有显著影响,但对不同层次、不同类型的医疗服务利用影响不同,同时,老年人的自理能力水平对这种影响发挥调节作用。在我国已经实现了医疗保险全覆盖的背景下,拓宽社区支持功能,提高老年人医疗服务的可及性并提升基层医疗服务质量应成为医疗政策的重要议题。     

隔代照料孙子女对中老年人心理健康的影响研究

使用 2013 年中国健康与养老追踪调查(CHARLS)数据，以抑郁情况与生活满意度作为 心理健康的代理指标，探讨隔代照料孙子女对中老年人心理健康的影响，为克服由于自我选择所 产生的内生性问题，进一步运用倾向得分匹配法分析隔代照料孙子女对中老年人心理健康的影响。 研究结果表明，我国 51.7% 的中老年人提供隔代照料;提供隔代照料对中老年人心理健康有显著 的改善作用;隔代照料孙子女对男性、农业户口、未达到退休年龄中老年人影响更为显著;此外， 对影响路径的分析表明，提供隔代照料会通过显著增加人们参加社交活动的可能性以及参加社交 活动的频率来改善心理健康。     

Impact of urban-rural health insurance integration on health care: Evidence from rural China

In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.     

政府补助、保险支付与老年临终照料成本——基于2002-2014年CLHLS死亡人口追踪数据的分析

为应对日益增大的老年人照料压力,我国各地试点通过政府补助或社会保险支付的方式满足老人的照料需求。基于2002-2014年CLHLS死亡人口追踪数据,文章用两部分模型、Heckman选择模型和结构方程模型,分析了政府补助、保险支付对老年临终照料直接成本和总成本的影响及其中介机制。研究发现,老年临终照料服务由保险支付的直接成本和总成本都比家庭支付明显更高,政府补助的直接成本比家庭支付更高,保险支付的直接成本比政府补助更高。保险支付和政府补助对照料成本影响的机制存在差异,保险支付主要通过收入效应对照料成本产生显著影响,但替代效应也发挥了中介作用,政府补助则主要通过替代效应对照料成本产生显著影响。文章的研究结论具有重要的政策含义。我国发展长期护理保险,应合理界定政府、市场、社会和家庭对老年人的照料责任,并明确长期护理保险的有限责任,尽量降低可能的收入效应和替代效应对照料成本的影响。     

Modelling the influence of caring for the elderly on migration: estimates and evidence from Indonesia

In a society where children are expected to support the elderly, the ill health of an elderly parent is likely to influence an individual's propensity to migrate. Using data from the Indonesian Family Life Survey, we examine the manner in which the responsibility to care for an elderly parent who is in poor health affects the migration decisions of working-age adults. Our analysis suggests that individuals will be less likely to migrate if they have elderly parents who are in poor health. These findings are robust to specifications using alternative measures of poor health.     

Are people in the SADC region willing to pay more tax to fund public healthcare?

ABSTRACT

For Africa to develop and achieve sustainable development, African governments have to prioritise spending on public health. However, the current spending data shows that health spending is a continuing struggle for African countries. Many researchers have the view that African governments have to collect more tax to spend enough on public healthcare. The question here is what extent people are willing to pay more tax to increase spending on public healthcare? Employing a multilevel regression model on Afrobarometer survey data, this paper examined to what extent individual and country level factors influence people’s willingness to pay more tax to increase spending on public healthcare in 12 Southern African Development Community (SADC) member states. This study found that peoples’ trust in their government is an important determinant of willingness to pay more tax, while factors such as the country’s quality of democracy, economic condition, and current per capita health expenditure have no influence.     

Relative deprivation and health revisited: New evidence from middle-aged and older adults in rural China

The critical role of income in individual health is not only reflected in the direct effect of income but also derived from the relative income levels within cohorts. This study first constructs relative deprivation indicators to measure the relative income levels of rural households by taking village-level households as the reference group. Using the data from the four waves of the China Health and Retirement Longitudinal Study (2011–2018), we apply a panel event study approach to detect the impact of relative deprivation on the health status of rural middle-aged and older adults. The estimation results show the significantly negative and persistent effects of deterioration in relative deprivation on the physical and mental health outcomes of these adults. In rural China, the impact of relative deprivation on individual health shows significant age and wealth differences, but no significant gender differences are observed. Meanwhile, local collective culture plays important roles. The findings have important implications for the government to improve public health policies and promote healthy aging.     

Government expenditure in the independent and self‐governing national states of Southern Africa: An evaluation

Various commentators recently drew attention to the expenditure and financing of the independent and self‐governing national states in Southern Africa. The inference has been drawn that this expenditure appears wasteful and ineffective and constitutes little more than a costly political luxury.

This article makes an attempt at evaluating government expenditure in the national states in terms of the type and level of expenditure, its benefit incidence, as well as its efficiency.

Expenditure of the governments of the national states is largely on collective or social goods and services and therefore of the type widely expected to be provided by governments. Since the benefit incidence of this expenditure is not confined within the borders of the national states, but spills over into South Africa, government expenditure by these states benefits the common integrated economic system of Southern Africa.

With regard to the levels of expenditure, indications are that expenditure in many instances is too low. Increased expenditure in some categories might well show significantly increasing returns.     

Estimating the future health care cost of population aging in South Africa

ABSTRACT

This paper analyses the relationship between health care expenditure and population aging in South Africa using yearly data from 1983 to 2015. Empirical evidence from an Autoregressive Distributed Lag approach to cointegration indicates that old dependency and life expectancy are major drivers of public health expenditure in South Africa besides the income. Particularly, when structural breaks are controlled for, income exhibits a long-term elasticity with respect to health spending greater than unity; suggesting that South African public health care has become a luxury good over time. Interestingly, South African public health spending is found to be responsive to demographic development only in the long run. This is consistent with the micro evidence that health expenditure increases with individual age with significant impacts in the long term. Finally, using economic and demographic projections statistics, we find that public health expenditure could roughly double in the next fifteen years ceteris paribus.     

补充医疗保险对中老年人医疗服务利用的影响研究

我国基本医疗保障制度顶层设计逐渐完善，但针对部分高额医疗费用，基本医保的报销水平仍然有限，与基本医疗保险相衔、面向全体基本医疗保险参保人员的补充医疗保险将作为在更大范围分散风险的补偿手段满足人民群众的医疗需求，为此探究补充医疗保险对中老年人医疗服务利用的影响。 采用2018年中国健康与养老追踪调查（CHARLS）的数据，构建两部模型进行分析探究。 结果表明，补充医疗保险增加了中老年人体检、门诊和住院的可能性，同时减少了其在门诊费用支出。 因此，政府应鼓励居民购买补充医疗保险，以解决基本医疗保险无法满足患者的医疗服务需求的问题，同时为我国补充医疗保险发展提出相关建议。     

The effect of HIV on health care in sub‐Saharan Africa

This article is concerned with the hitherto neglected area of the effect of HIV on the delivery of health care in sub‐Saharan Africa. The task is hampered by a lack of usable data. In most countries there have been no sentinel HIV surveys, so we have no clear idea of the magnitude of the epidemic. However, it is certain that HIV will alter the demand for health care, and the supply and quality of services.

Demand will grow as infected adults and children seek care. Most HIV‐related illness is found in people who would not normally require care, and therefore creates additional demand. Demand for care will also be determined by the availability and accessibility of services. Ironically, the middle‐income countries may face higher bills, and in this sense the effect of the HIV epidemic may be worse in the more developed world.

The supply of services will be affected by increased morbidity and mortality among health care workers. This is already happening. The generous terms and conditions of service that most governments offer to workers in the public sector will make the problem worse.

HIV has served to improve the quality of health care in most of the developed world. Patients have sought to take control over their own care, and staff have been more rigorous in taking universal precautions. But in developing countries external aid often determines how health care is organised, and money spent on AIDS is diverted from other areas. This may also be true of local funding.

The effect of HIV on health care is lamentably under‐researched. This is particularly worrying as the effects of HIV will be felt first by the health care sector. The problem must be confronted urgently from the point of view of the suppliers of health care services, the users, and the policy‐makers.     

Ciskei's business reforms in the context of regional development∗

In the May edition of Development Southern Africa (Vol 2, No 2), four papers discussed various aspects of the taxreforms in Ciskei. The general conclusion was that the steps would most probably not greatly assist Ciskei's economic development, in fact the opposite could be true: that the steps would harm the country's economic development

In this reply, Dr DHM Bridgman does not react to any of the papers in particular, but states the case for Ciskei: why the steps were taken and in what frame of reference; what Ciskei's expectations are, and why the previous situation could not continue.     

Consuls and nations in the Levant from 1570 to 1650

Abstract

The purpose of this article is to compare the consular institutions of four European states in the Levant during a specific period, in the hope that this will illuminate the strengths and weaknesses of the various institutional forms that were adopted.     

Cold waves in southern cities of European Russia and premature mortality

The results of the next stage of works for assessing the effects of temperature waves on mortality indicators have been presented. The danger of cold waves for the public health in Southern cities of European Russia has been evaluated. Cold waves with duration of 5–20 days, during which the air temperature was below the threshold value determined based on the probability characteristics of the multi-year distribution of daily average temperatures in each city, have been studied. The cold thresholds were equal to (–12.6°C in Volgograd,–9.4°C in Rostov-on-Don and Astrakhan’, and–4.4°C in Krasnodar). The premature mortality rates per 100000 people in the population per year caused by cold waves in Southern cities of Russia were calculated. A meta analysis of risks by the four Southern cities showed statistically significant results almost for all the studied causes of death; the highest values of risk were determined for diseases of the circulatory system for individuals aged 65 and older.     

Contextual determinants of family dissolution in sub-Saharan Africa

ABSTRACT

The question of family dissolution has been widely debated by demographers, economists and health experts in developed countries. However, there appears to be a dearth of research on the contextual determinants of family dissolution in sub-Saharan Africa (SSA) and the variations that exist within regions. This article is stimulated by the recognition that family dissolution is associated with negative consequences both for adults and for children. Using pooled data from the recent Demographic and Health Surveys of 16 SSA countries with a weighted sample of 51 474 (Central Africa), 61 069 (East Africa), 42 247 (Southern Africa) and 83 187 (West Africa) women, the article examines the contextual determinants of family dissolution in SSA. Dissolution rates ranged from 12% in East Africa to 20% in Central Africa. Socio-economic variables were strong predictors of dissolution in all of the regions although direction of association differed. This article adds to the body of knowledge of family dissolution in SSA.     

长三角非中心区城市“医养结合”养老服务需求研究——基于安徽省蚌埠市的调研

长三角地区非中心区城市大多属于经济欠发达地区，人口老龄化使得这些地区的社会养老问题凸显。而“医养结合”集中医疗和养老功能的新型养老模式可以作为缓解老年人口养老压力的有效手段。积极推行长三角地区一体化“医养结合”新型养老服务，应进一步明确长三角非中心区城市“医养结合”养老结合保障需求因素。通过对长三角非中心区典型城市安徽省蚌埠市老年人进行问卷调查的方式收集数据，采用Logistic回归模型进行分析，得出结论:老年人健康状况与参加“医养结合”意愿呈负相关；购买过商业健康保险和商业意外保险与参加“医养结合”意愿呈负相关；“医养结合”的服务类型也对“医养结合”意愿有显著影响，并以此提出相关政策建议，以期促进中国养老产业的转型和升级。     

Social capital as correlate,antecedent, and consequence of health service demand in China

Amid increasing interest in how social relationships play an important role in health and health behavior, it remains unclear whether social activities and social capital in general benefit individuals' health literacy and in turn affect their health care consumption. More specifically, this article proposes a research hypothesis to address the question: Do individuals who are strongly tied to other individuals within the social networks become more health conscious or literate and hence use more health services? This paper extends prior research on social support, health literacy and health care utilization to investigate the association between social interaction and health service demand. Using the China Health and Nutrition Survey, the paper provides cross-sectional evidence that people who are socially active and connected with their friends made more visits to health care providers. It also finds that people of male gender, being single, having more years of education, and no health insurance coverage tend to avoid seeking health services. The quasi-experimental study, which examines the events that exogenously intensified social interactions in some but not all Chinese provinces, indicates that social capital is more an antecedent than a consequence of health service needs.     

An appropriate development strategy for Southern Africa∗

The limited successes achieved with development in the Third World and the national states in Southern Africa have necessitated a considerable change in development thinking and practice. The conventional developmental approach, which is based on growth models, is inappropriate for the conditions in the LDCs. A new development approach, coupled with an appropriate development strategy, has culminated in the development literature.

In this article the poverty problem in Southern Africa is outlined as a general background, whereafter the new development approach and a few guidelines for an appropriate development strategy is discussed. The application of the new strategy in the circumstances of Southern Africa is highlighted.     

Welfare spending and mortality rates for the elderly before the Social Security era

We analyze the impact of the original means-tested old-age assistance (OAA) programs on the health of the elderly prior to the first Social Security pension payments. Before 1935 a number of states had enacted their own OAA laws. After 1935 the federal government began offering matching grants and thus stimulated the adoption of OAA programs by the states. A new panel data set of 75 cities for each year between 1929 and 1938 combines mortality rates for older age groups with three measures of the OAA programs, spending on non-age-specific relief and a rich set of correlates. The data are analyzed using difference-in-difference-in-difference and instrumental variables methods. Our results suggest that old-age assistance in the 1930s had little impact on the death rate of the elderly. Our sense is that the OAA programs in the 1930s transferred the elderly from general relief programs without necessarily increasing the resources available to them.