高龄化、健康不平等与社会养老保障绩效研究——基于长期多维健康贫困指数的度量与分解

快速高龄化是新时代中国老龄工作面临的一项重大挑战。本文利用中国老年健康影响因素跟踪调查2005—2014年的数据,通过长期多维健康贫困指数的度量与分解,考察了高龄化背景下老年人病残趋势、健康不平等以及社会养老保障与服务在改善老龄健康上的政策效果。结果发现:高龄老人长期"带残生存"的问题不容忽视,自理能力与认知功能受损对总体健康状况的影响突出;女性、农村及低收入等弱势群体更容易陷入长期多维健康贫困;医疗服务可及性与社区养老服务水平的提升能够显著降低长期多维健康贫困的发生风险。鉴于此,政府应在提升医疗及社区养老服务供给和均等化水平的基础上,重点推进社区长期照料服务和老年认知功能的早期筛查与干预。     

农村社区居家养老服务需求强度的实证分析——基于辽宁省S镇农村老年人的问卷调查

基于辽宁省S镇农村社区老年人居家养老服务需求调查发现,农村社区居家养老更加符合农村老年人的养老意愿。依据克雷顿·奥尔德弗"ERG"需求层次理论,将农村老年人需求分为生活照料、医疗保健、精神赡养三个层次。通过李克特量表法衡量居家养老服务需求强度得出,农村老年人所需的医疗保健和精神赡养与生活照料相比需求强度较高。运用spearman相关系数模型测算了年龄、性别、生活自理能力、婚姻状况、健康自评等因素对居家养老服务需求强度的影响程度。为此,我国发展农村居家养老服务需要尊重老年人的养老意愿,以居家养老服务需求强度为依据实施精准供给,积极完善农村社会化养老服务政策支持体系,逐步满足农村社区老年人的养老需求。     

维吾尔族老年人的机构养老意愿研究

本文基于700份新疆哈密市伊州区维吾尔族老年人的问卷调查数据,系统探讨了维吾尔族老年人的机构养老意愿。研究发现,机构养老已成为维吾尔族老年人的一种重要养老途径。本文利用多分类Logistic回归模型分析发现,年龄、自理能力、慢性病、汉语水平、子女数量、养老观念、社会宗教活动、社区关系以及居住地是维吾尔族老年人机构养老意愿的显著影响因素,其中汉语水平、养老观念、社会宗教活动、社区关系、居住地是重要影响因素。由此,本文建议,应发展医养结合的机构养老模式,在养老服务方面考虑不同民族老年人的生活习俗,由政府主导宣传和提倡多元化养老观念,引导社会舆论,促进维吾尔族养老资源加入社会养老服务体系并发挥其在本民族中的养老优势。     

失能与非失能老人社区养老服务需求比较研究——以上海市为例

随着我国失能老年人口规模的不断增加,相应地使社区养老服务面临着不均衡发展。本文以调研为基础,通过比较分析失能老人与非失能老人对社区养老服务需求的不同,并分析社区养老服务需求的影响因素,最终发现,不同健康状况、不同年龄、患慢性病的种数、子女数量等因素影响着老年人的需求。     

美国社区养老服务设施建设及启示

中国是老年人口大国,传统的农业社会家庭养老模式已经不能适应工业化时代老龄化发展需要,因此学习国外的经验有助于解决今后中国老年人口养老服务问题。研究方法是收集文献资料和到养老机构实地调查。美国是一个崇尚年轻人文化的老龄化社会,但目前,老年人不再是从家庭到养老院的单一生活轨迹,社区为老年人提供了更多的选择机会,从健康老人服务、自理、半自理服务到专门护理,各种服务设施齐全。服务提供者以私人、企业、教会为主,服务质量要符合联邦政府及当地政府的标准。     

社区养老正当其时

<正>构建贴心暖心的老年人养老关爱服务体系，是积极应对人口老龄化和提高老年人生活幸福感的重要途径。社区养老更加贴近老年人生活，符合老年人就近养老的习惯。尽管当前城镇社区养老服务设施已初步建成，但依然无法满足社区老年人提高生活品质的需求，尤其无法满足高龄、空巢、独居、失能、特困供养等特殊老年人对关爱服务的迫切需要。因此，应加快为社区老年人提供暖心、贴心、安心的高质量关爱服务。     

农村老年人社区养老意愿与影响因素分析——基于长株潭地区370份问卷数据

基于2015年7月-8月湖南省长株潭地区的370份问卷调查数据,运用二元logistic模型实证分析了农村老年人社区养老的意愿与影响因素。研究结果表明,年龄、身体状况、婚姻状况、与子女交流次数、家庭年收入这5个变量对农村老年人的社区养老意愿正向影响显著。没有配偶比有配偶的农村老年人入住社区养老意愿的可能性增大1.474倍;老年人的子女数每减少一个,愿意入住社区的可能性增大2.351倍;家庭年收入每上一个档次,愿意居住社区养老的可能性就增大1.918倍。精神慰藉变量负向影响显著。性别、文化程度、子女数、日常生活照料、医疗服务、收入水平、是否有稳定经济收入对社区养老意愿没有显著影响。     

基于个体差异的“互联网+”居家社区养老服务需求分析

随着我国人口老龄化趋势的加快,老年人养老需求日益增加,为了满足老年人多元化的养老服务需求,社区通过服务模式的创新提供多样化和个性化的养老服务项目。本文运用个体差异理论分析"互联网+"居家社区养老服务需求及其影响因素,发现老年人的年龄、性别、健康状况、文化程度、居住情况和收入水平对"互联网+"居家社区养老服务的需求产生不同程度的影响。不断提高老年人收入,加快发展"互联网+"助餐服务,以需求为导向提供个性化养老服务,更新理念及提升"互联网+"居家社区养老服务技术,营造养老、孝老、敬老的社会氛围,对推进"互联网+"养老服务建设和满足老年人养老需求具有重要的现实意义。     

“社区为依托”的养老服务有效吗——基于老年人生活质量的检验

本文以老年人生活质量为切入点,探究社区养老服务对老年人生活质量的影响,进而评估"社区为依托"的养老服务的有效性。基于中国老年健康影响因素跟踪调查(CLHLS)2014年截面数据,使用二元Logistic模型,研究发现:以社区为依托提供养老服务的政策是有效的,社区养老服务对老年人的生活质量产生了积极的影响;通过对社区养老服务分类发现,精神慰藉类服务对提升老年人生活质量的作用最强,其后依次是生活照料类服务、法律援助类服务、健康卫生类服务。为发挥社区的养老"依托"作用及发展社区养老服务业,政府应重视社区养老服务的规划、发展和推动,避免陷入求大求全的误区,应重点关注对老年人生活质量提升作用较强的精神慰藉服务和生活照料服务。     

健康状况、空巢原因与社区居家养老服务需求——以恩施市农村空巢老人为例

本文根据恩施市农村空巢老人的实地调查数据,描述了农村空巢老人社区居家养老服务需求的基本特征,并利用二项Logistic回归模型分析了农村空巢老人社区居家养老服务需求的影响因素。研究结果表明,农村空巢老人对医疗保健服务的需求最多,其次为精神慰藉服务,最后为生活照顾服务,且与非空巢老人的需求强度有较大的差异。研究证实了健康状况和空巢原因显著影响了空巢老人对社区居家养老服务的需求,凸显了由子女外出务工形成的空巢老人的养老困境。由此,社区居家养老要首先满足空巢老人的医疗保健需求,并切实提升农村社区提供精神慰藉的能力,从而保障农村空巢老人的养老需求。     

房贷风险不可小视——美国“次贷危机”带来的思考

次级抵押贷款,是指美国一些金融机构向信用度低、收入证明缺失、负债较重的人提供住房贷款。2007年3月,美国第二大次级抵押贷款公司——新世纪金融公司,由于收不回贷款损失惨重,被迫向美国联邦破产法院提出破产保护申请。从此,“多米诺骨牌”相继倒下,30多家次级抵押贷款公司先后停业。美国和欧洲的许多共同基金、对冲基金、     

Collaborative Commissioning of Secondary Care Services by Primary Care Trusts

This article examines collaborations between primary care trusts in the commissioning of secondary care services in England. It applies principal-agent theory qualitatively to two case studies. The theory suggests that collaboration should take place if organizations share relevant information and agree joint objectives. The study findings show that sharing information is not a major problem for these case studies, but that agreeing joint objectives is.     

树立人本管理意识乃管理之本

科学管理是企业永恒的主题,从严管理企业是振兴国企的必由之路,而强化科学管理正需要加强人本管理,充分发挥员工们的积极性,创造性,为广大员工创造一种能够掌握自己命运,激励其潜在能力的文化氛围,一个企业是否注重人本管理,在某种程度上是衡量该企业管理是否现代化的一个重要标准。人本性管理这种人性化管理方式必将成为２１世纪管理的主流。     

Reimbursing Preventive Care

The paper focuses on secondary prevention, such as diagnostic screening, medical examinations and checks-up, which refers to the early detection of disease. Secondary prevention is analyzed as a self-insurance activity reducing the negative shock of illness and can be either complement or substitute to illness treatment. This paper analyses the optimal reimbursement scheme for both prevention and treatment when each activity receives either a linear subsidy (i.e. cost sharing) or tax. Although optimal reimbursement systematically encourages treatment, it positively affects prevention if and only if prevention reduces the cost of treatment, that is in the case the two activities are substitutes.     

Reimbursing Preventive Care

The paper focuses on secondary prevention, such as diagnostic screening, medical examinations and checks-up, which refers to the early detection of disease. Secondary prevention is analyzed as a self-insurance activity reducing the negative shock of illness and can be either complement or substitute to illness treatment. This paper analyses the optimal reimbursement scheme for both prevention and treatment when each activity receives either a linear subsidy (i.e. cost sharing) or tax. Although optimal reimbursement systematically encourages treatment, it positively affects prevention if and only if prevention reduces the cost of treatment, that is in the case the two activities are substitutes.     

老年长期照护研究综述

本文对长期照护概念从"长期"和"照护"两个方面进行剖析,从长期照护模式分类、长期照护评估机制、法律法规和保险制度等方面介绍各国研究状况,提出我国发展长期照护制度的建议:满足照护需求,构建合理的长期照护模式;发展老龄产业,培养优质的长期照护人才;健全法律法规,构建长期照护保险制度;提供护理津贴,合理分担财政负担;发展评估,及时干预老年人健康状况。     

Predicting the Frequency and Amount of Health Care Expenditures

Abstract

This article extends the standard two-part model for predicting health care expenditures to the case where multiple events may occur within a one-year period. The first part of the extended model represents the frequency of events, such as the number of inpatient hospital stays or outpatient visits, and the second part models expenditure per event. Both component models also use independent variables that consist of an individual’s demographic and access characteristics, socioeconomic status, health status, health insurance coverage, employment status, and industry classification. The second part of the model also includes a variable representing the number of events to predict the expenditure per event, thus capturing dependencies between the first and second parts. This article introduces closed-form predictors of annual total expenditures and demonstrates how to create simulated predictive distributions for individuals and groups. The data for this study are from the Medical Expenditure Panel Survey (MEPS). MEPS panels 7 and 8 from 2003 were used for estimation; panels 8 and 9 from 2004 were used to validate predictions. This annual expenditures model provided a better fit to the data than standard two-part models. The count variable was significant in predicting outpatient expenditures. The aggregate expenditures model provided better point predictions of held-out total expenditures than competing models, including the standard two-part model. The predictive distribution for aggregate expenditures for small groups is long tailed, with both the variability and skewness decreasing as the group size increases, an important point for programs designed to manage expenditures.     

老年长期照护研究综述

本文对长期照护概念从"长期"和"照护"两个方面进行剖析,从长期照护模式分类、长期照护评估机制、法律法规和保险制度等方面介绍各国研究状况,提出我国发展长期照护制度的建议:满足照护需求,构建合理的长期照护模式;发展老龄产业,培养优质的长期照护人才;健全法律法规,构建长期照护保险制度;提供护理津贴,合理分担财政负担;发展评估,及时干预老年人健康状况。     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers.     

Long‐Term Care Across Europe and the United States: The Role of Informal and Formal Care

Large cross‐country variation in long‐term‐care (LTC) policy in conjunction with household‐level data on caregiving provides a valuable laboratory for policy analysis. However, there is a lack of comprehensive cross‐country data on how care is provided. In order to close this gap, we draw on data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS) in the United States. Because care hours are missing for some care forms (especially for nursing‐home residents), we propose a selection model to impute these. The model allows selection into care forms to differ by country. Our estimates imply that nursing‐home residents have higher care needs, even when conditioning on observed characteristics. In contrast to the bulk of the literature, we also take into account care provision from persons in the same household, and we find that this contributes one‐third of all care hours. Informal‐care provision in Europe follows a steep North–South gradient, with the United States falling in between Central European and Southern European countries. The results are robust to alternative imputation schemes.