医疗保险是否改善了老年人的慢性病医疗状况? ——基于CHARLS数据的实证分析

本文基于中国健康与养老追踪调查(CHARLS)数据,利用Heckman样本选择模型、二阶段最小二乘模型(2SLS)等方法,在高血压、糖尿病等慢性病纳入医保门诊报销的背景下,实证检验了医疗保险对我国城乡老年人慢性病医疗状况的影响.研究发现:(1)医疗保险显著增加了老年人慢性病的门诊和住院医疗费用,且城市和男性老年人的支出明显高于农村和女性老年人,但医疗保险对老年人慢性病住院医疗支出增长的影响呈减弱趋势;(2)医疗保险显著提高了老年人慢性病医疗服务利用率,增加了老年人及时就医的概率;(3)医疗保险显著降低了老年人慢性病的自付比例,减轻了老年人的医疗负担.     

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。     

建立和完善社区卫生服务中心老年人健康保健服务体系的探讨

当前中国人口老龄化问题严重,老年人健康状况日益被社会所重视。社区卫生服务工程的开展,全科医师对社区老年人进行健康调整,宣传传统预防保健知识,帮助老年人树立正确的健康观、疾病观,养成健康的生活习惯,减少疾病的发生率,降低医疗费用开支,是对社区老年人健康保健管理的重点。本文就老年人健康保健服务体系的建立和完善进行探讨。     

甘肃城乡老年人身体健康和医疗状况分析

我国总体上已进入老龄化社会,为了客观地对甘肃省城乡老年人口的主要卫生和健康问题作出"诊断",寻求符合现代城乡环境下老年人口健康状况的生活模式和行之有效的城乡老年人健康教育、健康医疗策略,为人口老龄化带来的社会问题提供解决方案,本文对甘肃省14个市州、86个县市区60岁及其以上老年人的主要健康问题及医疗状况进行了研究,并提出了相应对策。     

老龄化背景下城镇老年人健康促进体系探讨

近年来,医疗费用的持续增长加重了政府财政和居民的负担,老龄化的人口趋势无疑是医疗费用持续增加的重要因素.老年人群是疾病的高危人群,是城镇医疗费用的主要支付群体.对城镇老年人进行健康管理是提高居民健康水平、降低医疗费用的有效方式之一.因此,要建立对城镇老年人的健康促进体系,主要是要形成多元化的老年人健康促进资金筹资方式;创设"五环节"老年人纵向健康促进系统;将中医"治未病"方法融入健康监测、分析、评估、维护的全过程,创建具有中医特色老年人健康促进方式;建立多维度老年人健康保健机制.     

我国医养保健模式现状、困境及应对策略分析——以大连地区调查为例

近年我国人口老龄化现象日益严重,持续增长的老年人口给我国的养老、医疗带来了巨大挑战。我国现有的老年人医疗养老保健主要有"医养融合"、"中心辐射"及"养老产业城"三类模式,这三类模式在发展过程中都面临着老年人对医养保健模式认识不足、医养保健模式发展滞后的困境。针对此困境建议我国从医疗保健知识宣传、社区机构服务、护理人员培训及完善立法规范方面进行改进,从而满足我国老年医疗养老需求,提高老年人生活水平。     

居家和社区养老服务与老年人精神健康

中国人口正在快速老龄化，同时老年人的精神健康状况不容乐观。基于中国健康与养老追踪调查（CHARLS）2011—2018年数据和双重差分法，本文研究了居家和社区养老服务改善对老年人精神健康的影响。结果表明，居家和社区养老试点政策显著改善了老年人精神健康状况。机制分析表明，试点城市老年人能够享受到更多医疗和照护服务、能够享受到更多日常陪伴是这一政策改善老年人精神健康状况的重要机制。异质性分析表明，这一政策只对高收入、城镇地区、50至59岁以及70岁以上老年人的精神健康状况有显著的改善作用。     

推进医养深度融合 打造养老服务品牌——南京市秦淮区深化“医养融合”工作的调查与思考

南京市秦淮区是全市老龄化程度最高的区,截止2013年12月,全区60周岁以上老年人达16.48万,占户籍人口22.01％.群众对养老服务需求迫切,对解决老人看病就医问题非常关注.新秦淮区成立后,率先在全市开展“医养融合”探索,医疗服务与养老服务结合,老年人享受更多便捷优质基本医疗服务,取得初步成效.对此,多家媒体进行了报道.为进一步促进医养深度融合,推进“医养融合”工作开展,更好地为全区老年人提供便捷的医疗服务,区人大常委会对全区“医养融合”工作情况进行了专题调研,召开了区政府相关部门、街道、社区、卫生和养老机构座谈会,形成以下报告.     

农村老年人的生活状况与农村养老模式探析

随着人口老龄化的发展,老年人的社会保障问题日益引起关注,其中农村老年人的养老问题更显突出。本文从居住方式、经济状况、医疗状况、闲暇活动、养老方式与养老观念几个方面调查分析了农村老年人的生活状况,并以此为基础探讨了我国农村养老模式的现状与发展趋势。     

关于老年手机的人机学分析与设计

随着我国老年人的数量和比例不断增加,设计适合老年人使用的手机来对提升老年人的生活质量、改善老年人的生活品质具有十分重要的社会意义。本文基于人因工程的理论对老年用户的生理和心理进行分析,采用人的因素、色彩理论、人机界面和人体测量等方法,在用户界面、外观和功能三个方面对老年手机进行了科学化、系统化的设计。     

Medical insurance system evolution in China

Healthcare financing and payment in China are mainly based on medical insurance. This paper examines the key issues of the Chinese medical insurance system, with a particular emphasis on basic social medical insurance, which has the broadest coverage in China. It reviews the evolution of the basic social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system. The paper concludes with a discussion of some suggestions for the future development of the system.     

二元老年社会保障体制的尴尬与对策研究

我国面临着严峻的人口老龄化挑战已是一个不争的事实,同时让我们必须正视的是农村人口老龄化程度远远高于城市,但农村老年社会保障却与城市相差甚远,呈二元结构。本文以《中国城乡老年人口状况追踪调查》研究报告数据为基础,对我国城市和农村的老年人口的养老保障、医疗保障、社会福利、为老服务等方面进行了对比分析,并在此基础上对解决途径进行探讨。     

“Un-American” or unnecessary? America’s rejection of compulsory government health insurance in the Progressive Era

Between 1915 and 1920, 18 U.S. states considered the introduction of compulsory health insurance. Progressive reformers expected state health insurance to be welfare enhancing for American wage-workers since it would result in lower cost insurance and an extension of coverage to more of the population. The evidence presented in this paper indicates that the absence of broad political support for health insurance legislation in this early period reflects that compulsory insurance would not have improved on what was available and affordable through voluntary arrangements and had the potential to reduce the welfare of wage-earners.     

新疆医疗保险制度存在的问题及对策

职工医疗保险制度自1950年代实施以来,对于保障职工身体健康、减轻职工的个人和家庭负担、提高全民族的健康水平等起到了积极作用。但随着我国改革开放的不断深入,传统的公费医疗和劳保医疗制度的弊端逐渐显露出来。本文分析了新疆医疗保险制度的现状和存在的问题,提出应加大对医疗保险制度的改革,建立有中国特色的医疗保险制度。     

U.S. Healthcare Reform, 2009-2010: Implications for African Americans

This paper describes issues that need to be addressed to reform the U.S. healthcare delivery system, the solutions to some of these issues that are part of the Patient Protection and Affordable Care Act (as amended), and the implications for African Americans of some of the recently enacted reforms. These reforms take the first steps toward eliminating the insurance coverage gap that keeps many from receiving needed care. The necessary and simultaneous emphasis on cost containment of this legislation, however, may limit access to health care for African Americans.     

Does health insurance promote people's consumption? New evidence from China

In order to change the situation that reimbursement rate of the new rural cooperative medical care system (NCMS) was too low to alleviate farmers medical burden, in August 2012, China began to expand the coverage of the NCMS to include the treatment of critical illnesses. Could more effective health insurance promote the consumption of rural residents? We studied the impact of the critical illness insurance (CII) on rural household consumption, and find that the CII increases per capita household daily consumption by >15%. But healthcare and medical expenditures have not been affected. Our comparison of outcomes for households with different levels of consumption and income shows the CII mainly promote the consumption of rural affluent family, but no incentive for poor family, resulting in deterioration of consumption inequality of rural households. The finding is robust to various alternative hypotheses and specifications.     

Impact of supplementary private health insurance on hospitalization and physical examination in China

Private health insurance (PHI) is considered an important supplement to the basic social health insurance schemes in the Chinese healthcare system. However, whether the strategy of engaging PHI as supplementary coverage is effective cannot be determined without knowing the impact of supplementary PHI on healthcare access and utilization, the evidence on which is currently absent in China. Therefore, we aimed to investigate the effects of supplementary PHI on hospitalization and physical examination to provide such evidence in the Chinese setting. We conducted a cross-sectional analysis using data from the 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Using probit models and bivariate probit models with instrumental variables (IVs), we evaluated the effects of supplementary PHI on the utilization of hospitalization and physical examination. Our analyses provided evidence that supplementary PHI increased the probability of physical examination but decreased that of hospitalization.Our findings suggest that supplementary PHI in China may effectively promote the use of high-value preventive care, thereby reducing subsequent utilization of expensive medical services. The present study provided preliminary evidence that the China healthcare system can benefit from engaging PHI as supplements to SHI.     

Health insurance reform and economic growth: Simulation analysis in Japan

This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations. Our simulation produced the following results: first, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior following the increase in co-payment rates, however, reduces economic growth. Third, Japan's trend of increasing the future public health insurance benefits can mainly be explained by its aging population, and increasing the co-payment rate does little to reduce future payments of public health insurance benefits. Fourth, the effect on future economic burdens of reducing medical costs through efficiencies in public health insurance, emphasis on preventive medical care, or technological progress in the medical field is small. Finally, a policy of maintaining public health insurance at a fixed percentage of GDP will require reducing public health insurance benefits, perhaps up to 45% by 2050. Such a policy also reduces economic growth until approximately 2035. Our simulation indicates that the reform does not significantly reduce future public health insurance benefits, but it can enhance economic growth and welfare by encouraging private saving.