居家还是住机构——临终老人的照料成本和死亡质量比较

我国将逐步进入深度老龄化和高龄化阶段,老年临终照料成本也将快速增长,如何在提升临终照料服务质量的同时降低照料成本成为重要的政策议题。本文利用2002—2014年中国老年健康影响因素跟踪调查(CLHLS)中的死亡人口跟踪调查数据,借助两部分模型、样本选择模型、工具变量和倾向得分匹配方法,首次对住机构老人和居家老人的临终照料直接成本和总成本进行深入比较,并借助Mlogit回归模型和倾向得分匹配方法,研究居住安排与照料成本对死亡质量的影响。研究发现,住机构老人和居家老人在支付的直接成本、总成本、死亡质量方面都没有显著差异,我国临终老人照料成本的增加显著降低了死亡质量。因此,完善养老服务体系应根据老人照料需求强度和特征精准施策。为提高老人临终前的生存质量和死亡质量,我国应开展临终照料供给侧结构性改革,大力发展机构照料,并提高临终照料的专业性。

Living in Institution or at Home--Comparative Analysis of Care Cost of the Elderly at the End of Life and Quality of Death

With the acceleration of advanced ageing in China,the care cost of the elderly at the end of life will increase rapidly,and how to improve the care quality and reduce the cost will become an important policy issue.Using the death population tracking data from 2002 to 2014 in Chinese Longitudinal Healthy Longevity Survey(CLHLS),this paper compares the care costs of the elderly at the end of life with the two-part model,Heckman sample selection model,instrument variables and propensity score matching method and explores the effects of living arrangements and care cost on the quality of death with Mlogit model and propensity score matching.Research shows that there are not significant differences in direct cost,total cost and quality of death of the elderly at the end of life between living in institutions and living at home.However,the increase in cost for the care of the elderly leads to a significant decrease in quality of death.Therefore,precise measures should be taken according to the intensity and characteristics of the elderly care for the improvement of the old-age care service system.In order to improve the quality of death for the elderly,China should carry out supply-side structural reform on caregiving for the elderly at the end of life,vigorously develop institutional care and provide professional care services for the elderly.