本文選題：人口老齡化 + 醫(yī)療保險(xiǎn)��； 參考：《湘潭大學(xué)》2016年博士論文

【摘要】：隨著預(yù)期壽命的延長,加之計(jì)劃生育政策的長期約束,被視作“銀發(fā)浪潮”的人口老齡化問題在中國將變得愈發(fā)嚴(yán)重。據(jù)預(yù)測,中國60歲及以上老年人將從2014年的2.12億上升至2025年的3.08億,從相對數(shù)來看,老年人口占中國總?cè)丝诘谋戎貙?014年的15.5%上升至2025年的21.1%。在人口老齡化和高齡化日益嚴(yán)峻的背景下,老年人問題逐漸提上日程,且受到了人民群眾的密切關(guān)注。而在影響老年人生活質(zhì)量的諸多因素中,健康因素始終扮演著十分重要的角色。隨著中國人口的迅速老化,醫(yī)療保健服務(wù)壓力將不斷加大。出于預(yù)防目的的健康老年人、或者出于治病目的的帶病老年人均對醫(yī)療衛(wèi)生服務(wù)有了更高的渴求。在可預(yù)計(jì)的未來,中國將迎來老年人高負(fù)擔(dān)期,醫(yī)療衛(wèi)生支出這一重要的民生問題勢必會(huì)更加凸顯�！翱床≠F、看病難”一直是困擾城鄉(xiāng)居民切身利益的突出難題,也是中國社會(huì)建設(shè)方面的薄弱環(huán)節(jié)。本文以人口老齡化背景下的城鄉(xiāng)居民醫(yī)療衛(wèi)生支出作為切入點(diǎn),為實(shí)現(xiàn)在宏觀層面,醫(yī)療衛(wèi)生制度的總體安排以滿足居民合理的醫(yī)療需求;在微觀層面,醫(yī)療費(fèi)用報(bào)銷比例的提高、老年健康行為的宣傳以更好的控制個(gè)人醫(yī)療衛(wèi)生費(fèi)用支出的上漲。接下來將主要從這兩個(gè)層面來探討人口老齡化背景下的城鄉(xiāng)居民醫(yī)療衛(wèi)生支出問題。從宏觀數(shù)據(jù)的實(shí)證結(jié)果來看:城鄉(xiāng)居民收入水平對其醫(yī)療衛(wèi)生支出具有重要影響,少年人口撫養(yǎng)比的下降,促使更多的中國家庭人口生產(chǎn)偏好由之前的“人口數(shù)量”向更重視人力資本投資的“人口質(zhì)量”轉(zhuǎn)變,進(jìn)而通過增加醫(yī)療衛(wèi)生支出促進(jìn)了人口的“少生、優(yōu)生”,而不斷演化的老齡化進(jìn)程也顯著增加了居民的醫(yī)療衛(wèi)生支出。就城鄉(xiāng)間醫(yī)療衛(wèi)生支出的差異比較來看,由于農(nóng)村地區(qū)的老齡化更為嚴(yán)重,且收入水平更低,因此醫(yī)療衛(wèi)生支出面臨的壓力更大。而伴隨著中國人口老齡化大潮的來臨,未來中國人口總撫養(yǎng)比與醫(yī)療衛(wèi)生支出將表現(xiàn)為明顯的正相關(guān)性。從中國老年健康影響因素跟蹤調(diào)查(CLHLS)微觀數(shù)據(jù)的實(shí)證結(jié)果來看:社會(huì)醫(yī)療保險(xiǎn)雖然在一定程度上減輕了參保人的醫(yī)療支出負(fù)擔(dān),但是醫(yī)療保險(xiǎn)卻扭曲了醫(yī)療服務(wù)質(zhì)量,并通過各種機(jī)制影響患者的醫(yī)療需求行為,可能導(dǎo)致道德風(fēng)險(xiǎn)的產(chǎn)生。更高的醫(yī)療保險(xiǎn)保障水平將增加醫(yī)療服務(wù)的需求,意味著醫(yī)療保障中存在道德風(fēng)險(xiǎn)。根據(jù)傾向得分匹配(PSM)方法控制除保險(xiǎn)以外的其他因素以觀察是否參加醫(yī)療保險(xiǎn)對老年人醫(yī)療支出的影響。結(jié)果發(fā)現(xiàn)參與醫(yī)療保險(xiǎn)在一定程度上降低了老年人的自付醫(yī)療支出,但是醫(yī)療保險(xiǎn)并沒有降低老年人的總醫(yī)療支出,反而增加了老年人的總醫(yī)療支出,說明醫(yī)療保險(xiǎn)使得老年人支出的多、報(bào)銷的也多,驗(yàn)證了醫(yī)療保險(xiǎn)中道德風(fēng)險(xiǎn)的存在。同時(shí),基本藥物政策并未降低老年人醫(yī)療支出,反而增加了老年人醫(yī)療支出�；舅幬镎邔]有參與醫(yī)療保險(xiǎn)以及農(nóng)村的老年人的影響作用更加顯著�；舅幬镎卟⑽唇鉀Q“看病貴”這一難題。從人口老齡化背景下的城鄉(xiāng)居民醫(yī)療衛(wèi)生支出問題研究的對策建議來看:首先,積極促進(jìn)城鄉(xiāng)居民收入持續(xù)增長,努力進(jìn)入經(jīng)濟(jì)發(fā)展高水平階段,同時(shí)向著更加公平的方向發(fā)展,這是中國應(yīng)對老齡化的核心戰(zhàn)略。由于醫(yī)療保健消費(fèi)是一種更高層次的消費(fèi),而家庭收入水平也是影響居民醫(yī)療保健消費(fèi)支出的重要因素,因此居民醫(yī)療保健消費(fèi)水平與其家庭的收入水平密切相關(guān)。同時(shí)城鄉(xiāng)間收入水平的差異在一定程度上能夠造成城鄉(xiāng)居民的健康不平等,這也使得城鄉(xiāng)間居民醫(yī)療衛(wèi)生支出(需求)存在差異成為必然。收入差距的拉大也影響到低收入居民家庭在醫(yī)療保健方面的進(jìn)一步消費(fèi)。因此,在人口老齡化背景下,城鄉(xiāng)居民醫(yī)療衛(wèi)生支出的增加,需要以收入水平的持續(xù)增長和公平為前提。其次,在城市化加速的背景下,農(nóng)村老齡問題應(yīng)受到更多的關(guān)注。因此有必要廣泛開展老年健康教育,促使其醫(yī)療保健觀念逐步由“治病型”轉(zhuǎn)向防患于未然的“保健型”。同時(shí),城鄉(xiāng)間財(cái)政醫(yī)療衛(wèi)生資源分配不平衡特征,使得農(nóng)村居民醫(yī)療保健投入過度依賴家庭,導(dǎo)致家庭消費(fèi)其他方面的需求不足,因此需要強(qiáng)化農(nóng)村醫(yī)療衛(wèi)生投入的政府責(zé)任。最后,現(xiàn)代社會(huì)的醫(yī)學(xué)模式應(yīng)由重事后治療轉(zhuǎn)向重事前預(yù)防,醫(yī)療服務(wù)的需求也應(yīng)從低層次的“疾病需求”向高層次的“健康需求”演進(jìn)。健康的實(shí)現(xiàn)既依賴于醫(yī)療保障制度的安排,也得益于個(gè)人的自覺努力。隨著疾病模式的轉(zhuǎn)變,健康與疾病的界限越來越模糊,我們往往強(qiáng)調(diào)對收益性較好的醫(yī)療的供給而忽視了公共性較強(qiáng)的預(yù)防服務(wù)的供給,隨著老齡人口的增加,針對治療老齡人口多發(fā)疾病的醫(yī)療服務(wù)需要加強(qiáng),針對老年人養(yǎng)老的預(yù)防保健服務(wù)也將是未來發(fā)展的一個(gè)方向。
[Abstract]:With the prolongation of life expectancy and the long-term constraints of the family planning policy, the problem of population aging, regarded as the "wave of silver hair", will become more serious in China. It is predicted that the age of 60 and older in China will rise from 212 million in 2014 to 308 million in 2025. From the logarithmic point of view, the proportion of the elderly population is the proportion of the total population of China. From the 15.5% rise of 2014 to the 2025 21.1%. in the background of the aging and aging of the population, the problem of the elderly is gradually put on the agenda and is closely concerned with the people. Among the factors affecting the quality of life of the elderly, the health factors have always played a very important role. The pressure of health care service will increase rapidly. The health care service for the elderly, or the elderly for the purpose of prevention, is higher. In the expected future, China will have a high burden of the elderly, and the important livelihood problem of medical health expenditure is bound to be more serious. It is a prominent problem that puzzles the vital interests of urban and rural residents, and is also a weak link in the construction of Chinese society. This article takes the medical and health expenditure of urban and rural residents as a breakthrough point under the background of population aging, and the overall arrangement of the medical and health system to meet the residents reasonable at the macro level. Medical needs; at the micro level, the increase in the proportion of medical expense reimbursement and the promotion of the health behavior of the elderly in order to better control the increase of personal medical and health expenditure. The following will be mainly from the two levels to explore the problem of medical and health support for urban and rural residents under the background of population aging. The income level of the rural residents has an important impact on its medical and health expenditure, and the decline of the child support ratio has prompted more Chinese family population production preferences to change from the previous "population" to the "population quality" which pays more attention to human capital investment, and thus promotes the population "less living and eugenics" by increasing medical treatment and health expenditure. And the continuous evolution of the aging process also significantly increased the health expenditure of residents. Compared to the differences in urban and rural medical and health expenditure, the aging of rural areas is more serious, and the income level is lower, so the pressure of medical and health expenditure is greater. China's total population dependency ratio and medical and health expenditure will be positively correlated. From the empirical results of the CLHLS micro data, the social medical insurance reduces the burden of medical expenditure to the insured, but it distorts the quality of medical services. And the effects of various mechanisms on the patient's medical needs may lead to moral hazard. Higher health insurance levels will increase the demand for medical services and mean moral hazard in medical care. The PSM method controls other factors other than insurance to observe whether to participate in medical insurance. The result shows that the participation of medical insurance in medical insurance reduces the self paid medical expenditure of the elderly to some extent, but the medical insurance does not reduce the total medical expenditure of the elderly, but increases the total medical expenditure of the elderly. It shows that medical insurance makes the old people spend more, and the reimbursement is much more. The existence of moral hazard in medical insurance. At the same time, the basic drug policy did not reduce the medical expenditure of the elderly, but increased the medical expenditure of the elderly. The basic drug policy has a more significant impact on the lack of participation in medical insurance and the elderly in the rural areas. The countermeasures and suggestions on medical and health expenditure of urban and rural residents under the background of aging are: first, actively promote the continuous growth of urban and rural residents' income, strive to enter the high level of economic development, and develop in a more equitable direction. This is the core strategy for China to deal with aging. High level of consumption, and family income level is also an important factor affecting residents' health care expenditure, so the level of health care consumption of residents is closely related to the income level of their families. At the same time, the difference of income level between urban and rural areas can cause the health inequality of urban and rural residents to a certain extent, which also makes urban residents. The widening of medical and health expenditure (demand) is inevitable. The widening of the income gap also affects the further consumption of low-income households in health care. Therefore, in the context of the aging population, the increase of medical and health expenditure in urban and rural residents should be based on the continuous growth and equity of income level. Secondly, the urbanization is added to the urbanization. In the rapid context, the problem of aging in rural areas should be paid more attention. Therefore, it is necessary to develop health education for the elderly so that the concept of health care is gradually shifted from "cure type" to "health care". Meanwhile, the distribution of medical and health resources in urban and rural areas is not equal, so that rural residents' health care has been put into health care. Depending on the family, the demand for other aspects of household consumption is insufficient, so it is necessary to strengthen the government responsibility of rural medical and health investment. Finally, the medical model of modern society should turn from heavy post treatment to pre prevention, and the demand of medical service should also evolve from low level "disease demand" to high level "health demand". The realization of health depends not only on the arrangement of the medical security system but also by the self-conscious effort of individuals. With the change of the disease pattern, the boundary between health and disease is becoming more and more blurred. We often emphasize the supply of better benefit medical care and neglect the supply of strong public preventive services, with the increase of the aging population. Medical services for the treatment of elderly patients with multiple diseases need to be strengthened. Preventive health care services for the elderly will also be a direction for future development.

【學(xué)位授予單位】：湘潭大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.1;F126.1

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