Effect of long-term care insurance on health condition, medical expenditure and family care of the urban elderly in China: a CHARLS data analysis
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摘要:
目的 分析长期护理保险对中国城市老人健康水平、医疗支出和家庭照护的影响，为长期护理保险制度完善和老年人健康水平提升提供依据。 方法 收集中国健康与养老追踪调查数据（CHARLS）2013年、2015年、2018年3期面板数据，从中抽取2 278名 ≥ 60岁城市老人，将其中11个长期护理保险试点城市的798人为研究组，非试点城市的1480人为对照组。采用双重差分法（DID）分析长期护理保险对城市老人健康水平、医疗支出和家庭照护的影响，以及低龄老人和高龄老人之间的异质性。采用倾向得分匹配法（PSM-DID）进行稳健性检验。 结果 研究组的自评健康得分显著高于对照组（2.92 ± 0.87 vs. 2.62 ± 0.95，P = 0.04），流调中心抑郁量表（CESD-10）得分高于对照组（9.93 ± 8.05 vs. 10.24 ± 7.08，P = 0.04），组间健康自评得分差值为0.30（P < 0.01），心理健康差值为 – 0.32（P = 0.02），说明长期护理保险对老年人身心健康有积极作用；研究组老人每月医疗支出高于对照组（449.08 ± 1 024.42 vs. 220.43 ± 605.62元，P = 0.03）；研究组老人每月接受家庭照护天数（3.47）或小时数（41.47）低于对照组（均P < 0.05）。异质性分析结果表明，长期护理保险对低龄和高龄老人健康状况均影响显著，影响程度相近；仅对低龄老人的月医疗费用影响显著，对高龄老人的月家庭照护天数或小时数方面影响更大。 结论 长期护理保险总体提高了城市老人的健康水平，减少了家庭照护时间，但在降低老人实际医疗费用支出方面的作用仍十分有限。 Abstract:Objective To examine the effect of long-term care insurance on health condition, medical expenditure and family care of urban elderly in China for providing evidence to the improvement of long-term care insurance system and health condition of elderly population. Methods The data on 2 278 urban residents aged 60 years and above were from three waves of China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015, and 2018 across China. Of the urban elderly selected, 798 from 11 pilot cities of implementing long-term care insurance for elderly residents were assigned into a study group and 1 480 from non-pilot cities were regarded as the controls. Difference-in-differences (DID) method was adopted to analyze the effect of long-term care insurance on health condition, medical expenditure, family care of urban elderly and to assess the heterogeneity between the young-old and the older-old residents. Propensity score matching-difference-in-differences (PSM-DID) method was used in robustness test. Results Compared to those of the controls, significantly higher self-rated health score (2.92 ± 0.87 vs. 2.62 ± 0.95, P = 0.04 ) and lower Center of Epidemiological Studies Depression Scale-10 (CESD-10) score (9.93 ± 8.05 vs. 10.24 ± 7.08, P = 0.04) were observed in the study group, with a DID of 0.30 (P < 0.01) for self-rated health score and – 0.32 (P = 0.02) for mental health between the two groups, indicating a positive effect of long-term care insurance on the physical and mental health of the elderly; while, the monthly medical expenses of the study group was significantly higher than that of control group (449.08 ± 1024.42 vs. 220.43 ± 605.62 RMB yuan, P = 0.03). The elderly of the study group received significantly lower monthly number of days (3.47) or hours (41.47) of home-based care than those of the control group (both P < 0.05). Heterogeneity analysis results showed that long-term care insurance had a significant effect on the health condition of both the young-old and the older-old persons to a similar extent. The effect of long-term care insurance on monthly medical expense was significant only for the young-old elderly; the effect of long-term care insurance on monthly number of days or hours of home-based care was much stronger for the older-old persons. Conclusion In general, long-term care insurance could improve the health condition and reduced the time of home-based care for urban elderly, but the role of reducing the actual medical expenses is limited. -
Key words:
- long-term care insurance /
- health condition /
- medical expenditure /
- home care
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表 1 不同组别对象各变量统计结果比较（$ \bar{{x}} $ ± s）
Table 1. Differences in demographics, health status, medical expenditure, home-based care, and chronic disease conditions between 798 urban elderly in pilot cities and 1 480 in non-pilot cities for long-term care insurance based on the data from three waves of China Health and Retirement Longitudinal Study (CHARLS)in 2013, 2015, and 2018
变量 研究组（n = 798） 对照组（n = 1480） t 值 P 值 自评健康状况（分） 2.92 ± 0.87 2.62 ± 0.95 19.80 0.04 心理健康状况（分） 9.93 ± 8.05 10.24 ± 7.08 79.09 0.04 月看病费用（元） 449.08 ± 1024.42 220.43 ± 605.62 133.60 0.03 年住院费用（元） 2052.17 ± 9416.23 2936.42 ± 10217.80 23.49 0.04 家庭月照护天数（天） 3.44 ± 9.70 6.91 ± 16.38 32.50 0.03 家庭月照护小时数（小时/月） 29.30 ± 144.85 76.49 ± 425.72 42.39 0.02 年龄（岁） 74.52 ± 7.42 75.49 ± 7.06 40.94 0.03 受教育年限（年） 11.70 ± 4.53 10.77 ± 4.86 10.29 0.02 子女数（个） 1.50 ± 1.73 3.50 ± 1.79 24.21 0.04 养老金月收入（元） 3159.33 ± 1515.94 1476.41 ± 1644.74 558.77 < 0.01 慢性病患病状况（种） 0.85 ± 1.22 2.07 ± 5.57 19.83 0.02 
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表 2 基于双重差分的长护险对城市老人健康水平、医疗支出和家庭照护的影响
Table 2. Effect of long-term care insurance on health status, medical expenditure, and home-based care among 2 278 urban elderly in pilot and non-pilot cities for long-term care insurance: an difference-in- difference analysis on the data from three waves CHARLS survey in 2013, 2015, and 2018
变量 DID $ {S_{\bar x}} $ R2 值 P 值 自评健康 0.30 0.09 0.25 < 0.01 心理健康 – 0.32 0.68 0.13 0.02 月看病费用 0.34 0.19 0.13 0.04 年住院费用 – 0.24 0.25 0.08 0.27 月照护天数 – 3.47 1.77 0.22 0.03 月照护小时数 – 41.47 9.30 0.16 0.04 注：月看病费用和年住院费用转换为自然对数后纳入模型；DID为差分估计值。
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表 3 长护险对城市老人健康水平、医疗支出和家庭照护影响的异质性检验
Table 3. Effect of long-term care insurance on health status, medical expenditure, and home-based care among 1 613 junior elderly and 665 senior elderly in pilot and non-pilot cities for long-term care insurance: an difference-in-difference analysis on the data from three waves CHARLS survey in 2013, 2015, and 2018
变量 DID $ {S_{\bar x}} $ R2 值 P 值 自评健康 低龄老人 0.30 0.11 0.21 < 0.01 高龄老人 0.30 0.17 0.19 0.01 心理健康 低龄老人 – 0.55 0.74 0.11 0.02 高龄老人 – 0.57 1.51 0.10 0.03 月看病费用 低龄老人 0.92 0.39 0.11 0.03 高龄老人 0.08 0.37 0.12 0.47 月照护天数 低龄老人 – 1.06 1.61 0.13 0.04 高龄老人 – 9.40 4.63 0.16 0.04 月照护小时数 低龄老人 – 4.58 23.68 0.12 0.02 高龄老人 – 130.11 122.78 0.12 0.02 注：月看病费用转换为自然对数后纳入模型；已控制个体固定效应及时间固定效应；DID为差分估计值。
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表 4 PSM-DID稳健性检验估计结果
Table 4. Robustness for estimated differences in health status, medical expenditure, and home-based care between 798 urban elderly in pilot cities and 1 480 in non-pilot cities for long-term care insurance: propensity score marching difference-in-difference analysis on the data from three waves CHARLS survey in 2013, 2015, and 2018
变量 研究组 对照组 DID P 值 DID P 值 自评健康 0.32 < 0.01 0.46 0.54 心理健康 – 0.83 0.02 – 1.32 0.34 月看病花费 0.41 0.03 – 0.61 0.07 年住院花费 – 0.30 0.37 – 0.75 0.22 家庭月照护天数 – 2.78 0.03 – 4.52 0.23 家庭月照护小时数 – 40.37 0.04 – 18.80 0.08 注：月看病费用转换为自然对数后纳入模型；已控制个体固定效应及时间固定效应，DID为差分估计值。
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