《保险研究》20190408-《社会医疗保险对老人临终医疗服务利用的影响》（龚秀全）

［摘   要］本文利用2002~2014年CLHLS死亡人口数据,借助样本选择模型、两部分模型和bootstrap中介效应检验方法,首次比较全面深入地分析了社会医疗保险对老人临终总医疗费用支出和自负医疗费用支出的影响。研究发现,我国社会医疗保险既显著提高了老人临终医疗服务利用,也显著降低了自负水平。不同类型的社会医疗保险对临终医疗服务利用影响存在差异,医疗保险类型对临终医疗服务利用具有直接效应,医疗保险水平发挥了中介作用。医疗保险覆盖率在死亡年份影响临终医疗服务利用中发挥了中介作用。我国应该通过实行健康老龄化战略、加强死亡教育、发展临终关怀和完善医保监管等措施控制临终医疗支出增长以促进医疗保险可持续发展,并提升临终老人生存和死亡质量。

［关键词］社会医疗保险；临终医疗服务利用；医疗总支出；医疗自负支出

［基金项目］本文得到国家社会科学基金课题“人口老龄化高龄化背景下老年医疗服务保障网络优化研究(13CGL139)”的资助。

［作者简介］龚秀全,经济学博士,华东理工大学社会与公共管理学院副教授,研究方向:老年健康保障政策。

The Effects of Social Medical Insurance on the Utilization of Hospice Medical Services of Elder Adults

GONG Xiu-quan

Abstract：In the process of aging,it is an inevitable choice for controlling the social medical insurance expenditure by controlling the growth rate of the utilization of hospice medical services of elder adults. Based on the death data of 2002-2014 of Chinese Longitudinal Healthy Longevity Survey,this paper used the sample selection model，two-part model,and bootstrap mediation test method to study the effects of social medical insurance on the utilization of hospice medical services and out-of-pocket medical expenditure. It was found that social medical insurance not only increased the utilization of hospice services but also reduced the out-of-pocket spending in the last year of life of elder adults. Different types of social medical insurance had different impacts on usage of hospice medical services. Medical insurance itself had a direct effect on the utilization of hospice medical services and the level of medical insurance played the mediating role on the relationship between the types of medical insurance and utilization of medical services,and the medical insurance coverage ratio played the mediating role. The rate of coverage of medical insurance had a mediating role on the usage of hospice medical services in the year of death. In order to promote the sustainable development of medical insurance and improve the quality of life and death of the elderly,it is necessary to control the growth of terminal medical expenditures by implementing healthy aging strategy,strengthening death education,offering hospice care services,and improving supervision of medical insurance.

Key words：social medical insurance;the utilization of hospice medical services;total spending on medical care;out-of-pocket spending