中老年家庭灾难性医疗支出的测度及影响因素 ——基于CHARLS数据的实证

基于2011-2015年三期平衡面板数据,对中老年家庭的灾难性医疗支出进行测度并分析其影响因素。研究发现:我国中老年家庭灾难性医疗支出发生率在考察期内进一步扩大,差距也进一步上升。以家庭可支付能力的40%为灾难性医疗支出的界定标准,则在2015年其发生率依然高达25.4%,平均差距为0.069,相对差距为0.272。引入安德森医疗服务利用模型对影响因素进行分析,结果显示家中有住院、门诊及残障人员更容易发生灾难性医疗支出,经济状况对灾难性性医疗支出发生起着显著作用,总体而言灾难性医疗支出具有"亲贫"效应,越是贫困的家庭越容易发生灾难性医疗支出。据此,文章提出应该采取分类管理的措施,通过发放免费医疗服务券、强化医疗费用控制等政策建议来切实降低灾难性医疗支出的发生。

Measurement and Its Determinants of Catastrophic Health Expenditures by Middle-aged and Elderly Households: An Empirical Study Based on CHARLS

Based on the balance panel data of 2011-2015 CHARLS, the paper tries to estimate the catastrophic health expenditures of middle-aged and elderly households and the influencing factors. It finds that the incidence of catastrophic health expenditures of middle-aged and elderly households in China further expanded during the study period, and the gap increased further. Taking 40% of household affordability as the criteria for catastrophic health expenditure,the incidence can be as high as 25.4% with an average gap of 0.069 and a relative gap of 0.272 in 2015. The Andersen medical service utilization model show that the family with inpatients, outpatients and disabled member are more likely to have catastrophic health expenditure, and the household’s economic status has a significant effect on catastrophic health expenditure. Generally speaking, catastrophic health expenditure has a pro-poor effect, the poorer the households, the more likely to have catastrophic health expenditure. The policy implications lead to a better classified social security system with issuance of free medical service vouchers and better medical expenditure control for a more effective reduction of catastrophic medical expenditures.