《保险研究》20201105-《慢性病的老年贫困风险理论机制与实证检验》（刘二鹏、张奇林、冯艳）

［摘   要］在人类疾病模式从以急性病传染为主转变成以慢性非传染病为主的背景下,慢性病的经济风险已引起学界关注,但其中的机制与微观效应有待进一步探讨。本文在理论分析的基础上提出慢性病影响老年贫困状况的机制——降低劳动参与和增加医疗支出,并利用中国老年健康影响因素追踪调查数据(CLHLS)进行了实证分析。研究发现:患慢性病使低龄老人和农村老人劳动参与概率分别下降46.3%、20.6%,患慢性病老人比未患慢性病老人的门诊医疗支出、住院医疗支出、总和医疗支出分别增加20.1%、11.5%和13%,其后果是老年人个体及其家庭发生灾难性医疗支出贫困的概率上升1%~2.3%。考虑到患慢性病与贫困之间可能存在的内生性,在使用双重差分倾向得分匹配法(PSM-DID)控制内生性后,患慢性病对老年人贫困状况的影响仍被证实。本文建议从源头上强化对慢性病的防控,增强医疗保险与健康扶贫措施对患慢性病老人经济风险的分担,提高老年人的转移性收入以抵御慢性病的经济风险。

［关键词］慢性病；劳动参与；医疗支出；老年贫困风险；PSM-DID

［基金项目］本文系高等学校学科创新引智计划(B20084)、国家社会科学基金应急项目“‘历程—任务—能动’框架下慈善组织参与重大突发事件应急管理的机制研究”(20VYJ030)；教育部人文社会科学重点基地重大项目“人口老龄化与养老服务体系建设研究”(16JJD840011)；中央高校基本科研业务费“健康行为、社区环境与老年人的健康结果”（31722041207/412）的阶段性成果。

［作者简介］刘二鹏,中南财经政法大学收入分配与现代财政研究院助理教授,教育部“111计划”收入分配与现代财政学科创新引智基地研究员,研究方向:健康经济学；张奇林,武汉大学社会保障研究中心教授、博士生导师,研究方向:医疗保障政策；冯艳,贵州民族大学社会学与公共管理学院讲师,研究方向:长期护理保险。

Elderly Poverty Risk due to Chronic Diseases:Theoretical Mechanism and Empirical Analysis

LIU Er-peng,ZHANG Qi-lin,FENG Yan

Abstract：Human disease model has changed from the dominance of acute diseases to chronic non-contagious diseases,therefore the economic risk of chronic diseases has attracted academic attention,but the inherent theoretical mechanism and micro-effect remain to be further explored.On the basis of theoretical analysis,the paper constructed the theoretical mechanism that chronic diseases affected the poverty situation of the elderly through reducing labor participation and increasing medical expenditure.And an empirical analysis based on Chinese Longitudinal Healthy Longevity Survey was carried out accordingly.The study shows that chronic diseases reduce the labor participation probability of the younger  elderly and the rural elderly by 46.3% and 20.6% respectively.The outpatient,inpatient and total medical expenditures of the elderly with chronic diseases are increased by 20.1%,11.5% and 13% respectively compared with those of the elderly without chronic diseases.The consequence is that the probability of poverty due to disastrous medical expenditure of the elderly individuals and their families increases by 1%~2.3%.Using the PSM-DID method to control the possible endogenous problem between chronic diseases and economic conditions,the impact of chronic disease on the economic status of the elderly is still confirmed.The article put forward policy suggestions from the perspectives of strengthening prevention and control of chronic diseases,sharing chronic diseases′ economic risks by medical insurance and health-related poverty alleviation policy,and increasing the transfer income of the elderly to improve their copying with chronical diseases.

Key words：chronic diseases;labor participation;medical expenses;poverty risk of the elderly;PSM-DID method