《保险研究》20221002-《长期护理保险缩小了失能老人健康差距吗？》（谢宇菲、封进）

［摘   要］建立长期护理保险制度是我国在老龄化背景下健全社会保障体系的战略环节。本文使用失能等级评估数据、长护险服务使用数据和医保账户数据,评估了某典型城市长期护理保险试点政策在职工医保和居民医保参保者之间的健康效果差异。文章采用匹配方法和多种检验稳健地发现,使用长护险有助于改善失能者健康,职保和居保样本死亡率都有显著下降,但职保参保人的死亡率下降更多,职保与居保样本降幅相差约5个百分点。研究结果表明,尽管两类参保人享受了统一的长护险政策,不同参保人的健康差距并未缩小。异质性分析表明,长护险的健康效果差异在重度失能群体中尤其明显,一个原因是重度失能居保人群由于收入和健康意识等制约未能充分利用长护服务。本文的结论可为长护险试点政策的扩面及其待遇设计的进一步完善提供参考。

［关键词］长期护理保险；死亡率；健康差距

［基金项目］国家自然科学基金面上项目(71974036)。

［作者简介］谢宇菲,复旦大学经济学院博士研究生；封进(通讯作者),复旦大学经济学院教授,经济学博士后。感谢复旦大学的王子太博士、艾静怡博士和王贞博士、上海财经大学的余央央和唐珏副教授对本文的评论和建议。

Has the Long-term Care Insurance Resolved Disparities in Health for Disabled Elderly Chinese?

XIE Yu-fei,FENG Jin

Abstract：Establishing the long-term care insurance (LTCI) system is a strategic link in completing China’s social security system against the background of population aging.Using disability classification evaluation statistics and data for LTCI service use and social medical insurance fund,this study evaluated the different effects of LTCI pilots among Basic Medical Insurance for Urban Employees (BMIUE) participants and Basic Medical Insurance for Urban Residents (BMIUR) participants of a typical city.After going through multiple tests and with the help of the matching method,the paper finds that LTCI helps to enhance health of the disabled people,and significantly decreases the participants’ mortality and that the effect is 5 percentage points larger among BMIUE participants than BMIUR participants.Therefore,health disparities among the disabled elderly have not been resolved even though both groups have participated in the uniform LTCI policy.The heterogeneity analysis further shows that the difference in effects is more pronounced among participants with severe disabilities,and one of the reasons is that they haven’t fully utilized the care services due to the income constrain or lack of health awareness.The results of the study can provide new insights into improving the benefit design of the LTCI system and widening the its pilot geographically.

Key words：long-term care insurance；mortality；health disparities