《保险研究》20250106-《长期护理保险、临终医疗费用与价值医疗效应》（赵明、赵正堂、佘佐萱、阴奕雯、刘璐）

［摘   要］探究长期护理保险对老年人临终医疗费用的影响及其价值医疗效应，对实施积极应对人口老龄化战略具有重要意义。本文基于中国老年健康影响因素跟踪调查(CLHLS)2008年、2011年、2014年和2018年的四期数据，使用双重差分模型，考察了长期护理保险对老年人临终医疗费用及临终生命质量的影响。研究发现，长期护理保险对老年人医保支付临终医疗费用具有显著的抑制效应，而对自付医疗费用和总医疗费用的影响不显著。其中，降低老年人患重大疾病及住院的概率是长期护理保险发挥抑制临终医疗费用的作用机制。调节效应分析表明，长期护理保险对与家人同住和存活子女数量多的老年人临终医疗费用的抑制效应较小。异质性分析显示，长期护理保险对抑郁程度较低的老年人临终医疗费用抑制作用的效应值较大，并且对较低家庭收入的老年人临终医疗费用抑制效应显著。同时，长期护理保险政策的实施不仅有效抑制了老年人临终医疗费用，还降低了老年人临终痛苦程度，契合“价值医疗”理念。研究结论为完善长期护理保险制度、优化医疗资源配置及合理控制医保费用提供政策启示。

［关键词］长期护理保险；临终医疗费用；价值医疗

［基金项目］本文得到国家社科基金后期资助项目“长期护理保险高质量发展：精算平衡机制与政策外溢效应研究”(23FJYB024)、教育部人文社会科学研究青年项目“普惠医疗保险高质量发展的精算定价模型与风险管理研究”(23C10038050)、北京市属高等学校优秀青年人才培育计划项目“大数据背景下老年人健康预期寿命不平等的多维测度研究”(BPHR202203166)的资助。

［作者简介］赵明，首都经济贸易大学金融学院副教授，研究方向：社会保险精算；赵正堂(通讯作者)，厦门大学经济学院副教授，研究方向：长期护理保险；佘佐萱，对外经济贸易大学保险学院硕士研究生，研究方向：健康保险；阴奕雯，首都经济贸易大学金融学院硕士研究生，研究方向：社会保险精算；刘璐，东北财经大学金融学院教授，研究方向：医疗保险。

Long-Term Care Insurance,End-of-Life Medical Expenses and Value-Based Healthcare Effects

ZHAO Ming,ZHAO Zheng-tang,SHE Zuo-xuan,YIN Yi-wen,LIU Lu

Abstract：Exploring the impact of long-term care insurance on end-of-life medical expenses for the elderly and its value-based healthcare effects is of great significance for actively responding to population aging. Based on the data from four periods of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008,2011,2014,and 2018 and using a Difference in Differences Model,this study examines the impact of long-term care insurance on end-of-life medical expenses and quality of life for the elderly. The results show that long-term care insurance has a significant constraining impact on the end-of-life medical expenses paid by social medical insurance for the elderly,while its impact on total medical expenses and out of pocket medical expenses is not significant. Among them,reducing the probability of elderly people suffering from critical illnesses and hospitalization is the mechanism by which long-term care insurance plays a role in constraining end-of-life medical expenses. The moderation effect analysis indicates that long-term care insurance has a relatively minor constraining effect on the end-of-life medical expenses of elderly individuals living with family and those with a higher number of surviving children. Heterogeneity analysis reveals that long-term care insurance has a relatively larger effect on those with lower levels of depression,and significantly reduces end-of-life medical expenses for elderly individuals with lower household income. At the same time,the long-term care insurance policy not only effectively reduces the end-of-life medical expenses of the elderly,but also reduces the degree of end-of-life pain,which has valuable medical effects. The conclusion provides policy insights for improving the long-term care insurance system,optimizing the allocation of medical resources,and reasonably controlling social medical insurance expenses.

Key words：long-term care insurance;end-of-life medical expenses;value-based healthcare