《保险研究》20250204-《医养结合试点政策缓解了老年人健康不平等吗？》（欧阳宇明、申曙光）

［摘   要］推动医养结合高质量发展是完善社会养老服务体系、实现健康老龄化、提升老年人幸福感的重要途径。本文基于2011~2020年中国健康与养老追踪调查数据(CHARLS)，运用双重差分法、集中指数分解法等计量方法，实证分析了医养结合试点政策对老年人健康以及健康不平等的影响。研究发现：医养结合试点政策显著改善了老年群体的健康状况；加深不同收入水平老年群体之间的健康不平等程度。机制分析表明，试点政策通过加深了不同收入水平老年群体间的医疗服务利用不平等，加剧健康不平等。异质性分析发现，试点政策对农村地区和中西部地区不同收入老年群体之间健康不平等的贡献更大。进一步研究发现，尽管医养结合试点政策加深了城乡间老年群体的健康不平等程度，但也缩小了区域间老年群体的健康不平等程度。本研究为进一步推广医养结合养老模式，推动实现健康公平提供了政策启示。

［关键词］医养结合；健康不平等；准自然实验；集中指数分解

［基金项目］国家社会科学基金重大项目“预防为主的大健康格局与健康中国建设研究”(17ZDA080)。

［作者简介］欧阳宇明，中山大学岭南学院博士研究生；申曙光(通讯作者)，中山大学岭南学院教授、博士生导师。

Does the Integration of Medical and Elderly Care Pilot Policy Alleviate Health Inequality among the Elderly?

OUYANG Yu-ming,SHEN Shu-guang

Abstract：Promoting the high-quality development of the integration of medical and elderly care is an important way to improve the social service system for the elderly,realize healthy aging and enhance the sense of well-being of the elderly.Based on the 2011-2020 CHARLS data,this paper empirically analyzes the impact of the integration of medical and elderly care pilot policy on the elderly’ health and their health inequality by employing Difference-in-Differences method,concentration index decomposition and other econometric methods.This study reveals that the pilot policy significantly improves the health status of the elderly,but deepens the degree of health inequality among the elderly at different income levels.The mechanism analyses suggest that the pilot policy has exacerbated inequalities in health care utilization to exacerbate health inequalities among the elderly at different income levels.Also,Heterogeneity analyses find that the pilot policy contributes more to health inequality among the elderly in rural areas and central and western regions.Last,further research finds that although the pilot policy deepens the degree of health inequality between urban and rural areas,the implementation of this pilot policy narrows the degree of the health inequality among the elderly between regions.This study provides policy insights for promoting and applying the integrated medical and elderly care model and promoting the realization of health equity.

Key words：integration of medical and elderly care;health inequality;quasi-natural experiment;concentration index decomposition