《保险研究》20250506-《医疗可及性对老年人死亡质量不平等的影响研究——基于CLHLS死亡老人调查数据》（龚秀全、曹恬）

［摘   要］在提升我国老年人死亡质量总体水平的同时，政策制定亦应关注死亡质量的公平性，切实缓解弱势群体的临终困境。本研究基于CLHLS 2002~2018年65岁及以上死亡老人样本形成的混合截面数据，利用Wagstaff指数（WI）和Erreygers指数（EI），考察收入差距引发的死亡质量不平等问题，采用RIF-I-OLS模型分析医疗可及性对死亡质量不平等的边际影响，并结合Ordered Probit模型，探讨医疗可及性对死亡质量不平等的具体作用机制。研究发现，我国老年群体存在收入差距引发的死亡质量不平等问题，较高的死亡质量集中在高收入老年群体中，医疗可及性对死亡质量不平等具有显著影响。提高家庭医疗支付能力和治疗及时性，可缓解不平等；而医疗保险报销比例的提高，不仅不能改善低收入老人的死亡质量，反而引发高收入老人死亡质量的下降。因此，我国应大力发展安宁疗护，推广优逝理念，优化临终阶段的报销政策，合理配置资源，弥合收入差距对死亡质量的影响。

［关键词］死亡质量；不平等指数；医疗可及性；老年人

［基金项目］国家社会科学基金项目“老年临终关怀服务标准化及其保障机制研究”（20BGL269）。

［作者简介］龚秀全，华东理工大学社会与公共管理学院教授、博士生导师；曹恬，华东理工大学社会与公共管理学院硕士研究生。

The Effect of Healthcare Accessibility on Inequality in the Quality of Death among the Elderly—Based on CLHLS Mortality Survey Data

GONG Xiu-quan，CAO Tian

Abstract：While improving the overall quality of death among the elderly in China，policy-making should also prioritize the equity in death quality，with the aim of effectively alleviating end-of-life distress among vulnerable groups.Based on cross-sectional data from the CLHLS 2002–2018 sample of deceased individuals aged 65 and above，this study investigates income-related inequality in death quality using the Wagstaff Index （WI） and Erreygers Index （EI）.The marginal impact of healthcare accessibility on such inequality is analyzed using the RIF-I-OLS model，and the specific functioning mechanisms are explored through the Ordered Probit model.The results reveal the existence of income-related inequality in death quality among the elderly in China and significant impact of healthcare accessibility on the inequality in death quality，with higher death quality concentrated among high-income groups.Improving household medical payment capacity and treatment timeliness can help alleviate inequality，whereas increasing medical insurance reimbursement ratios not only fails to enhance the quality of death among low-income individuals but also leads to a decline in death quality among high-income individuals.Therefore，it is imperative to promote palliative care，advocate for the concept of good death，optimize reimbursement policies at the end of life，and allocate resources rationally to mitigate the impact of income disparities on death quality.

Key words：quality of death;inequality index;healthcare accessibility;the elderly