《保险研究》20250602-《照护服务对医疗服务利用的影响研究》（李民、王震、朱凤梅）

［摘   要］随着中国人口老龄化加剧及长期护理保险试点深化，科学识别照护服务与医疗服务的协同边界对优化医养资源配置至关重要。本研究基于某省2018~2023年医保报销数据，分析了照护服务资源对医疗服务利用的影响及其空间与制度调节机制。结果表明：照护服务资源与基层医疗机构存在互补效应，2公里服务半径内每增加1个照护床位，基层医疗机构住院天数增加2.394天，但效应随距离增加显著衰减；照护服务资源对二级医院存在替代效应，每增加1个照护床位，长期住院天数减少19.73天，但对短期住院无显著影响；长护险强化了照护服务资源与基层医疗机构的互补效应并增强对二级医院的替代效应。空间溢出分析显示，邻近地区照护资源增加可减少本地住院天数1.474天。本文建议以2公里为基准优化照护设施布局，建立长护险与医保支付联动机制，并推动跨区域医养协同平台建设，为建设高效医养体系提供实证依据。

［关键词］医养结合；空间溢出效应；长期护理保险

［基金项目］国家自然科学基金重点项目“大数据环境下医保资源优化配置的支付机制与政策研究”(72334002)；中国社会科学院“青启计划”项目“中国特色医保支付改革的政策效果：费用控制与资源配置”(2024QQJH100)。

［作者简介］李民，中国社会科学院大学经济学院博士研究生；王震(通讯作者)，中国社会科学院经济研究所研究员、中国社会科学院大学经济学院教授；朱凤梅，中国社会科学院工业经济研究所副研究员。

The Impact of Elderly Care Services on Healthcare Service Utilization

LI Min，WANG Zhen，ZHU Feng-mei

Abstract：Amid China′s accelerating population aging and expanding Long-Term Care Insurance (LTCI) pilots，identifying the synergistic boundaries between elderly care and medical services is critical for optimizing healthcare resource allocation.Using social medical insurance claims data from a Chinese province (2018-2023)，this study examines the impact of elderly care services on healthcare service utilization and its spatial and institutional mechanisms.Findings reveal： elderly care services complement primary healthcare，with each additional care bed within a 2 km radius increasing inpatient days at grassroots facilities by 2.394 days，though effects diminish with larger distance.They substitute for secondary hospitals，reducing long-term hospitalization by 19.73 days per care bed，but no significant impact on short-term stays.LTCI amplifies complementarity in primary care facilities and strengthens substitution in secondary hospitals.Spatial spillovers show neighboring regions’ care resources reduce local inpatient days by 1.474 days per bed.The study recommends optimizing care facility layouts within a 2 km radius，linking LTCI with medical payment reforms，and establishing cross-regional care coordination platforms to enhance the efficiency of the integrated elderly care and medical service systems.

Key words：integrated elderly care and medical service;spatial spillover effects;LTCI