社会杂志 ›› 2014, Vol. 34 ›› Issue (2): 193-214.

• 论文 • 上一篇    下一篇

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

刘晓婷  浙江大学公共管理学院   

  • 出版日期:2014-03-20 发布日期:2014-03-20
  • 通讯作者: 刘晓婷 xtliu@zju.edu.cn
  • 基金资助:

    本研究获得国家自然科学基金项目“老年护理保障需求、成本与筹资机制研究”(71273228)、国家社会科学基金青年项目“社会分层理论视角下维护弱势社会群体健康权益研究 ”(12CSH020)的资助。

The Impact of Social Health Insurance on Health Outcomes among Older Adults: An Empirical Study in Zhejiang Province, China

 LIU Xiaoting，School of Public Affairs，Zhejiang University   

  • Online:2014-03-20 Published:2014-03-20
  • Supported by:

    This research was supported by the project “Research on the Demand, Cost and Financing Mechanism of LongTerm Care Security for the Elderly” of the National Natural Science Foundation (71273228)， and the project “Research on Protection of Health Rights for Vulnerable Groups under the Theoretical Perspective of Social Stratification” of Youth Project of National Social Science Fund (12CSH020).

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摘要： 本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为，对于老年人的社会医疗保险问题，不仅要关注保险覆盖面的扩大，更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上，研究发现，职工医保作为moderator可以改善使用较多医疗服务老人的健康水平，新农合的作用则相反。研究希望对医疗保险的改革思路进行反思，全民医保的改革思路不仅是医疗服务可及性的提高，更应该是不同社群享有平等的医疗福利，并最终促进健康结果的平等。

关键词: 医疗保险, 健康水平, 医疗服务使用, 社会支持, 健康平等

Abstract:  Debates about the relationships between health insurance, healthcare utilization and health outcomes in the empirical studies at home and abroad are not over yet. What has been empirically confirmed is the positive correlation between health insurance and healthcare utilization although direct associations between health insurance and health outcomes are not clear. Only when health insurance has the improvement of people’s health as its ultimate goal can it be said as being effective and fair. However, examining health outcomes is absent in the assessment of the current health insurance reform.
The outcomes of statistical analyses of the data of 2010 Sampling Survey of the Status of the Elderly in Urban and Rural China  (Zhejiang Province) suggested that the sole concentration on expanding insurance coverage would not be enough. More importantly, attention should be given to the equality in healthcare and health outcomes across different insurance plans. A oneway ANOVA analysis demonstrated unequal disparities in participation in health insurance plans and health outcomes among the older adults. Multiple linear regressions showed the significance of health insurance coverage as an independent variable in predicting health outcomes but this significance was replaced by the significant effects of specific insurance plans.  Analyses of the interactions revealed a main negative relationship between healthcare utilization and health outcomes but health insurance, as a moderator, could improve the health status of the older adults who utilized healthcare more, although the effect of the New Rural Cooperative Medical System (NRCMS) was in the opposite direction. The mediating effects of health insurance on older adults’ health outcomes were a function of the individual and structural factors such as socioeconomic status and number of chronic diseases but social support and social networks should be included as influencing factors as well.
This study has concluded that reflecting upon the health insurance reform is needed as the universal health insurance is not only to improve the accessibility to the service in the healthcare system but also to guarantee the equal medical welfare entitlement across different social groups, and ultimately, to obtain equal health outcomes. At present, however, NRCMS resulting from the differentiated treatment in different insurance plans and the vulnerability of the urban older adults with health insurance and those without in receiving healthcare benefits have led to their poorer health and their inferior status in terms of equal health outcomes.

Key words: health insurance, health outcome, health care utilization, social support, health equality