农村空巢老人家庭疾病经济风险预警模型及风险管理策略研究

The issue of health poverty among the older people is one of the most important challenges of anti-poverty action in rural China, and disease economic risk is known as a key point of the incentives to such health poverty. Compared with non-empty nesters, the status of the health poverty induced by disease economic risk is more serious among the empty-nest seniors. Previous studies have demonstrated that risk management after the incidence of the diseases economic risk is inefficient. Hence, this study will focus on how to predict and control disease economic risk prior to the risk incidence. We will assess the risk based on three core indicators, catastrophic health expenditure, impoverishing health expenditure, and vulnerability to poverty of the sampling households. Based on a household cohort design, we will carry out a baseline survey, and also a two-year follow-up observations to identify the incidence of some key outcome events. Then, based on the risk factors identified by previous studies, we wil develop some specific risk models by using cause-specific competing risk function. After that, we will analyze the integrated disease economic risk based on the developed specific risk models, and also the risk coping ability of the households. We will also develop some risk alleviating strategies in two levels, one level for general households from a view of social capital, and the other for targeted household from a view of speicific risk factors of a household. The results of this study can not only enhance the effeciancy of anti-poverty in rural areas, especially the effect of targeting poverty alleviation, but also play an important role in promoting the healthy aging in rural China.

老年健康贫困是中国农村地区消除贫困行动的重要挑战之一，疾病经济风险是诱发老年健康贫困的核心要素，该问题在空巢老人中更为严重。已有研究表明事后管理对疾病经济风险控制效果甚微。本研究以农村空巢老人疾病经济风险事前预警管理为切入点，利用灾难性卫生支出、致贫性卫生支出及家庭贫困脆弱性等核心风险评价指标，基于已有研究证实的疾病经济风险因素集，在建立的2年期家庭队列基线调查基础上，随访观察2年后重要结局事件发生水平，使用疾病别竞争风险模型构建疾病经济风险核心指标别风险预警模型。其后结合家庭应对疾病经济风险能力现状，对农村空巢老人家庭疾病经济风险进行综合预警分析。而后基于社会资本视角，提出农村空巢老人家庭应对疾病经济风险群体管理策略。同时，针对家庭个性化风险指标集，提出精准化风险管理策略。研究结果不仅能提升农村地区反贫困尤其是精准扶贫行动效果，也为有效推进农村地区健康老龄化发挥积极作用。

老年健康贫困是中国农村地区消除贫困行动的重要挑战之一，疾病经济风险是诱发老年健康贫困的核心要素，该问题在空巢老人中更为严重。目前尚缺乏对该群体健康贫困的全面测度。本研究基于山东省农村面板数据，全面了解该群体健康贫困现状，明确主要健康贫困问题，探索主要影响因素，为后扶贫时代健康贫困治理提供依据。.研究发现，CHE发生率呈下降趋势，而发生差距呈现上升趋势。基于面板随机效应模型，CHE影响因素包括家庭做饭燃料、住房面积、空巢年限等。家庭脱离CHE状态比例高于陷入CHE状态比例。做饭燃料（使用柴火）、子女数量（多）、户主年龄（高）等降低了从不发生CHE概率，增加了暂时和持续发生CHE概率；建档立卡贫困户（非贫困户）、家庭经济状况（最高收入组）等增加了从不发生CHE概率，降低了家庭暂时和持续发生CHE概率。.OOP致贫率几乎没有变化，而致贫差距呈下降趋势。基于混合效应Logit模型，家庭做饭燃料、家庭经济状况等是IHE的影响因素。家庭脱离IHE比例明显高于陷入IHE比例。基于有序Probit模型，做饭燃料、居住安排、户主年龄等降低了从不发生IHE概率，增加了暂时和持续发生IHE概率；家庭经济状况、家庭劳动力数增加了从不发生IHE概率，降低了家庭暂时和持续发生IHE概率。.贫困脆弱性水平随着贫困标准提高而升高；在同一贫困线标准下，贫困脆弱性水平随时间推移呈现递减趋势。家庭脱离贫困脆弱明显高于陷入贫困脆弱比例；随着贫困线提高，贫困脆弱状态从暂时脆弱向持续脆弱转变。基于有序Probit模型发现做饭燃料、空巢年限、子女数量等降低了家庭从不脆弱概率，增加了暂时和持续脆弱概率；厕所类型、居住安排、建档立卡贫困户等增加了从不脆弱概率，降低了暂时和持续脆弱概率。.基于上述发现，提出如下建议：重点关注农村空巢老年群体，巩固拓展脱贫攻坚成果；建立健康贫困动态监测评估体系，构建风险预警机制；优化生计资产结构，提高农村空巢老年群体抵御风险冲击能力；构建多层次医疗保障和贫困救助制度，协同发挥反贫困效应。