健康老龄化视角下老年人医疗服务需求与医疗保障制度优化策略研究

The aging of the population has brought many challenges, including the demand for medical services of the elderly. Around the world for the role of medical insurance system has been a consensus, which can improve the accessibility of medical services, promote the quality of medical services and reduce the burden of medical expenses, in order to improve the utilization of medical services, to achieve the goal of the level of personal health. However, as an important economic leverage, can the current medical insurance system play a role in stimulating the demand for medical services of the elderly? What factors restrict or hinder its incentive mechanisms play a role? How to optimize medical insurance system in order to improve the medical choice of the elderly? It is urgent to provide objective basis and decision reference from theoretical and empirical aspects. The research will analyze how to optimize and improve medical insurance system from the perspective of healthy aging in order to realize the incentive function of the elderly patients. We will measure and calculate elasticity of demand for medical services of the elderly, and then analyze the impact of income and price on the demand for medical services. We will use sample selection model to study the regulating effect of medical insurance system on the demand for medical services of the elderly, and explicit the causes of restricting the effect of medical insurance system by application of SWOT analysis and PEST analysis method, to provide an empirical basis for the optimization of medical insurance system in China.

人口老龄化带来了诸多挑战，其中就是老年人医疗需求问题。而医疗保障制度通过改善医疗服务的可及性、提升医疗服务质量、减轻医疗费用负担进而提高医疗服务的使用，达到提高个人健康水平目标，这在全球各国已形成共识。但是，作为重要的经济杠杆，当前的医疗保障制度能否对老年人医疗服务需求起到了一定激励作用？又有哪些因素制约了或阻碍了其激励机制发挥作用呢？如何优化医疗保障制度使其能有效地提高老年人就医选择？亟需本研究从理论和实证层面提供客观依据和决策参考。本研究将从健康老龄化视角分析如何优化及完善医疗保障制度以实现对老年患者就诊选择的激励作用。通过测算老年人医疗服务需求的弹性分析收入、价格对其医疗服务需求的影响。应用样本选择模型研究医疗保障制度对老年人医疗服务需求的调节作用，并应用SWOT分析和PEST分析法明确制约医疗保障制度效果的成因，为探索适应我国国情的医疗保障制度优化策略提供实证依据。

十九届五中全会指出，全面推进健康中国建设，实施积极应对人口老龄化国家战略。医疗保障制度作为重要的经济杠杆，能否对老年人医疗服务需求起到一定的激励作用，是本课题探讨的重点。首先利用黑龙江省第五次卫生服务调查中的60岁及以上老年人数据，对门诊率和住院率分别构建Probit回归模型。结果发现，黑龙江省老年人两周门诊率为18.8%，年住院率为15.8%；门诊需求的自价格弹性为-0.241，住院需求的自价格弹性为-0.351；门诊需求的收入弹性为0.345，住院需求的收入弹性为 0.683；门诊医疗服务需求的交叉价格弹性为0.275，住院医疗服务需求的交叉价格弹性为0.046。提示黑龙江省老年人门诊与住院服务利用均较高；门诊和住院需求对其价格缺乏弹性，略低于一般人群；门诊和住院需求对收入也缺乏弹性，但高于同时期的一般人群；黑龙江省老年人门诊医疗服务与住院医疗服务之间为替代关系。对黑龙江省城市和农村老年人卫生服务利用及影响因素研究发现,城市老年人两周患病率为48.3%，两周就诊率为9.0%，两周应就诊未就诊率为30.7%，慢性病患病率为56.6%，年住院率为12.1%，年龄和是否患有慢性病是城市老年人两周就诊率的影响因素；农村老年人两周患病率为45.0%，两周就诊率为20.6%，两周应就诊未就诊率为18.5%，慢性病患病率为56.4%，年住院率为16.8%，上一年家庭人均收入和自我健康评价状况是老年人两周就诊率的影响因素。.通过对专家的定性访谈结果进行内容归纳与信息发掘，发现我国医疗保险制度设计有待进一步提高，未发挥其风险共济与分担的作用。我国医疗保险宽度覆盖（参保率）取得的进展并不意味着居民，尤其是老年人口抵御疾病经济风险的能力提高。医疗保险制度作为提高居民抵御经济风险能力的有效途径，其制度安排和设计至关重要。医疗保险制度要想实现广泛覆盖的终极目标，不仅仅要注重覆盖人群范围，还应加强对卫生服务项目内容的覆盖宽度和对医疗卫生费用报销的覆盖深度，即拓宽卫生服务包覆盖卫生服务项目，减少居民医疗卫生费用共付比例，改变供方按项目付费的支付方式。