生育数量对晚年医疗费用的影响研究

The influence of birth number on medical expenses in later life

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摘要在生育损害健康、增加晚年医疗费用观点盛行且现实中生育水平下降、积极生育政策实施效果有限的背景下,基于2018年中国老年人健康影响因素跟踪调查(CLHLS)截面数据,以4695名65岁以上被访老人为研究对象,运用OLS模型、工具变量模型等,探究生育数量对晚年医疗费用的影响及作用机制并分析群体异质性。研究发现,生育数量对老年个体医疗费用支出有显著负向效应,每增加1个孩子,医疗总费用减少8.2%,且该效应主要通过增加老年人照料投资、改善老人精神状况,从而降低老人就医概率实现。从性别看,生育男孩或女孩均能降低老人医疗费用,但男孩起到的相关作用更显著;从医疗费用类型看,生育数量主要抑制老人的门诊费用,老人多1个孩子,其门诊费用减少9.7%,对住院费用影响不显著。异质性分析表明,该负向效应在男性、与家人同住、乡村、非“文盲”及已参加医疗保险的老年群体中更明显。应加强家庭照料体系建设、推行性别平等家庭支持政策、优化生育政策、制定差异化群体政策、促进社保与生育政策衔接,树立积极婚育观念、助力积极生育政策落实。 gainst the backdrop of prevalent views that childbirth impairs health and increases medical expenses in old age,coupled with the actual decline in fertility levels and the limited effectiveness of proactive fertility policies,this study explores the impact of the number of children on medical expenses in old age,its mechanism of action,and analyzes group heterogeneity.It is based on cross-sectional data from the 2018 China Longitudinal Healthy Longevity Survey(CLHLS),with 4,695 elderly respondents aged 65 and above as the research objects,using OLS models,instrumental variable models,and other methods.The study finds that the number of children has a significant negative effect on the medical expenses of elderly individuals.Each additional child reduces total medical expenses by 8.2%,and this effect is mainly achieved by improving the care investment and mental state of the elderly and reducing the probability of seeking medical treatment.In terms of gender,having either boys or girls can reduce medical expenses,but boys play a more significant role in this regard.From the perspective of medical expense types,the number of children mainly inhibits the outpatient expenses of the elderly.Each additional child of the elderly reduces their outpatient expenses by 9.7%,while the impact on hospitalization expenses is not significant.Heterogeneity analysis shows that this negative effect is more obvious among elderly groups who are male,live with family members,reside in rural areas,are not illiterate,and have participated in medical insurance.Suggestions are put forward,including strengthening the construction of the family care system,promoting gender-equality family support policies,optimizing fertility policies,formulating differentiated group policies,and enhancing the connection between social security and fertility policies,so as to establish a positive attitude towards marriage and childbirth and assist in the implementation of proactive fertility policie.

作者杨华磊郝杰方格格 YANG Hualei;HAO Jie;FANG Gege

机构地区中南财经政法大学公共管理学院

出处《人口与社会》 2025年第6期65-79,共15页 Population and Society

基金国家社会科学基金后期资助项目“生育与老年人福利问题研究”(21FRKB003)。