摘要
在全面推进健康中国建设和积极应对人口老龄化的背景下,提高医保制度统筹层次已成为促进健康公平与公共服务均等化的重要环节。基于中国健康与养老追踪调查(CHARLS)数据,结合中国城市统计年鉴及各地市官方政策文件,文章构建多时点双重差分模型,系统评估医保市级统筹改革对老年人医疗服务利用的影响效应。研究结果表明,医保市级统筹显著提升了老年人的医疗服务利用水平,政策效应主要体现在门诊服务领域,且结论经一系列稳健性检验后依然成立。具体而言,市级统筹显著提高了老年人门诊就医概率与就医频次,增强其选择高等级医疗机构的倾向,同时带来相应的医疗支出增长。进一步分析显示,政策效应具有一定的滞后性,随时间推移呈现逐步增强的趋势。调节效应分析表明,个体健康状况在市级统筹与医疗服务利用之间具有显著的调节作用,而地区医疗资源的影响较为有限。为此,政策上应稳步推进医保统筹一体化改革,强化对健康脆弱群体的制度倾斜,完善门诊保障体系,推动医保资源精准配置,以促进医疗服务利用公平与效率提升。
Against the backdrop of advancing the Healthy China initiative and proactively addressing population aging,improving the level of health insurance risk pooling has become a critical instrument for promoting health equity and equalization of public services.Drawing on data from the China Health and Retirement Longitudinal Study(CHARLS)combined with the China City Statistical Yearbook and official municipal policy documents,this study constructs a multi-period difference-in-differences model to systematically evaluate the effects of municipal-level medical insurance integration on healthcare utilization among older adults.The results show that municipal integration of medical insurance significantly enhances healthcare utilization among older adults,with the most pronounced effects observed in outpatient services.Specifically,municipal integration increases the probability and frequency of outpatient visits,encourages older adults to seek care at higher-level healthcare institutions,and leads to corresponding increases in medical expenditures.Further analysis reveals that the policy effect exhibits a time lag but strengthens gradually over time.The moderation analysis indicates that individual health status plays a significant moderating role in the relationship between municipal integration and healthcare utilization,while the role of external healthcare resources is relatively limited.These findings suggest that medical insurance integration should be steadily advanced to achieve greater institutional coordination,strengthen policy support for older adults,improve outpatient benefit coverage,and promote the precise allocation of medical insurance resources,thereby enhancing both equity and efficiency in elderly healthcare utilization.
作者
张硕
张思清
宋佳莹
Zhang Shuo;Zhang Siqing;Song Jiaying
出处
《兰州学刊》
2026年第1期188-207,共20页
基金
江苏省社会科学基金青年项目“江苏省深度老龄化进程中社会保障基金承载力评估及其提升路径研究”(项目编号:25ZHC044)
江苏省研究生科研与实践创新计划项目“基本养老保险对‘成熟夹心代’双向代际支持的影响研究”(项目编号:KYCX25_0122)。
关键词
市级统筹
医疗服务利用
健康公平
老年人
municipal-level integration
healthcare service utilization
health equity
lder adult
