长期护理保险对医疗支出和健康状况的影响：全国队列研究

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Archives of Public Health Pub Date : 2024-09-12 DOI:10.1186/s13690-024-01388-0

Shanshan Yin, Wen Chen, Changli Jia, Yifan Yao, Lan Yao

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引用次数: 0

摘要

为解决人口老龄化带来的养老问题，中国实施了长期护理保险（LTCI）。从价值医疗的角度评估长期护理保险的实施效果至关重要。本研究旨在探讨长护险对中国医疗支出和健康状况的影响。我们基于2011年至2018年的中国健康与退休纵向研究数据，采用交错差分法（DID）分析了长护险政策对医疗支出和健康状况的影响。我们的研究结果证实了长护险政策对医疗支出和健康状况的积极贡献。我们发现，长护险的实施显著降低了住院和门诊支出、健康自我报告得分和CESD得分，降幅分别为26.3%、12.3%、0.103和0.538。此外，ADL 分数也有所下降，但下降幅度不大。对于 65 至 80 岁的人以及居住在城市地区和东部城市的人来说，长期护理保险对减少住院费用的影响更大。在门诊费用方面，长期护理保险对中高收入人群、中部和东部城市居民的影响更为明显。对于农村人口、80 岁以下的人以及中部和东部城市的人来说，长期护理保险对自我健康报告的影响更大。在 ADL 评分方面，LTCI 对 65-80 岁人群的影响最大。在 CESD 评分方面，长期护理保险对农村人口、45-65 岁人群、中位收入人群和东部城市人群的影响更大。我们的研究强调了长效医疗保险在降低医疗支出和改善健康状况方面的有效性，为中国和其他地区未来的长效医疗保险发展提供了宝贵的启示。加快发展长护险有利于提高失能老年人的生活质量，增进民生福祉，实现价值医疗的目标。

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Effect of long-term care insurance on medical expenditure and health status: National cohort study

Long-term care insurance (LTCI) was implemented in China to solve the elderly care problems caused by the aging population. It is crucial to evaluate the effectiveness of LTCI implementation from the perspective of value-based healthcare. This study aimed to investigate the impact of LTCI on medical care expenditure and health status in China. We used staggered difference-in-differences (DID) analysis to analyze the effect of LTCI policy on medical expenditure and health status based on China Health and Retirement Longitudinal Study data from 2011 to 2018. Our findings confirmed the positive contribution of LTCI policies to medical expenditures and health status. We found that the implementation of LTCI significantly reduced inpatient and outpatient expenditure, scores of self-report of health, and CESD scores by 26.3%, 12.3%, 0.103, and 0.538, respectively. It also decreased ADL scores, but the decrease was not significant. The impact of LTCI on reducing inpatient expenditure was greater for individuals aged between 65 and 80 and those residing in urban areas and eastern cities. In terms of outpatient costs, the effect of LTCI was more pronounced among median and high-income people and people living in central and eastern cities. The impact of LTCI on self-report of health is stronger for rural populations, individuals under 80, and those in central and eastern cities. For ADL scores, LTCI affected those aged 65–80 the most. About the CESD scores, LTCI had a greater impact on rural populations, people aged 45–65, median income groups, and those in eastern cities. Our study underscored LTCI’s effectiveness in curbing medical expenditures and enhancing health status, offering valuable insights for future LTCI development in China and beyond. Accelerating the development of LTCI is conducive to improving the quality of life of the disabled elderly, enhancing the well-being of people’s livelihoods, and realizing the goal of value-based healthcare.

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来源期刊

Archives of Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

4.80

自引率

3.00%

发文量

244

审稿时长

16 weeks

期刊介绍： rchives of Public Health is a broad scope public health journal, dedicated to publishing all sound science in the field of public health. The journal aims to better the understanding of the health of populations. The journal contributes to public health knowledge, enhances the interaction between research, policy and practice and stimulates public health monitoring and indicator development. The journal considers submissions on health outcomes and their determinants, with clear statements about the public health and policy implications. Archives of Public Health welcomes methodological papers (e.g., on study design and bias), papers on health services research, health economics, community interventions, and epidemiological studies dealing with international comparisons, the determinants of inequality in health, and the environmental, behavioural, social, demographic and occupational correlates of health and diseases.