Zhang Hongfeng, Cheng Peng, Huang Lu
School of Public Administration and Policy, Shandong University of Finance and Economics, Jinan 250014, China.
School of Economics, Shandong University of Finance and Economics, Jinan 250014, China.
Int J Environ Res Public Health. 2023 Feb 21;20(5):3817. doi: 10.3390/ijerph20053817.
The impact of the medical insurance system (MIS) on the health of older adults is a key element of research in the field of social security. Because China's MIS consists of different types of insurance, and the benefits and levels of coverage received by participating in different medical insurance vary, different medical insurance may have a differential impact on the health of older adults. This has rarely been studied before. In this paper, the panel data of the third phase of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015 and 2018 were used to investigate the impact of participation in social medical insurance (SMI) and commercial medical insurance (CMI) on the health of urban older adults and its mechanism relationship. The study found that SMI had a positive impact on the mental health of older adults, but only in the eastern region. Participation in CMI was positively correlated with the health of older adults, but this association was relatively small and was only observed in the sample of older adults aged 75 years and above. In addition, future life security plays an important role in the process of improving the health of older adults through medical insurance. Both research hypothesis 1 and research hypothesis 2 were verified. The results of this paper show that the evidence of the positive effect of medical insurance on the health of older adults in urban areas proposed by scholars is not convincing enough. Therefore, the medical insurance scheme should be reformed, focusing not only on coverage, but on enhancing the benefits and level of insurance, so as to enhance its positive impact on the health of older adults.
医疗保险制度（MIS）对老年人健康的影响是社会保障领域研究的关键要素。由于中国的医疗保险制度由不同类型的保险组成，且参与不同医疗保险所获得的福利和覆盖水平存在差异，不同的医疗保险可能对老年人的健康产生不同的影响。此前对此鲜有研究。本文利用2013年、2015年和2018年开展的中国健康与养老追踪调查（CHARLS）第三阶段的面板数据，研究了参加社会医疗保险（SMI）和商业医疗保险（CMI）对城市老年人健康的影响及其作用机制关系。研究发现，社会医疗保险对老年人的心理健康有积极影响，但仅在东部地区如此。参加商业医疗保险与老年人的健康呈正相关，但这种关联相对较小，且仅在75岁及以上的老年人样本中观察到。此外，未来生活保障在通过医疗保险改善老年人健康的过程中发挥着重要作用。研究假设1和研究假设2均得到验证。本文结果表明，学者们提出的医疗保险对城市老年人健康有积极作用的证据并不充分。因此，应改革医疗保险方案，不仅要关注覆盖范围，还要提高保险福利和水平，以增强其对老年人健康的积极影响。
