Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei, China.
BMC Geriatr. 2023 Jun 23;23(1):384. doi: 10.1186/s12877-023-04079-7.
With population aging becoming a pressing global concern, social support is more meaningful for older adults. In particular, financial supports, such as health insurance and financial assistance derived from family, all play great role in assistance affairs. Research shows social support possibly has an impact on poverty, but the association between formal and informal supports is unclear. We are aimed at verifying the association between distinct social supports and exploring whether this association would affect poverty alleviation for older adults.
A total of 2,683 individuals aged 60 years or older who have medical expenses were included in a survey conducted by the China Health and Retirement Longitudinal Study in 2018. A chi-square analysis and an independent samples T test all were used to explore the differences of social supports among old people with different economic condition. A binary logistic regression was aimed at analyzing the association between social supports and poverty for older adults. The structural equation model was established to evaluate the association between formal support and informal support and the mechanism(s) of social supports affecting poverty.
The overall average rate of reimbursement for outpatient care was 0.20 with standard deviation 0.22, and the average reimbursement rate of inpatient care for the poor older adults is nearly 5% lower than the average of the non-poor older adults. We found that having private health insurance and higher reimbursement rate of inpatient care were associated with lower likelihood of living in poverty for older adults. Formal support would directly affect poverty, but its impact on poverty through informal support is insignificant even if formal support is negatively associated with informal support.
A dilemma in reducing the economic burden of disease and receiving family assistance for older adults was revealed, and a more complete health security and higher level of medical expenses compensation would be beneficial to prevent poverty. Optimizing the primary healthcare and increasing the percentage of insurance compensation, policies that focus on the specific cultural values and strengthening the role of supplementary insurance are advantaged for alleviating poverty among older adults.
随着人口老龄化成为全球关注的紧迫问题，社会支持对老年人更为重要。特别是医疗保险和家庭经济援助等经济支持在援助事务中发挥着重要作用。研究表明，社会支持可能对贫困产生影响，但正式和非正式支持之间的关系尚不清楚。我们旨在验证不同社会支持与老年人贫困之间的关系，并探讨这种关系是否会影响老年人的脱贫。
本研究使用 2018 年中国健康与退休纵向研究调查的 2683 名 60 岁及以上有医疗费用的老年人数据。使用卡方检验和独立样本 T 检验分析不同经济状况老年人社会支持的差异。采用二元逻辑回归分析老年人社会支持与贫困的关系。建立结构方程模型，评估正式支持和非正式支持之间的关系以及社会支持影响贫困的机制。
门诊费用报销的总体平均比率为 0.20，标准差为 0.22，贫困老年人的住院费用报销率平均比非贫困老年人低近 5%。我们发现，拥有私人医疗保险和较高的住院费用报销率与老年人贫困的可能性降低有关。正式支持会直接影响贫困，但即使正式支持与非正式支持呈负相关，其通过非正式支持影响贫困的作用并不显著。
揭示了老年人减轻疾病经济负担和获得家庭援助的困境，更完善的健康保障和更高水平的医疗费用补偿将有利于预防贫困。优化基层医疗服务，提高保险补偿比例，关注特定文化价值观，加强补充保险作用的政策，有利于缓解老年人的贫困。
