Sun Jian, Yu Shui, Lu Wanjun, Liu Yujiang
College of Public Administration, Nanjing Agricultural University, 1 Weigang, Xuanwu District, Nanjing, 210095, China.
Research Center for Local Governance and Policy, Nanjing Agricultural University, 1 Weigang, Xuanwu District, Nanjing, 210095, China.
Arch Public Health. 2023 Aug 31;81(1):164. doi: 10.1186/s13690-023-01167-3.
Previous studies have not investigated the association between medical insurance and instrumental activity of daily living (IADL) disability. To fulfill this research gap, this study aims to explore the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and IADL disability among middle-aged and older adults in China.
The data of this study were sourced from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). Logit regression models were used to analyze the association between URRBMI and odds of suffering from IADL disability. Furthermore, we used IV-Probit regression model to address the potential endogeneity problem. Moreover, propensity score matching and generalized random forest model were employed to conduct robustness checks.
The logit regression results reveal that URRBMI participation was significantly related to reduced odds of suffering from IADL disability by 39.86% after adjusting for the control variables (p < 0.01). The results of IV-Probit estimation show that URRBMI was an exogenous variable. Further robustness checks reported similar estimation results. The results of heterogeneity analysis reveal that URRBMI produced a statistically stronger effect on IADL disability for the older adults (OR = 0.5815, p < 0.01) when compared with the middle-aged adults (OR = 0.5690, p < 0.05). The results of impact channel analysis indicate that physical exercise was a channel involving the effect of URRBMI on IADL disability.
This study finds that the middle-aged and older adults who were covered by URRBMI had a reduced possibility of suffering from IADL disability when compared with those without URRBMI. Furthermore, it is found that URRBMI produced a statistically stronger effect on IADL disability for the older adults when compared with the middle-aged adults. Moreover, we obtain evidence indicating that physical exercise was a channel involving the effect of URRBMI on IADL disability.
以往研究尚未探讨医疗保险与日常生活工具性活动（IADL）残疾之间的关联。为填补这一研究空白，本研究旨在探讨中国城乡居民基本医疗保险（URRBMI）与中老年人群IADL残疾之间的关联。
本研究数据来源于2018年中国健康与养老追踪调查（CHARLS）。采用Logit回归模型分析URRBMI与IADL残疾患病几率之间的关联。此外，我们使用IV-Probit回归模型来解决潜在的内生性问题。而且，采用倾向得分匹配和广义随机森林模型进行稳健性检验。
Logit回归结果显示，在调整控制变量后，参与URRBMI与IADL残疾患病几率降低39.86%显著相关（p < 0.01）。IV-Probit估计结果表明URRBMI是一个外生变量。进一步的稳健性检验报告了相似的估计结果。异质性分析结果显示，与中年成年人相比，URRBMI对老年人IADL残疾的影响在统计学上更强（OR = 0.5815，p < 0.01）（中年成年人OR = 0.5690，p < 0.05）。影响渠道分析结果表明，体育锻炼是URRBMI对IADL残疾产生影响的一个渠道。
本研究发现，与未参加URRBMI的人群相比，参加URRBMI的中老年人群患IADL残疾的可能性降低。此外，还发现与中年成年人相比，URRBMI对老年人IADL残疾的影响在统计学上更强。而且，我们获得的证据表明体育锻炼是URRBMI对IADL残疾产生影响的一个渠道。
