| BackgroundSince the reform and opening-up,China's poverty alleviation work has made major achievements,which have lifted more than 700 million people out of poverty.With the completion of a well-off society in an all-round way and the realization of the goal of poverty alleviation,China's poverty alleviation work will enter a "post poverty alleviation era" after 2020.Although the absolute poverty has all been eliminated,the poverty alleviation work is not done once and for all,some people who have been lifted out of poverty still have the risk of returning to poverty and causing poverty in the future.There are many reasons for returning to poverty and increasing poverty,among which health poverty is the primary cause.With the increase of age,the gradually decline of physical function and the increasing risk of disease,health poverty has become the main form of rural elderly poverty.At the same time,with the accelerated development of urbanization,the empty nests phenomenon in rural areas has become increasingly serious.Compared with non-empty-nest elderly,empty-nest elderly has a higher risk of health poverty,and the problem of health poverty is more prominent.However,under the background that the health poverty problem of rural empty nest household is more prominent,there is a lack of comprehensive measurement on the health poverty status of the rural empty nest elderly.On the one hand,most of the existing health poverty assessment methods are post measurement of the health poverty status,which are lagging.On the other hand,most of the existing health poverty assessment methods are static,which do not take into account the dynamic changes of health poverty risk and have limitations.To sum up,through the combination of ex-post measurement and ex-ante prediction,and the combination of static and dynamic methods,we can comprehensively grasp the current health poverty situation of rural empty nest elderly families,and cut-off the vicious circle of disease and poverty,which is of great significance to build a long-term mechanism for sustainable and healthy poverty alleviation,and to consolidate and expand the gains in poverty alleviation in the post poverty alleviation era.ObjectivesThe overall objective of this study is based on the panel data in rural Shandong Province,comprehensively evaluate the health and poverty of empty-nest elderly families in rural areas,clarify the main health poverty problems of this group,explore the main influencing factors of health poverty,and formulate precise strategies to improve the health poverty situation,thus provide the corresponding theory and implementation basis for the health and poverty governance in the post-poverty alleviation era.The specific objectives are as follows:(1)To understand the occurrence and dynamic changes of health poverty measured after the event,and to explore the main influencing factors.(2)To understand the occurrence and dynamic changes of poverty vulnerability predicted in advance,and to explore the main influencing factors.(3)From the perspective of ex ante prediction,evaluate the effect of health shocks on poverty vulnerability,and further analyzes the mechanism of health shocks on poverty vulnerability.(4)Based on the above review and summary,we put forward the precise strategies for improving the health poverty of rural empty-nest elderly household.Data source and sampleWe use the data from the "Health cohort survey of the elderly in rural Shandong Province" in 2019 and 2020.Taking the rural empty-nest elderly household as the study object,we got the balance panel data of 1951 households survey in 2019 and 2020.Research contents and methodsThe main research contents and methods include the following five parts:(1)Based on the method of literature analysis,this study collects and organized the theoretical and empirical research on health poverty and health poverty vulnerability at home and abroad,clarifies the research status and progress,and summarizes the gaps and deficiencies in the current research.(2)Based on the calculation method proposed by the World Health Organization to measure the incidence and gap of CHE and IHE,use the transfer matrix to understand the occurrence and dynamic changes of CHE and IHE from 2019 to 2020,and use the panel random effect Logit model,mixed effect model and ordered Probit model to analyze the effect of household livelihood capital stock on the occurrence and dynamic changes of CHE and IHE.In addition,we use the concentration index to measure the equity of CHE,and further use the decomposition of the concentration index and change in concentration index to analyze the main contributing factors that affect the inequality and inequality changes of CHE.(3)Based on the three-stage feasible generalized least squares method to measure the poverty vulnerability empty-nested elderly households,and further verify the accuracy of poverty vulnerability prediction.Based on the transfer matrix to understand the occurrence and dynamic changes of poverty vulnerability,and further use the ordered Probit model to analyze the effect of household livelihood capital stock on the occurrence and dynamic changes of poverty vulnerability.(4)Based on the panel bidirectional fixed effects model and Propensity score matching-Difference in Difference model are used to assess the net effect of health shocks on the poverty vulnerability,and further analyze their mechanism in rural empty nest elderly household.(5)Aiming at the existing health poverty problems,propose precise strategies to improve the health poverty situation;Aiming at the possible health poverty problems in the future,formulate forward-looking anti-poverty policies to consolidate and expand the gains in poverty alleviation.Results1.Analysis of CHE and its equity in rural empty nest elderly household(1)Regarding the status quo of CHE,in general,the CHE incidence and gap showed a downward trend with the increase of the threshold;the CHE incidence showed a downward trend over time,while the CHE gap showed an upward trend over time.Based on the panel random effect Logit model,it is found that the influencing factors of CHE in rural empty nest elderly household include cooking fuel,toilet type,housing area,duration of empty nest,number of children,household economic status,number of family labor force,age of household head,the number of household chronic patients,and inpatient service utilization.(2)Regarding the dynamic change of CHE,in general,the states of moving out of CHE and falling into CHE coexist,and the proportion of moving out of CHE is higher than those falling into CHE.The main type of occurrence of CHE is temporary.Based on the ordered Probit model,it is found that cooking fuel(using firewood),the number of children(more),the age of household head(older),the number of household chronic patients(more),and inpatient service utilization reduce the probability of CHE that never occurred,increase the probability of temporary CHE and persistent CHE;household economic status(the richest)and the number of family labor(more)increase the probability of CHE that never occurred,reduce the probability of temporary CHE and persistent CHE.(3)Regarding the equity in CHE,the concentration index of CHE incidence and gap of rural empty-nest elderly households in 2019 and 2020 are negative,and gradually approaches negative 1 over time.The static decomposition result of the concentration index shows that the household economic status and the number of household labor are the main contributors to CHE inequality in 2019 and 2020;The dynamic decomposition results of the concentration index show that household economic status and household inpatient service utilization are the main factors for the transfer of CHE to low-income households from 2019 to 2020.2.Analysis of IHE in rural empty-nest elderly household(1)Regarding the status quo of IHE,in general,the higher the poverty line standard,the more rural empty-nest elderly households fall into poverty due to out-of-pocket medical expenditures,and the higher the poverty gap and the standardized poverty gap.Compared with 2019,the poverty incidence of OOP in 2020 has almost no change,while the poverty gap of OOP shown a downward trend in 2020.Based on the mixed effect Logit model,it is found that regardless of which poverty line standard,household cooking fuel,household economic status,the number of family labor,the age of household head,the number of household chronic patients,and inpatient service utilization are the influencing factors of IHE.(2)Regarding the dynamic change of IHE,in general,the states of moving out of IHE and falling into IHE coexist,and the proportion of moving out of IHE is higher than those falling into IHE.The main type of occurrence of IHE is temporary.Based on the ordered Probit model,it is found that cooking fuel(using firewood),living arrangement(living with spouse),the number of household chronic patients(more),and inpatient service utilization reduce the probability of IHE that never occurred,increase the probability of temporary IHE and persistent IHE;household economic status(the richest)and the number of family labor(more)increase the probability of IHE that never occurred,and reduces the probability of temporary IHE and persistent IHE.3.Analysis of the poverty vulnerability in rural empty-nest elderly households(1)Regarding the status quo of poverty vulnerability,in general,the poverty vulnerability level of rural empty-nest elderly households gradually increases with the increase of poverty standard;under the same poverty standard,the poverty vulnerability level shows a decreasing trend over time.Compared the poverty vulnerability with the actual poverty,we found that with the increase of poverty line standards,the poverty vulnerability indicators correctly predicted the proportion of poverty rose from 40.37%to 61.74%.(2)Regarding the dynamic change of poverty vulnerability,in general,the states of moving out of poverty vulnerability and falling into poverty vulnerability coexist,and the proportion of moving out of poverty vulnerability is higher than those falling into poverty vulnerability.With the increase of the poverty line,the occurrence of poverty vulnerability changes from temporary vulnerability to persistent vulnerability.Based on the ordered Probit model,it is found that cooking fuel(using electricity and firewood),the number of children(more),the household size(large),the age of household head(older),health shocks reduces the probability of poverty vulnerability that never occurred,increase the probability of temporary poverty vulnerability and persistent poverty vulnerability;the toilet type(sanitary toilets),living arrangement(not living alone),non-poverty-stricken households,number of family labor force(more),number of household chronic patients(more),and inpatient service utilization increase the probability of poverty vulnerability that never occurred,reduce the probability of temporary poverty vulnerability and persistent poverty vulnerability.4.The effect of health shocks on poverty vulnerability and its mechanism(1)Using catastrophic health expenditure indicator as reference index of health shocks,based on the panel bidirectional fixed effects model and Propensity score matching-Difference in Difference model,it is found that regardless of which poverty line standard,the health shocks significantly increase the poverty vulnerability of rural empty nest elderly households.Specifically,under the poverty standards of 2 US dollars,Shandong poverty line and 3 US dollars,the health shocks can increase the probability of rural empty-nest households falling into poverty in the future by 5.8%,7.1%and 7.8%respectively.(2)Regarding the mechanism of health shocks on the poverty vulnerability of rural empty-nest elderly households,it is found that physical capital,financial capital,social capital,and human capital are all significantly effective channels.Specifically,the use of firewood for cooking,the more children,and the larger family size can enhance the positive effect of health shocks on poverty vulnerability.The longer duration of empty nest,not living alone,the more household labor,and the more chronic patients in the family can reduce the positive effect of health shocks on poverty vulnerability.Conclusions and policy implicationsMain Conclusions:(1)In general,the incidence of CHE and IHE in rural empty-nest elderly household is relatively high,their changes over time is relatively small,and health poverty problem is still relatively serious.From a dynamic perspective,the proportion of moving out of CHE/IHE is higher than those falling into CHE/IHE,and the main type of occurrence of CHE/IHE is temporary.Cooking fuel,the household head age,the number of family labors,the number of household chronic patients,inpatient services utilization,and household economic status are the main influencing factors of the occurrence and dynamic changes of CHE and IHE in rural empty nest elderly household.(2)The CHE of rural empty-nest elderly household is inequality and the degree of inequality is gradually deepening.Whether it is the decomposition of CHE concentration index or the changes of CHE concentration index,household economic status is the main contributing factors.(3)The poverty vulnerability of rural empty-nest elderly households shows a downward trend over time.From a dynamic perspective,although the proportion of moving out of poverty vulnerability is higher than those falling into poverty vulnerability,with the increase of the poverty line,the occurrence of poverty vulnerability has changed from temporary vulnerability to persistent vulnerability,which reflects that it will be more difficult for rural empty-nest elderly families to get rid of poverty in the future,and the poverty vulnerability problem cannot be ignored.(4)Regardless of the poverty line,the health shocks can significantly increase the poverty vulnerability of rural empty-nest elderly household.Regarding the mechanism of health shocks on the poverty vulnerability,it is found that physical capital,financial capital,social capital,and human capital are all significantly effective channels.Policy implications:(1)Focus on the rural empty-nest elderly household,and effectively improve the efficiency of poverty alleviation.(2)Establish a dynamic monitoring and evaluation system for health poverty,and further build a risk early warning mechanism.(3)Optimize the structure of livelihood assets and improve the risk resistance ability of rural empty-nest elderly household.(4)Construct a multi-level medical security system and poverty relief system to coordinate the anti-poverty effect.(5)Improve the basic pension system in rural areas and strengthen the role of family pensions.Strengths and WeaknessesStrengths:(1)This study adopted the combination of ex-post measurement and ex-ante prediction,and the combination of static and dynamic perspectives to evaluate and analyze the health poverty of rural empty-nest elderly household.The innovation of this research perspective can not only help the local government to take corresponding measures to improve the current health poverty status of the rural empty-nest elderly household,but also identify groups that may fall into health poverty in the future and adopt advance intervention measures to reduce the occurrence of poverty.(2)From the perspective of research methods,this study adopts the panel bidirectional fixed effects model and PSM-DID model to evaluate the effect of health shocks on vulnerability to poverty,which can clarify the net effect of health shocks on poverty vulnerability and make up for the deficiency of endogenous problems caused by the selection bias or missing variables in traditional method.(3)From the perspective of the research objects,the rural empty-nest elderly household is the key group of health poverty in the future.Through the special research on the health poverty and poverty vulnerability of this group can provide relevant basis for health poverty governance in the post-poverty alleviation era.Weaknesses:(1)The length of panel data used in this study is relative short,which cannot fully explore the long-term regularity of occurrence and dynamic changes of health poverty.Moreover,when using the PSM-DID method,parallel trend testing cannot be performed,and the research conclusions are slightly weak.(2)This study did not explore the effect of medical security system on health poverty and poverty vulnerability.Future study can further explore the effects of various risk management strategies such as the medical security system on the health poverty and poverty vulnerability,which can provide policy implications for the government to develop risk management strategies and improve the health risk management capabilities of the elderly. |
PDF Full Text Request