| Global aging has become an important social trend in the 21 st century,which has brought opportunities and challenges to many fields in the world.Different from the developed countries,the situation of “getting old before getting rich” in China will lead to greater financial pressure of the health care system and social security.In order to actively respond to the aging,the government has been emphasizing the importance of“healthy aging”.At the same time,the household registration system in China has led to disparities in resource allocation,social and economic development,and basic public services between urban and rural areas.So,the rural residents are facing more serious risks in the process of aging,including the health inequity problem between urban and rural residents.In order to ensure the basic life of the rural elderly,promote the equalization of basic public services in urban and rural areas,and gradually break the urban-rural dual barriers,China launched the pilot work of the New Rural Social Pension(i.e.,NRSP)in 2009.By the end of 2012,it has been basically covered all the country.And in 2014,the government established the unified resident basic pension system by combining the NRSP and the Urban Resident Pension.The conduction of resident pension has promoted a series of academic studies on the evaluation of its effects on residents' economic welfare,labor supply and so on.However,there is still no uniform conclusion due to the immaturity and regional differences of the system.In this context,this paper discusses the effect of resident basic pension system on the health inequity between rural and urban elderly,from the perspective of inequality of opportunity,which is introduced by Roemer.Based on the principle of responsibility,the theory of equality of opportunity attributes total inequality to levels of effort,which individuals ought to be held responsible for,and circumstance factors,which are outside the sphere of individual responsibility.Inequality attributable to circumstance factors is here referred to as inequality of opportunity(i.e.,IOp),namely inequity.The IOp is unfair and ethically offensive.Based on this framework,this paper designs a series of theoretical and empirical studies so as to achieve two core purposes.The first purpose is to analyze the IOp of health between the urban and rural residents in China,and the second one is to evaluate the effect of resident basic pension on the IOp of health,then to explore its mechanism.Chapter 1 introduces the study background,main contents,significance of the study,methods,contributions,and limitations of the study.Chapter 2 includes the basic concepts,the Grossman model and its empirical applications,the framework of IOp based on Roemer' theory and its related empirical studies in a range of fields,primarily with respect to income,education,and health.Chapter 2 also reviews the literature on the policy effect evaluation of the NRSP on the aspects of individuals' economic welfare,intergenerational support,labor supply and health.Finally,this Chapter points out the potential guiding value of the literature,and the areas that still need to be improved.Chapter 3 is the basic study of this paper.It uses the Grossman model to construct the general health production function of Chinese residents,and conducts the empirical tests based on stepwise regression model,using data from China Health and Retirement Longitudinal Study(i.e.,CHARLS).In the study,this paper designs two types of health indexes,i.e.,Self-Assessed Health and PCA Health(which is built using principal component analysis),to ensure the robustness of the measurement.The results show that income,nutritional intake,access to medical services,education level,public health environment,health behavior and lifestyle(smoking,drinking,napping and social activities),gender and age are the significant influencing factors of resident health in China.Chapter 4 analyzes the IOp of health between the urban and rural residents in China.First,the Grossman model and theory of equality of opportunity are combined theoretically,and the behavior model of IOp in health is derived.Then,based on the compensation principle of the theory of equality of opportunity,the model of fairness gap of health between the urban and rural residents is constructed to measure the IOp.In this model,the type of household registration is designed as the circumstance factor(i.e.,c),while the income,nutrition intake,accessibility of medical services,education level and the public health environment are e1 effort factors,and health behavior,lifestyle,gender,and age are e2 effort factors.The total IOp in health between urban and rural residents are divided into direct effects caused by c,and indirect effects caused by the relative e1 factors and e2 factors.In the micro empirical study,the firstorder stochastic dominance method is used to test the existence of IOp in health between the urban and rural residents in China.Then,based on the regression method,the extent and heterogeneity of fairness gap in health are measured using the CHARLS data.The results show that there were obvious IOp in health between the urban and rural residents in China during the period from 2011 to 2018: In 2011,the fairness gap was 4.696,then significantly reduced by about 20.34% in 2013,and decreased to 1.749 in 2018.Compared to the middle-aged group,male and eastern regions,the elderly,female,and residents in central and western regions faced greater IOp in health in the year of 2011.However,in 2018,the IOp of the elderly was lower than that of the middle-aged group,while the situation of other groups remained.In the macro empirical study,this paper further analyzes the direct sources of IOp in health,using the data of China Statistical Yearbook and China Health Statistical Yearbook from2011 to 2018,based on the Theil index and its decomposition model.The results show that income distribution,medical resource allocation,and the structural disparities in health care,education and food expenditures between urban and rural residents are the direct sources of IOp in health between urban and rural residents in China.Chapter 5 evaluates the effect of resident basic pension on the IOp of health,and Chapter 6 explores the mechanism.Chapter 5 uses the PSMDD model and Quantile DD model to test the effect of resident's pension on the IOp of elderly health.The results show that the pension significantly reduces the IOp in elderly health and the effect is stronger at the higher quantile.Further studies also find that the effect is only significant for those who have received pension for more than six months,and the effect is reduced when the elderly receiving pension for more than eighteen months.According to the heterogeneity test,the rural elderly people with the following characteristics benefit more from the pension: living in central and western provinces,middle-income,receiving financial support from their children,living with their children,and having worse health status.However,the multiphase effect of the pension is not significant according to the data of 2018.Chapter 6 clarifies the mechanism of policy effect based on theoretical analysis and empirical test:(1)Receiving pension significantly increases the absolute and relative household income,and improves the economic independence of the elderly.And the effect on the middle-and high-income groups is more obvious.At the same time,it further enlarges the effect by increasing the financial supports from children.(2)Receiving pension significantly increases the absolute and relative food consumption,and the effect on the low-and middleconsumption group is more obvious.(3)Receiving pension significantly increases the absolute and relative medical expenditures,and the effect on the low-and middleconsumption group is more obvious.(4)Receiving pension significantly reduces the labor supply,especially the supply of agricultural labor,thus increasing the nap time and the possibility of participating in social activities.(5)Receiving pension increases the possibility for the elderly to take care of their grandchildren,thus reducing smoking,but having no impact on drinking.This paper also finds a limited positive effect of pension on the elderly health,mainly in the aspect of basic physiological functions and cognition.This reveals the great differences between equality of outcome and equality of opportunity.Chapter 7 summarizes the study and gave policy suggestions.First,it is necessary to focus on the public policies related to equality of opportunity.Second,it is important to promote the basic public service equalization of urban and rural areas.The gap between urban and rural areas(in the aspect of education,health care,social security,and infrastructure construction)needs to be gradually narrowed by increasing government investment,driving social capital,and optimizing the structure of financial expenditure.Third,the resident basic pension program still needs to be improved.The government needs to increase financial subsidies,optimize the allocation structure of pension resources,and improve pension levels of both the basic pension and personal account pension.Finally,the intergenerational support might play an important role in the positive effect of social pension.Therefore,it is necessary to encourage children to provide enough support for their parents. |
PDF Full Text Request