A Study On The Health Risk And Long-Term Care Mode Selection Of The Elderly

Health is the eternal pursuit of mankind and the starting point of people's happiness.The CPC Central Committee and the State Council attach great importance to people's health.President Xi Jinping pointed out in the 19 th National Congress of the CPC: "people's health is an important symbol of national prosperity and national rejuvenation".It is pointed out in the outline of "Healthy China 2030",the 14 th Five-Year Plan and the Long-Range Objectives of 2035 that the protection of people's health should be given priority to development.Since the founding of the People's Republic of China,especially since the reforms and openingup,remarkable achievements have been made in the reform and development of China's health field,and people's health level and physical quality have been continuously improved.At the same time,population aging,disease spectrum changes,family structure and lifestyle changes have also brought a series of new challenges to the maintenance and promotion of health.Especially with the population aging process accelerated and the elderly disabled population increasing,various practical problems related to the health of the elderly have attracted extensive attention from all walks of life.Nowadays,the research on the health problems of the elderly has become an important part of the national strategy and a major issue in the process of social development.Population aging is the basic national condition of our country for a long period of time in the future.To protect and improve the health level of the elderly is a livelihood issue that policy makers attach great importance to.So,what is the health status of the elderly in China,what are the factors affecting the health status of the elderly,and how does the health status affect the choice of the long-term care mode? Different from the developed countries,China has ushered in a wave of population aging when it is not yet wealthy.The rapid and largescale aging is in parallel with "getting old before getting rich" and "getting old before getting ready",which brings challenges to the protection of the health of the elderly and may lead to the characteristics of the changes in the health of the elderly in China.Many studies have shown that the prevalence of chronic diseases of the elderly in China are increasing,but the support of social security in China is limited,and the traditional family pension model is declining.The reduction of the number of children as the main source of care for the elderly may have a negative impact on the health of the elderly parents.At the same time,the increase of health risk factors of the elderly and the lack of family support function in our country also make the elderly care service subject transfer to the society,and stimulate the disabled elderly's demand for community nursing service and institutional nursing service.Based on this,through combing the theories related to the health risk and long-term care of the elderly,this paper investigates the dynamic trend of the health of the elderly in China,discusses the impact of the number of children on the health of the elderly,analyzes the choice of long-term care models for the disabled elderly,and puts forward policy suggestions on the construction of long-term care service system and long-term care insurance system.The key research content and research conclusions of this paper include the following aspects.First of all,the empirical study of the dynamic changes of the health status of the elderly in China.The understanding and judgment of the health status and change trend of the elderly is the premise of formulating the relevant policies of long-term care,medical care and pension.Based on the CLHLS data from 2002 to 2018,this paper uses the survival analysis method to investigate the cohort effect of the health status of the elderly born in different periods,to explore the development trend of the health status of the elderly,and to compare and analyze the changes and development differences of different health indicators.The study found that the risk rate of chronic diseases of the elderly is gradually increasing,while the risk rate of disability of self-care ability and cognitive function is decreasing.At the same time,the risk rate of death of the elderly after illness or disability has decreased,and the survival time of the elderly with disease has a trend of extension.Chronic diseases are becoming the main risk factors threatening the health of the elderly,but with the improvement of economic conditions and medical treatment,the risk of disability in the elderly is reduced,and the survival time of the disabled elderly is prolonged.With the prolongation of life expectancy and the aggravation of population aging,the increase of the number of sick elderly people poses a challenge to the medical insurance and long-term care insurance in China.Secondly,the empirical study on the influencing factors of the health status of the elderly based on the perspective of children number.At present,the support of social security in China is still limited,and the intergenerational support from the family is still the main source of pension for the elderly in China.However,the family with fewer children and the accompanying family size and structure simplification lead to the weakening of family support function,and may have adverse effects on the health of elderly parents.Based on the CLHLS data in 2018,this paper analyzes the impact of the number of children on the health of elderly parents and the internal influence mechanism,and discusses whether the socialized elderly care service can alleviate the negative impact on the health of elderly parents caused by the lack of children.The results show that the larger the number of children,the larger the family size and the more complex the intergenerational structure,the better the self-rated health status of elderly parents,that is,the less children in the family will have adverse effects on the health of elderly parents.Channel analysis shows that emotional support and care support from children are the main channels for the number of children to affect the health of elderly parents.Although more children can improve the economic level of elderly parents,it has no significant effect on their self-rated health.Improving the supply of community care services can make up for the lack of family care resources,and the substitution effect is more obvious in rural areas.Thirdly,the empirical study on the health status of the elderly and the choice of longterm care mode.With the deepening of aging,the number of non-health and disabled elderly will expand rapidly.In addition,with the change or even lack of the role of children,the demand for long-term care services is growing rapidly.At present,the development of nursing service in China is still lagging behind.The primary premise of improving the nursing service market and realizing the balance of nursing service supply and demand is to understand the long-term mode preference of the elderly.Based on CLHLS data in 2018,this paper uses the Mlogit model to analyze the relationship between the health status and disability degree of the elderly and the choice of long-term care mode,and analyze the differences of this relationship among different groups.The results show that,compared with home care,the higher the degree of disability,the more likely they are to use formal social care,and when the degree of disability is more serious,institutional care can better meet the needs of the elderly.In addition,there are urban-rural differences,regional differences and family care resource endowment differences between elderly health and long-term care mode selection.Influenced by the traditional family concept of providing for the aged,the level of economic development and the level of social nursing service,the relationship between disability and the choice of long-term care mode is more obvious in areas with higher economic development level and families with limited internal care resources.Finally,the policy implications of this paper mainly include the following three points.First,improving the long-term care system.In view of the important position of family care in the care of the elderly and the growing demand for formal nursing services,we should encourage home-based family care,develop community care,and improve institutional care.We should build a policy support and service support system for family caregivers,establish a connection platform between family care and community care,and allow social and market run long-term nursing service institutions.Second,it is necessary to build a long-term care insurance system.With the increasing demand for social care services for the elderly,it is imperative to establish a long-term care insurance system.Referring to the experience of medical insurance and endowment insurance,long-term care insurance should be based on social long-term care insurance and supplemented by commercial long-term care insurance.By giving full play to the compulsory and inclusive of social insurance,social long-term care insurance can overcome the short-sighted behavior of individuals participating.At the same time,commercial long-term care insurance can supplement it in breadth and depth,so that those who have enough economic ability can enjoy high-grade long-term care services.The third is to improve the auxiliary system of long-term care insurance,including establishing laws and regulations related to long-term care services,increasing policy support for long-term care insurance participants,improving the infrastructure of pension services,and strengthening the cultivation of nursing professionals.The possible innovations of this paper are mainly reflected in the following three aspects: First,in terms of research perspective,differently from the existing literature which mostly discusses the impact of population aging on economic growth and social security from the macro perspective,this paper focuses on the growing number of elderly groups and analyzes the health risk of the elderly from the micro individual perspective.Secondly,in terms of research content,previous domestic scholars mostly estimated and predicted the disability rate,disability scale and potential nursing labor demand of the elderly in China.This paper further explored the preference of the disabled elderly for long-term care mode,and the heterogeneity of the choice of elderly care models with different characteristics.Thirdly,in terms of research methods,this paper not only dynamically measures the health risk by the exposure time to health and death,but also uses survival analysis to solve the situation of loss or death in follow-up survey data in the second chapter.At the same time,this paper also uses a variety of ways to consider the endogenous problems and carry out the robustness test to maximize the robustness of the results in the third and forth chapter.