| In recent years,China’s aging population has been deepening.According to the data of the China Statistical Yearbook,the proportion of the population over 65 years old in the total population in 2021 was 14.2%,exceeding the international standard of the deep aging society by 14%for the first time.China has officially entered the deep aging society.The increase in the number of the elderly population and the acceleration of the aging process pose a serious challenge to the development of China’s elderly-care support system and the cause of aging.At the same time,the health of the elderly has taken on new features,the number of disabled and semi-disabled elderly has increased rapidly,the prevalence of chronic diseases continues to rise,and the comorbidity is serious.The health problems are not only related to their own quality of life,but also affect family utility and social welfare.How to improve the health of the elderly has become one of the key issues to actively respond to aging population.However,at present and in the future,the trend of aging will be accompanied by the characteristics of fewer children,older age and smaller family structure.The aging of fewer children and the continuous reduction of family size further exacerbate the difficulties of traditional family elderly care,and the trend of disease changes in the elderly population requires us to pay attention to the impact of social environmental factors on the health.Therefore,the elderly-care support provided outside of the family and the created elderly-care environment have gradually become important external resources to meet the healthy care needs of the elderly.In 2021,the Fourteenth Five-Year Plan for the National Economic and Social Development of the People’s Republic of China and the Outline of the Long-term Goals for 2035 put forward the implementation of the national strategy to actively respond to aging population.In terms of the supply of elderly-care services,it is emphasized that families should be supported to assume the elderly-care function,and the elderly-care service system should be built with the coordination of home-based community institutions and the combination of medical care and health care.With regard to community care support,due to the reduction of family structure and fewer children,the demand for home-based and community care services of the elderly has increased significantly,and the number of community care institutions and facilities is also growing rapidly.More and more scholars have paid attention to the role of communities in promoting aging-in-place and solving the problem of elderly care.In the process of improving elderly-care service system,as one of the ways to provide elderly-care support,can community care improve the physical and mental health of the elderly while playing the role of complementing and upgrading the traditional family care?More importantly,what is the internal mechanism of community care support affecting the physical and mental health of the elderly?This is the first issue that this paper is concerned about.The answers to these questions can not only provide a reference for improving the practical effect of the community care model and increasing health benefits,but also provide some enlightenment for exploring the practical direction of community care support in the future.As far as the supply form of elderly care services is concerned,integration service of medical care and endowment has the characteristics of relieving the medical pressure and improving the utilization efficiency of elderly-care resources,and has also been widely concerned by sociologists.In 2016,the pilot work of the integration service of medical care and endowment was officially launched,and 90 cities(districts)were established as national-level pilot cities.So,can the pilot policy meet the needs of the elderly forhealthy life,so as to improve their physical and mental health?The further question is,What are the mechanisms and channels through which the integration of medical care and elderly care support affects the health?This is the second issue that this paper is concerned about.Under the background of aging population in China,this part provides a useful reference for promoting the orderly development of the integration service of medical care and endowment in the country and improving the health support system for the elderly.In the process of actively responding to aging population,in addition to community care support and integrated medical care support,at a more macro level,urban development is related to individual well-being,and the urban elderly-care environment is also an important factor affecting health.With the development of population agglomeration and urbanization,it has become increasingly important to fully leverage the scale advantages of big cities,share more the aging social risks,and create a livable environment for the elderly.This leads to the third question that this paper is concerned about:Can the expansion of city size provide more health support for the elderly?Further,what is the potential mechanism of city expansion affecting the physical and mental health of the elderly?Do registered residence restrictions in big cities hinder the elderly from obtaining health benefits?This paper mainly focuses on the above three aspects,and the main research contents and conclusions are as follows:First,the impact of community care support on the health of the elderly.Based on the social support theory and social production function theory,this paper explains the internal relationship between community care support and the health of the elderly from the interdisciplinary perspective of economics and sociology.Using the data of China Family Panel Studies(CFPS)and China Health and Retirement Longitudinal Study(CHARLS),this paper empirically tests the impact of community care support on the physical and mental health of the elderly at the community and individual levels.The research results show that community care support has a significant positive impact on the physical and mental health of the elderly,and the conclusion is still robust after using instrumental variable.The results of mechanism analysis show that community care support can improve physical health by participating in sports and improving life independence,and improve mental health by protecting cognitive function and promoting social interaction.Different mechanism factors play different roles in the physical and mental health of the elderly affected by community care support.In addition,the health effects of community care support are heterogeneous.The elderly in poor communities get less health benefits,there is a "Matthew effect".Community care support plays a stronger role in improving the health of the elderly who do not live with their children,which shows that community care support plays a role in replacing family care.Compared to the younger elderly group,the impact of community care support on the physical and mental health of the oldest old is relatively weak.Second,the impact of integration service of medical care and endowment support on the health of the elderly.Based on CHARLS and CFPS data,this paper uses difference-in-differences method to evaluate the impact of the pilot policy of integration service of medical care and endowment on the health.The research results show that carrying out integration service of medical care and endowment can improve the physical and mental health,but the policy effect on the mental health is relatively weak in the short term.This conclusion remains stable after being estimated by event study method,PSM-DID method,control baseline factor and time linear trend,placebo test and other methods.The mechanism analysis shows that,strengthening elderly medical security,promoting daily preventive health care.and providing long-term elderly care are the internal mechanisms,and there are differences in the role played by different mechanism factors.Heterogeneity analysis shows that,integration service of medical care and endowment has a more significant effect on the mental health of female elderly and the oldest old.Compared with the elderly with higher education and urban registered residence,the health effect is more significant for the elderly with lower education and rural registered residence,which indirectly reduces the health inequality caused by education and registered residence factors,and promotes health equity.Third,the impact of urban elderly-care environment on the health of the elderly—based on the perspective of city size expansion.Based on the micro-data of CFPS and city-level data,we use instrumental variable of wall area of Qing Dynasty and the parameter estimation method based on distribution functions to identify the relationship between city size and the health of the elderly.The research results indicate that the expansion of city size helps to improve the physical and mental health of the elderly,and big cities have an advantage in creating a comfortable and healthy elderly-care environment for the elderly.Mechanism analysis shows that urban expansion has improved the health status of the elderly by providing more opportunities for social participation,increasing per capita household income,and providing better healthcare services.Heterogeneity analysis shows that big cities basically meet the health needs of the elderly with different income and education,which do not exacerbate the health inequality among the elderly.However,the household registration system restricts the floating elderly from obtaining health benefits from big cities.The elderly with different registered residence may have unfair opportunities in the process of obtaining public services.In addition,the crowding effect reflected by population density and transportation cost has negative impact on health,especially in cities with population of more than 5 million.Based on the existing research,the innovation and marginal contribution of this paper are reflected in the following aspects:(1)In the context of the increasingly severe aging population in China,this paper provides a relatively complete analytical framework for studying how elderly-care support and elderly-care environment affect the health of the elderly.Through theoretical analysis and empirical test,this paper examines the impact and mechanism of community care support,integrated care support,and urban elderly-care environment on the physical and mental health of the elderly,which broadens the research perspective of "aging health" and enriched the policy connotation of social forces outside the family to assist healthy aging.(2)This paper enriches the micro-mechanism of community care affecting the health of the elderly,and supplements the internal mechanism from four aspects:promoting the elderly to participate in sports,improving life independence,protecting cognitive function,and promoting social interaction.The use of "number of village/neighborhood committee members" as instrumental variable enriches the discussion ideas of the existing literature on finding suitable instrumental variables for community care support.(3)This paper takes the pilot project of integration service of medical care and endowment as a quasi natural experiment,and uses difference-in-differences method to test the impact of integrated medical and elderly care support on the health of elderly people.The existing literature has shifted from a more localized evaluation of a certain region to a more global and multidimensional evaluation,making the research conclusion more accurate and credible.This paper explores the internal mechanisms and specific situations of the impact of the integration care support on the health of the elderly from three channels:elderly medical security,daily preventive health care,and long-term elderly care.At the level of mechanism analysis,it effectively supplements existing literature.(4)In urban elderly-care environments,city size,as an environmental factor affecting individual health,has received less attention in existing literature.This paper explores the role of city size expansion in providing health support for the elderly,quantifying the impact of city size on the physical and mental health of the elderly and its underlying mechanisms.It provides a marginal supplement to existing literature in terms of research perspectives and mechanism analysis. |
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