| Research objectiveThis study uses the China Health and Retirement Longitudinal Study(CHARLS)database to understand the basic conditions and chronic disease prevalence of elderly residents in urban and rural areas in China.Through statistical analysis of the health service utilization and expenses of elderly patients with chronic diseases in urban and rural areas,understand the difference in medical burden of elderly patients with chronic diseases in urban and rural areas;Analyze the poverty-causing mechanism of chronic diseases from the two paths of labor participation and medical expenditure,and explore the factors affecting poverty among elderly residents in urban and rural areas;By analyzing the poverty reduction effect of medical insurance on elderly patients with chronic diseases,understand the difference in poverty reduction effect of medical insurance on urban and rural residents,groups of different characteristics,and different parts of medical expenditure;Finally,in view of the existing problems,in order to improve the medical security policy,rationally allocate health resources,and formulate targeted chronic disease prevention and control strategies,countermeasures and suggestions are put forward..Research methodsThis study adopts the literature research method,through extensive reading of literature,summarizes and analyzes domestic and foreign research results on elderly chronic disease health expenditures,elderly poverty,etc.,selects suitable analysis methods for this research,and defines and elaborates related concepts and related theories;direct method is used to measure the medical and health expenses of elderly patients with chronic diseases;The direct method in the intermediary effect model is used to analyze the mechanism of urban and rural elderly chronic disease poverty.In the process of intermediary effect analysis,the logit regression model is used for the dependent variable as a binary variable,and the linear regression model is used for the dependent variable if the dependent variable is a continuous variable;FGT index is used to analyze the poverty reduction effect of medical security from the three perspectives of poverty incidence,poverty gap and squared poverty gap.Research results1.Basic situationIn 2018,the prevalence of chronic diseases in the elderly in China’s urban and rural areas was 86.80% and 84.89%,respectively,and the prevalence of chronic diseases in urban areas was higher than that in rural areas.From the comparison of elderly patients with chronic diseases and non-chronic diseases,urban and rural elderly patients with chronic diseases are older than those with non-chronic diseases,have higher utilization rates of health services,more health expenditures,worse self-assessed health status,and are participating Less labor and higher children’s financial support rate;From the comparison of urban and rural elderly patients with chronic diseases,compared with rural elderly patients with chronic diseases,urban elderly patients with chronic diseases have more health expenditures,higher education levels,better self-evaluated health conditions,fewer people engaged in labor,and children Financial support is even less.The per capita income of elderly chronic disease patients in urban areas is 44895.6yuan/year,and the per capita income of elderly chronic disease patients in rural areas is 11872.55 yuan/year.2.Health Service Utilization and Expenses of Elderly Patients with Chronic DiseaseThe utilization rates of outpatient clinics,hospitalizations and selftreatment for elderly patients with chronic diseases in urban areas were18.4%,25.86%,and 64.15%,respectively,and those in rural areas were17.74%,21.87%,and 63.86%.The hospitalization rate of elderly patients with chronic diseases in urban areas is higher than in rural areas.The per capita expenses for outpatient,hospitalization and self-treatment of elderly patients with chronic diseases in urban areas are 4077.40 yuan/year,3788.14yuan/year,and 3701.08 yuan/year,while in rural areas they are 3217.76yuan/year,2898.50 yuan/year,and 2665.40 yuan/year.The medical expenditures of urban elderly patients with chronic diseases are higher than those of rural elderly patients with chronic diseases.3.Poverty mechanism of chronic diseases in the elderlyAmong elderly patients with chronic diseases,48.03% of residents suffer from poverty caused by illness.Among them,the incidence of chronic disease poverty in rural areas is higher than that in urban areas,59.63% and17.44%,respectively.With the increase in the number of chronic diseases,the greater the probability of the expenditure poverty caused by illness among the rural elderly.Analyze the poverty-causing mechanism of chronic diseases in the elderly from two channels: labor participation and medical expenditure.The first path uses labor participation as an intermediary variable analysis of chronic disease-induced poverty.The results show that whether chronic disease has a negative impact on the labor participation of urban and rural elderly residents.For urban elderly residents,labor participation is in chronic disease-induced poverty.There is a masking effect,that is,the impact of chronic diseases on poverty is not significant;For rural elderly residents,labor participation exerts an intermediary effect,that is,chronic diseases affect the labor ability of patients and reduce the probability of elderly labor participation,thereby affecting the economic income of individuals and families,thereby increasing the probability of poverty.The second path is to use medical expenditure as the intermediary variable of chronic disease causing poverty.The results show that whether chronic disease has a positive impact on the medical expenditure of urban and rural elderly residents.The results of the intermediary analysis are similar to the first path.Medical expenditure has a masking effect on the poverty caused by chronic diseases of the elderly in urban areas,and it plays an intermediary role in the process of poverty caused by chronic diseases of the elderly in rural areas.Chronic diseases increase the medical expenditure of rural elderly residents and reduce the disposable income of the elderly and their families,thereby increasing the probability of poverty.In addition,gender,education level,number of household members,self-rated health status,and personal income level have a negative impact on urban and rural elderly poverty.Marital status and whether there is pension insurance have a positive impact on rural elderly poverty.Regions have a negative impact on rural elderly poverty.4.Analysis of the effect of medical security in poverty reductionThere are differences in the poverty reduction effects of medical security on urban and rural residents,various parts of medical expenditures,and groups of different characteristics.The main differences are shown in the following aspects:(1)From the comparison between urban and rural areas,whether before or after medical security compensation,the poverty incidence,poverty gap,and squared poverty gap among chronic diseases of the elderly in rural areas are significantly higher than those of urban residents,and after the medical security compensation,the rural poverty index fell more than the urban;(2)From the comparison of poverty indicators,after medical security,the decline of each indicator is in descending order: poverty incidence <poverty gap < squared poverty gap;(3)Judging from the comparison of various parts of the cost,medical security has a better effect on reducing poverty in outpatient and hospitalization,and the effect of self-treatment cost compensation is relatively poor;(4)From the perspective of various characteristic groups,urban elderly chronically ill patients with more household members have a lower degree of poverty,while in rural areas,the higher the number of household members,the more severe the poverty situation.Medical security has a better effect on reducing poverty for patients with severe poverty;The poverty incidence of urban elderly patients with chronic diseases who participate in labor is higher than that of non-laborers,and the poverty incidence among rural residents who are not involved in labor is higher.The poverty incidence and poverty gap of urban and rural residents who are not involved in labor are higher than those of labor residents;The poverty indexes in the central and western regions are higher than those in the eastern regions,and medical security compensation has a greater effect on poverty reduction in the central and western regions;The poverty incidence,poverty gap,and squared poverty gap among elderly residents with higher income levels are significantly lower than those of lowincome elderly groups,but medical security has a greater effect on poverty reduction for high-income groups.Research conclusion1.The prevalence of chronic diseases,the utilization of health services and the cost of urban elderly residents in China are higher than those of rural residents,but the overall income level of urban elderly residents is also significantly higher than that of rural residents.Relatively low income levels and social security levels have resulted in a heavier medical burden for rural elderly patients with chronic diseases,and their incidence of expenditure poverty caused by illness is higher,and the poverty gap and squared poverty gap of poverty are significantly greater than that of urban elderly residents.2.Chronic diseases have an impact on poverty by increasing medical and health expenditures,reducing the probability of labor participation,and reducing income sources,that is,through the two paths of "increasing expenditure" and "decreasing income".Among them,the overall income level of rural elderly residents is relatively low,and they mainly rely on labor participation to obtain a source of income.At the same time,their health status is generally poor and they are more susceptible to chronic diseases and poverty.3.Medical security has a positive effect on poverty alleviation and to a certain extent alleviated the poverty of chronic diseases in the elderly.Among them,medical security has a greater effect on poverty reduction in rural elderly patients with chronic diseases,but at the same time there are still areas for further improvement: First,the expenditure-oriented poverty caused by outpatient and self-treatment expenses is relatively severe,but medical insurance does not compensate for this part of the expenses,especially the self-treatment expenses;second,the effect of medical security in poverty alleviation is significant,and the effect of poverty reduction needs to be improved;third,medical security has a greater effect on poverty alleviation for higher-income elderly residents,and the protection of lowincome elderly groups needs to be improved.fourth,the central and western regions suffer from severe expenditure poverty caused by illness,but medical security has a better effect in reducing poverty.The eastern region should pay attention to helping low-income elderly residents in rural areas. |
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