The Impact Of Long-term Care Services On Medical Utilization Of Disabled Elderl

In the context of accelerated development of aging,the number of disabled elderly in China is increasing.According to the fourth sample survey on the living conditions of the elderly in urban and rural areas conducted by the National Office on Aging,there were about 40.63 million disabled and semi-disabled elderly people in China in 2015,accounting for 18.5% of the total elderly population.Behind the large-scale disabled elderly population is a huge gap in care services.Because a sound long-term care service system has not been formed in our country,many elderly people who are difficult to obtain care services choose to increase the use of medical services,especially the excessive use of hospitalization services,that is,the problem of "social hospitalization".China launched a pilot project of long-term care insurance in 15 cities in 2016.one of its policy implications is to increase the use of old-age services for the disabled through subsidies for the disabled,thereby reducing the crowding out of medical services.Up to now,there is no fully mature conclusion on whether the longterm care service in China can reduce the use of medical services by the disabled elderly.Therefore,based on the sample survey data of the demand for long-term care services for the urban elderly independently conducted by the Institute of Population and Labor Economics of the Chinese Academy of Social Sciences,this paper takes the disabled elderly over 60 as the research object,measures the utilization of medical services by the probability and frequency of medical treatment,takes whether they have received long-term care services as the independent variable,and selects control variables according to Anderson’s health service utilization model for empirical research.Considering the endogenous problem,based on the linear model（LPM/OLS）,this paper uses the instrumental variable method（IV-OLS）to study the impact of longterm care service on the medical utilization of the disabled elderly,and then focuses on the differences of the impact of long-term care service on the disabled elderly in different age groups.Through empirical analysis,this paper mainly finds the following conclusions:（1）long-term care service has a significant substitution effect on the utilization of medical services for the disabled elderly.Specifically,receiving long-term care clothing can significantly reduce the annual outpatient utilization rate of 5.4% and the annual hospitalization rate of 47.4%,and significantly reduce the number of 0.661 outpatient visits and 1.319 annual hospitalization times.It can be seen that the substitution effect of receiving long-term care service on hospitalization utilization is much higher than that of outpatient service.（2）the sample is further divided into low age group（60-80 years old）and advanced age group（80 years old and above）.It is found that long-term care service has a significant substitution effect on medical services for the elderly in the low age group.For the disabled elderly in the low age group（60-80 years old）,under the premise of controlling other conditions unchanged,receiving long-term care service will significantly reduce their annual outpatient utilization probability and annual hospitalization rate by 8.8% and 58.4%.At the same time,it significantly reduced the number of 1.218 annual outpatient visits and 1.861 annual hospitalization times,but the effect on the elderly in the elderly group was not significant.（3）the sources of long-term care services for the disabled elderly are mainly intra-family and social services,and the accessibility of social pension resources can significantly promote the disabled elderly to receive long-term care services.The research results of this paper provide theoretical basis and policy guidance for the construction and improvement of long-term nursing service system in China.On the basis of this,three policy recommendations are put forward:（1）the state should actively strengthen the construction of the supply capacity of long-term care services,including support for informal care and formal care;（2）adhere to accurate services and effective supply,consider the heterogeneity of the needs of disabled elderly people of different ages and health levels.（3）accelerate the promotion of long-term care insurance coverage,gradually expand the insured population,enjoy the service population and the scope of service.