Article(id=1321169740962312815, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169668631548508, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145209, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1724947200000, receivedDateStr=2024-08-30, revisedDate=1727107200000, revisedDateStr=2024-09-24, acceptedDate=1743523200000, acceptedDateStr=2025-04-02, onlineDate=1792921012392, onlineDateStr=2026-10-25, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921012392, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921012392, creator=13701087609, updateTime=1792921012392, updator=13701087609, issue=Issue{id=1321169668631548508, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='9', pageStart='1025', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920995147, creator='13701087609', updateTime=1792920995147, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1112, endPage=1117, ext={EN=ArticleExt(id=1321169742770057840, articleId=1321169740962312815, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Associations of health resource allocation and health security with preferences for elderly care services among older adults in China: an analysis of CLHLS data, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the impact of health resource allocation and health security on the choice of elderly care services among China's elderly population, and to provide insights for promoting healthy aging.

Methods

The panel data of 2 444 elderly people aged over 65 years old were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2011, 2014, and 2018. A mixed-effects logit regression model (MLR) with random effects was used to analyze the impact of health resource allocation and health security on the choice of elderly care services. Age heterogeneity was examined through subgroup analysis based on age and residence type. The robustness of the results was tested by comparing different link functions (logit and probit) using generalized estimating equations (GEE), which were chosen to account for potential model misspecification and to ensure the reliability of the results.

Results

Health resource availability (β = 1.587, P < 0.05), health resource accessibility (β = 0.790, P < 0.05), and health security (β = 0.380, P < 0.05) were significantly associated with increased odds of the elderly choosing institutional care. Specifically, after exponentiating the beta coefficients, for each 1-grade increase in health resource availability, health resource accessibility, and health security, the odds of the elderly choosing institutional care increased by a factor of 4.89, 2.20, and 1.46, respectively (all P < 0.05). Heterogeneity analysis results indicate that both the availability (β = 1.729, P < 0.05) and accessibility (β = 0.832, P < 0.05) of health resources have a significant impact on the choice of elderly care services for the oldest elderly (≥ 80 years); the impact of health security on the choice of elderly care services for both the young elderly (β = 0.392) and the oldest elderly (β = 0.363) is significant (both P < 0.05); the availability of health resources (β = 1.433), accessibility of health resources (β = 0.619), and health security (β = 0.326) have a significant impact on the choice of elderly care services for the urban elderly population (all P < 0.05); availability of health resources (β = 1.850), accessibility of health resources (β = 1.084), and health security (β = 0.340) have a significant impact on the choice of elderly care services for the rural elderly population (all P < 0.05).

Conclusions

The allocation of health resources and health security significantly influence the choice of elderly care services. The allocation of health resources affects different age groups and residential types of the elderly population differently, while the impact of health security varies across residential types.

, authors=Xiaoou MAN, Shiyong JIANG, authorsList=Xiaoou MAN, Shiyong JIANG, authorCompany=null, correspAuthors=Xiaoou MAN, authorNote=null, correspAuthorsNote=
MAN Xiaoou, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169747941634709, articleId=1321169740962312815, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=卫生资源配置、健康保障与老龄群体养老服务选择分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

了解卫生资源配置、健康保障对我国老龄群体养老服务选择的影响,为促进健康老龄化发展提供参考依据。

方法

收集中国老年健康影响因素跟踪调查(CLHLS)2011、2014和2018年面板数据中2 444名≥65岁老龄人群样本,使用混合效应logit回归(MLR)模型分析卫生资源配置、健康保障对老龄群体养老服务选择的影响,并从年龄、居住地类型进行异质性分析,使用广义估计模型(GEE)设定不同的链接函数(logit和probit)进行稳健性检验。

结果

卫生资源可得性(β=1.587,P<0.05)和卫生资源可达性(β=0.790,P<0.05)越高、健康保障水平越高(β=0.38,P<0.05),老龄群体选择机构养老的概率更高;反之,老龄群体选择居家养老的概率更高。异质性结果表明,卫生资源可得性和卫生资源可达性均对高龄老人(≥80岁)影响显著(β=1.729,P<0.05; β=0.832,P<0.05);健康保障对低龄和高龄老人养老服务选择影响均显著(β=0.392,P<0.05; β=0.363,P<0.05);卫生资源可得性、卫生资源可达性和健康保障对乡镇老龄群体养老服务选择影响均显著(β=1.433,P<0.05; β=0.619,P<0.05;β=0.326,P<0.05);卫生资源可得性、卫生资源可达性和健康保障对农村老龄群体养老服务选择影响均显著(β=1.850,P<0.05; β=1.084,P<0.05;β=0.340,P<0.05)。

结论

卫生资源配置和健康保障对于老龄群体养老服务选择存在显著影响,同时卫生资源配置对不同年龄段和居住地类型老年群体影响存在差异,健康保障对不同居住地类型老龄群体影响存在差异。

, authors=满小欧*, *, 姜石勇, authorsList=满小欧, 姜石勇, authorCompany=null, correspAuthors=满小欧, authorNote=

满小欧(1983— ),副教授,博士,研究方向:公共政策,公共卫生管理

, correspAuthorsNote=
满小欧,E-mail:
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companyId=1321169748168127126, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=东北大学文法学院,沈阳 110169)])], figs=[ArticleFig(id=1321169749623550637, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=EN, label=Tab.1, caption=

Influence of availability and accessibility of health resources, healthcare security, demographics, life satisfaction, health status, and pension status on the choice of institutional elderly care services among older Chinese residents (≥65 years): a mixed-effects logistic regression analysis of panel data from the CLHLS in 2011, 2013, and 2018

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性1.5870.2925.420.0001.013~2.1614.889
卫生资源可达性0.7900.174.620.0000.455~1.1252.203
健康保障0.3800.0914.160.0000.201~0.5591.462
年龄0.4510.2232.020.0430.014~0.8881.569
性别–0.5760.229–2.510.012–1.026~–0.1260.562
省份–0.1470.113–1.290.196–0.370~0.0760.863
居住地类型–0.490.153–3.190.001–0.792~–0.1890.612
同居状况–0.8570.135–6.320.000–1.123~–0.5910.424
生活满意度0.3480.1322.640.0080.090~0.6071.416
受教育程度0.4110.1482.770.0060.120~0.7011.508
健康状况0.3260.1242.620.0090.081~0.571.385
养老保障–0.2400.147–1.630.103–0.528~0.0480.786
婚姻状况0.3760.2371.580.113–0.089~0.8421.456
时间/个体效应控制
), ArticleFig(id=1321169749690659502, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=CN, label=表1, caption=

卫生资源配置、健康保障对老龄群体机构养老服务选择的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性1.5870.2925.420.0001.013~2.1614.889
卫生资源可达性0.7900.174.620.0000.455~1.1252.203
健康保障0.3800.0914.160.0000.201~0.5591.462
年龄0.4510.2232.020.0430.014~0.8881.569
性别–0.5760.229–2.510.012–1.026~–0.1260.562
省份–0.1470.113–1.290.196–0.370~0.0760.863
居住地类型–0.490.153–3.190.001–0.792~–0.1890.612
同居状况–0.8570.135–6.320.000–1.123~–0.5910.424
生活满意度0.3480.1322.640.0080.090~0.6071.416
受教育程度0.4110.1482.770.0060.120~0.7011.508
健康状况0.3260.1242.620.0090.081~0.571.385
养老保障–0.2400.147–1.630.103–0.528~0.0480.786
婚姻状况0.3760.2371.580.113–0.089~0.8421.456
时间/个体效应控制
), ArticleFig(id=1321169749770351279, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=EN, label=Tab.2, caption=

Adjusted influence of health resource availability, accessibility, and health insurance on institutional care choice among young-old (65–79 years) and oldest-old (≥80 years) Chinese residents: a mixed-effects logistic regression analysis of panel data from the 2011, 2013, and 2018 waves of the CLHLS

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性低龄老人1.0430.6481.610.108–0.228~2.3132.837
高龄老人1.7290.3694.670.0001.004~2.4535.635
卫生资源可达性低龄老人0.7380.3831.920.054–0.014~1.4902.091
高龄老人0.8320.2133.910.0000.415~1.2502.297
健康保障低龄老人0.3920.1602.440.0150.077~0.7081.479
高龄老人0.3630.1123.230.0010.142~0.5831.437
控制变量控制
时间/个体效应控制
), ArticleFig(id=1321169749971677872, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=CN, label=表2, caption=

卫生资源配置、健康保障对低龄-高龄老龄群体机构养老服务选择的异质性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性低龄老人1.0430.6481.610.108–0.228~2.3132.837
高龄老人1.7290.3694.670.0001.004~2.4535.635
卫生资源可达性低龄老人0.7380.3831.920.054–0.014~1.4902.091
高龄老人0.8320.2133.910.0000.415~1.2502.297
健康保障低龄老人0.3920.1602.440.0150.077~0.7081.479
高龄老人0.3630.1123.230.0010.142~0.5831.437
控制变量控制
时间/个体效应控制
), ArticleFig(id=1321169751515181745, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=EN, label=Tab.3, caption=

Adjusted influence of health resource availability, accessibility, and health insurance on institutional care choice among older Chinese residents living in urban, township, and rural areas: a mixed-effects logistic regression analysis of panel data from the 2011, 2013, and 2018 waves of the CLHLS

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性城市–0.4880.273–1.790.074–1.024~0.0470.614
乡镇1.4330.5832.450.0140.288~2.5774.191
农村1.8500.4164.440.0001.033~2.6666.360
卫生资源可达性城市–0.1320.474–0.280.781–1.062~0.7980.876
乡镇0.6190.3052.030.0430.020~1.2171.857
农村1.0840.2484.370.0000.598~1.5712.956
健康保障城市0.4380.2331.880.060–0.019~0.8941.550
乡镇0.3260.1552.090.0360.021~0.6311.385
农村0.3400.1721.980.0480.003~0.6781.405
控制变量控制
时间/个体效应控制
), ArticleFig(id=1321169751599067826, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=CN, label=表3, caption=

卫生资源配置、健康保障对不同居住地类型老龄群体机构养老服务选择的异质性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类β $ S_{\overline{x}} $χ2值P值95%CIExp(β)
卫生资源可得性城市–0.4880.273–1.790.074–1.024~0.0470.614
乡镇1.4330.5832.450.0140.288~2.5774.191
农村1.8500.4164.440.0001.033~2.6666.360
卫生资源可达性城市–0.1320.474–0.280.781–1.062~0.7980.876
乡镇0.6190.3052.030.0430.020~1.2171.857
农村1.0840.2484.370.0000.598~1.5712.956
健康保障城市0.4380.2331.880.060–0.019~0.8941.550
乡镇0.3260.1552.090.0360.021~0.6311.385
农村0.3400.1721.980.0480.003~0.6781.405
控制变量控制
时间/个体效应控制
), ArticleFig(id=1321169751657788083, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=EN, label=Tab.4, caption=

Differential influences of health resource availability and accessibility, healthcare security, demographics, life satisfaction, health status, and pension status on the choice of institutional elderly care services among older Chinese residents (≥65 years): analyses of panel data from the CLHLS in 2011, 2013, and 2018 using generalized estimating equation logit/probit models

, figureFileSmall=null, figureFileBig=null, tableContent=
变量logit模型probit模型
β $ S_{\overline{x}} $χ2值P值95%CIβ $ S_{\overline{x}} $χ2值P值95%CI
卫生资源可得性1.1990.2464.8700.0000.716~1.6810.5520.1154.8100.0000.326~0.776
卫生资源可达性0.6600.1474.4800.0000.371~0.9480.2620.0663.9600.0000.132~0.391
健康保障0.3440.0704.920.0000.207~0.4820.1450.0314.650.0000.084~0.207
省份–0.1230.094–1.3100.191–0.308~0.061–0.0620.041–1.5100.131–0.143~0.018
年龄0.0200.0101.9000.057–0.001~0.0400.0080.0051.7400.083–0.001~0.016
性别–0.5410.192–2.8200.005–0.917~–0.165–0.2280.083–2.7400.006–0.391~–0.065
省份–0.1230.094–1.3100.191–0.308~0.061–0.0620.041–1.5100.131–0.143~0.018
居住地类型–0.4080.133–3.0700.002–0.668~–0.147–0.1790.057–3.1200.002–0.290~–0.066
同居状况–0.8660.122–7.0700.000–1.105~–0.625–0.3710.051–7.2600.000–0.471~–0.271
生活满意度0.2610.1182.2000.0280.028~0.4920.1230.0522.3700.0180.021 4~0.224
受教育程度0.2540.1202.1100.0340.018 6~0.4890.1260.0562.2600.0240.016~0.235
健康状况0.3810.1113.4200.0010.162~0.5980.1580.0483.2700.0010.063~0.252
养老保障–0.2120.129–1.6400.101–0.465~0.041–0.0910.056–1.6200.104–0.200~0.018
婚姻状况0.3920.2121.8400.065–0.024~0.8080.1700.0901.8800.060–0.006~0.346
), ArticleFig(id=1321169751724896948, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169740962312815, language=CN, label=表4, caption=

广义估计模型稳健性检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量logit模型probit模型
β $ S_{\overline{x}} $χ2值P值95%CIβ $ S_{\overline{x}} $χ2值P值95%CI
卫生资源可得性1.1990.2464.8700.0000.716~1.6810.5520.1154.8100.0000.326~0.776
卫生资源可达性0.6600.1474.4800.0000.371~0.9480.2620.0663.9600.0000.132~0.391
健康保障0.3440.0704.920.0000.207~0.4820.1450.0314.650.0000.084~0.207
省份–0.1230.094–1.3100.191–0.308~0.061–0.0620.041–1.5100.131–0.143~0.018
年龄0.0200.0101.9000.057–0.001~0.0400.0080.0051.7400.083–0.001~0.016
性别–0.5410.192–2.8200.005–0.917~–0.165–0.2280.083–2.7400.006–0.391~–0.065
省份–0.1230.094–1.3100.191–0.308~0.061–0.0620.041–1.5100.131–0.143~0.018
居住地类型–0.4080.133–3.0700.002–0.668~–0.147–0.1790.057–3.1200.002–0.290~–0.066
同居状况–0.8660.122–7.0700.000–1.105~–0.625–0.3710.051–7.2600.000–0.471~–0.271
生活满意度0.2610.1182.2000.0280.028~0.4920.1230.0522.3700.0180.021 4~0.224
受教育程度0.2540.1202.1100.0340.018 6~0.4890.1260.0562.2600.0240.016~0.235
健康状况0.3810.1113.4200.0010.162~0.5980.1580.0483.2700.0010.063~0.252
养老保障–0.2120.129–1.6400.101–0.465~0.041–0.0910.056–1.6200.104–0.200~0.018
婚姻状况0.3920.2121.8400.065–0.024~0.8080.1700.0901.8800.060–0.006~0.346
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卫生资源配置、健康保障与老龄群体养老服务选择分析
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满小欧 *, * , 姜石勇
中国公共卫生 | 调查报告与分析 2025,41(9): 1112-1117
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中国公共卫生 |调查报告与分析 2025 , 41 (9) : 1112 -1117
卫生资源配置、健康保障与老龄群体养老服务选择分析
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满小欧(1983— ),副教授,博士,研究方向:公共政策,公共卫生管理

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满小欧*, * , 姜石勇
作者信息
  • 东北大学文法学院,沈阳 110169
通讯作者:
满小欧,E-mail:
作者简介:

满小欧(1983— ),副教授,博士,研究方向:公共政策,公共卫生管理

Associations of health resource allocation and health security with preferences for elderly care services among older adults in China: an analysis of CLHLS data
Xiaoou MAN , Shiyong JIANG
Affiliations
  • School of Humanities and Law Northeastern University, Shenyang, 110169, China
  • Corresponding Author:
    MAN Xiaoou, E-mail:
出版时间: 2025-09-10 doi: 10.11847/zgggws1145209
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目的

了解卫生资源配置、健康保障对我国老龄群体养老服务选择的影响,为促进健康老龄化发展提供参考依据。

方法

收集中国老年健康影响因素跟踪调查(CLHLS)2011、2014和2018年面板数据中2 444名≥65岁老龄人群样本,使用混合效应logit回归(MLR)模型分析卫生资源配置、健康保障对老龄群体养老服务选择的影响,并从年龄、居住地类型进行异质性分析,使用广义估计模型(GEE)设定不同的链接函数(logit和probit)进行稳健性检验。

结果

卫生资源可得性(β=1.587,P<0.05)和卫生资源可达性(β=0.790,P<0.05)越高、健康保障水平越高(β=0.38,P<0.05),老龄群体选择机构养老的概率更高;反之,老龄群体选择居家养老的概率更高。异质性结果表明,卫生资源可得性和卫生资源可达性均对高龄老人(≥80岁)影响显著(β=1.729,P<0.05; β=0.832,P<0.05);健康保障对低龄和高龄老人养老服务选择影响均显著(β=0.392,P<0.05; β=0.363,P<0.05);卫生资源可得性、卫生资源可达性和健康保障对乡镇老龄群体养老服务选择影响均显著(β=1.433,P<0.05; β=0.619,P<0.05;β=0.326,P<0.05);卫生资源可得性、卫生资源可达性和健康保障对农村老龄群体养老服务选择影响均显著(β=1.850,P<0.05; β=1.084,P<0.05;β=0.340,P<0.05)。

结论

卫生资源配置和健康保障对于老龄群体养老服务选择存在显著影响,同时卫生资源配置对不同年龄段和居住地类型老年群体影响存在差异,健康保障对不同居住地类型老龄群体影响存在差异。

卫生资源可得性  /  卫生资源可达性  /  健康保障  /  养老服务选择  /  老年人
Objective

To explore the impact of health resource allocation and health security on the choice of elderly care services among China's elderly population, and to provide insights for promoting healthy aging.

Methods

The panel data of 2 444 elderly people aged over 65 years old were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2011, 2014, and 2018. A mixed-effects logit regression model (MLR) with random effects was used to analyze the impact of health resource allocation and health security on the choice of elderly care services. Age heterogeneity was examined through subgroup analysis based on age and residence type. The robustness of the results was tested by comparing different link functions (logit and probit) using generalized estimating equations (GEE), which were chosen to account for potential model misspecification and to ensure the reliability of the results.

Results

Health resource availability (β = 1.587, P < 0.05), health resource accessibility (β = 0.790, P < 0.05), and health security (β = 0.380, P < 0.05) were significantly associated with increased odds of the elderly choosing institutional care. Specifically, after exponentiating the beta coefficients, for each 1-grade increase in health resource availability, health resource accessibility, and health security, the odds of the elderly choosing institutional care increased by a factor of 4.89, 2.20, and 1.46, respectively (all P < 0.05). Heterogeneity analysis results indicate that both the availability (β = 1.729, P < 0.05) and accessibility (β = 0.832, P < 0.05) of health resources have a significant impact on the choice of elderly care services for the oldest elderly (≥ 80 years); the impact of health security on the choice of elderly care services for both the young elderly (β = 0.392) and the oldest elderly (β = 0.363) is significant (both P < 0.05); the availability of health resources (β = 1.433), accessibility of health resources (β = 0.619), and health security (β = 0.326) have a significant impact on the choice of elderly care services for the urban elderly population (all P < 0.05); availability of health resources (β = 1.850), accessibility of health resources (β = 1.084), and health security (β = 0.340) have a significant impact on the choice of elderly care services for the rural elderly population (all P < 0.05).

Conclusions

The allocation of health resources and health security significantly influence the choice of elderly care services. The allocation of health resources affects different age groups and residential types of the elderly population differently, while the impact of health security varies across residential types.

health resource availability  /  health resource accessibility  /  health security  /  pension service choice  /  older adults
满小欧, 姜石勇. 卫生资源配置、健康保障与老龄群体养老服务选择分析. 中国公共卫生, 2025 , 41 (9) : 1112 -1117 . DOI: 10.11847/zgggws1145209
Xiaoou MAN, Shiyong JIANG. Associations of health resource allocation and health security with preferences for elderly care services among older adults in China: an analysis of CLHLS data[J]. Chinese Journal of Public Health, 2025 , 41 (9) : 1112 -1117 . DOI: 10.11847/zgggws1145209
国家统计局数据显示,2024年我国≥60 岁人口已达3.10亿人。预计到2050年,≥60岁老年人口数量将接近5亿,≥65岁人口比重将达29%,老龄化带来的健康保障与养老服务问题也将日益突出[1]。《健康中国2030规划纲要》指出,要推进老年医疗卫生服务体系建设,促进健康老龄化[2]。国家卫生健康委老龄健康司也特别强调,协同推进健康中国和积极应对人口老龄化战略,做好新时代老龄健康工作。尽管已有研究围绕卫生资源配置的公平和效率问题[3–4],医疗健康保障对老龄群体健康状况的影响[5–6]等进行了探讨,但两者对老年群体养老服务选择的影响却鲜有关注。因而,本研究收集中国老年健康影响因素跟踪调查(the Chinese Longitudinal Healthy Longevity Survey, CLHLS)2011、2014和2018年面板数据中2 444名≥65岁老龄人群样本,使用混合效应logit回归模型(the mixed-effect logit regression model,MLR)分析卫生资源配置和健康保障对我国老龄群体养老服务选择的影响及其异质性,为推动健康老龄化提供参考借鉴。
资料来源于由北京大学健康老龄与发展研究中心开展的中国老年健康影响因素跟踪调查(CLHLS),该数据库包含了我国≥65岁老龄群体家庭和个人的高质量微观数据样本[7]。本研究采用2011、2014和2018年3期调查数据构建了面板数据,以≥65岁老龄群体为研究样本,在对各年份数据进行清理,剔除关键变量缺失和异常值样本后,最终获得2 444个有效样本。
采用混合效应logit回归模型(MLR)评估卫生资源配置和健康保障对老龄群体养老服务选择的影响。相较于传统logit回归模型,混合效应logit回归模型可以更好地处理离散选择问题,并通过引入固定效应和随机效应减少结果估计偏差。具体建立计量模型如下:样本中养老服务变量选择符合伯努利分布,即:
$ Y\mathrm{~}Bernoulli({P}_{i}) $其中,$ {P}_{i} $是卫生资源配置和健康保障导致个体i选择机构养老的概率,1-$ {P}_{i} $表示个体选择居家养老的概率。概率$ {P}_{i} $通过对数联结函数与一组协变量相关联,可得公式:
$ \mathrm{Logit}(Y)=\mathrm{ln}\left(\frac{P_i}{1-P_i}\right)=\beta_0+\beta_1^TX_{st}+\beta_2^TX_{dc}+\lambda_i+\delta_i+\varepsilon_i $
其中$ {X}_{st} $是本研究的核心自变量卫生资源配置与健康保障,$ {X}_{dc} $表示老龄群体在人口统计学特征的自变量,$ {\beta }_{i} $(i=0、1、2)是回归参数,表示模型中自变量对因变量的影响效果。$ {\lambda }_{i} $表示个体异质性的截距项,$ {\delta }_{i} $表示时间效应,$ {\epsilon }_{i} $是随机扰动项。由于卫生资源配置和健康保障对于不同年龄段、居住地老龄群体养老服务选择的影响可能存在异质性,进一步对低龄老人(65~79岁)与高龄老人(≥80岁)、城市、乡镇和农村老人进行异质性检验。最后,通过使用广义估计模型(generalized estimating equations, GEE)对模型估计结果进行稳健性检验。
本研究将养老服务选择作为因变量,根据问卷中“您希望哪一种居住方式”,将“独居”“子女同居”定义为居家养老,赋值为0,“敬老院、老年公寓或福利院”定义为机构养老,赋值为1。根据研究设计及相关研究,选择以下变量作为自变量:(1)卫生资源配置。通过“卫生资源可达性”和“卫生资源可得性”对卫生资源的配置状况进行测量。卫生资源可达性根据问卷中“从您家到最近的医疗机构有多远?”测量和赋值[8],1~4分别代表“1 km以内”“1到5 km”“5到20 km”“20 km以上”。卫生资源可得性根据问卷中“如果您生重病,请问能及时到医院治疗吗?”进行测量(0=是、1=否)。(2)健康保障。根据问卷中“您目前有哪些社会保障和商业保险?”进行测量,依据健康保障水平排序(1=无医疗保险、2=城乡居民医疗保险、3=商业医疗保险、4=城镇职工医疗保险、5=公费医疗保险),其中,我国商业医疗保险中普惠性补充医疗保险受众最广,其保障水平介于城乡居民与城镇职工医疗保险之间[9]。由于老人养老服务选择亦受到人口学、社会经济等特征的影响,将老人年龄、性别(1=男性、2=女性)、婚姻状况(0=无配偶、1=有配偶)、居住地(1=城市、2=乡镇、3=农村)、受教育程度(1=小学及以下、2=初中、3=高中、4=大学及以上)、健康状况(1=很好、2=好、3=一般、4=不好、5=很不好)、同居状况(1=独居,2=与配偶,3=与子女等亲属)、养老保险(1=城镇职工养老保险、2=城乡居民养老保险、3=无养老保险)、生活满意度(1=很满意、2=满意、3=一般、4=不满意、5=很不满意)作为研究的控制变量。
借鉴已有研究[10],使用广义估计模型(GEE)设定不同的链接函数(logit和probit)进行稳健性检验。使用Stata18.0软件进行一般描述性分析、χ2检验、混合效应logit回归模型(MLR)分析,以P<0.05为差异有统计学意义。
2 444名研究对象平均年龄为(81.27±8.75)岁,其中低龄老人(65~79岁)占比为48.38%(1 182人),高龄老人(≥80岁)占比为51.62%(1 262人),老龄群体年龄组别差异有统计学意义(χ2=48.89,P<0.05)。男性1 142人(46.73%),女性1 302人(53.27%)。居住地为城市、乡镇、农村的老年人分别占比为16.03%(392人)、36.13%(883人)、47.85%(1 169人),老龄群体居住地差异有统计学意义(χ2=19.85,P<0.05)。研究对象中选择居家养老的老龄群体占比94.71%(2 315人),机构养老占比5.29%(129人)。卫生资源可得性中可以及时获得治疗的老龄群体占比94.2%(2 302人);卫生资源可达性中72.95%(1 783人)的老年群体距离最近的医疗机构在1~5 km范围内。健康保障方面,13.88%(339人)的老年人没有任何的医疗保障,有城乡居民医疗保险、商业医疗保险、城镇职工医疗保险、公费医疗的老年人分别占比46.69%(1 141人)、3.53%(86人)、23.28%(569人)、12.62%(308人)。除上述因素外,不同居住地、同居状况、生活满意度、健康状况、养老保障、婚姻状况方面比较差异均有统计学意义(均P<0.05)。
混合效应logit回归模型(MLR)分析结果显示,在控制相关变量以及时间与个体效应后,卫生资源可得性($ \beta $=1.587,P<0.05)和卫生资源可达性($ \beta $=0.790,P<0.05)的降低会显著提高老龄群体选择机构养老的概率,卫生资源可得性和卫生资源可达性每增加1个单位,老龄群体选择机构养老的概率分别上升4.89倍和2.2倍(均P<0.05)。健康保障方面,保障水平的提高会显著提高老龄群体选择机构养老的概率,具体而言,保障水平每提高1个单位,老龄群体选择机构养老的概率会增加1.46倍(P<0.05)。同时,不同年龄、性别、居住地类型、同居状况、生活满意度、受教育程度、健康状况均对老龄群体养老服务选择存在显著影响(均P<0.05)。
研究结果表明,卫生资源可得性对于高龄老人的养老服务选择存在显著影响(β=1.729,P<0.05),但对低龄老人的养老服务选择影响不显著(β=1.043,P>0.05),表明相较于卫生资源“可得”的高龄老人,卫生资源“不可得”的高龄老人选择机构养老的概率增加了5.64倍(P<0.05)。卫生资源可达性对高龄老人养老服务选择存在显著影响(β=0.832,P<0.05),但对低龄老人不存在显著影响(β=0.738,P>0.05),卫生资源可达性距离每增加1个单位,高龄老人选择机构养老的概率增加2.30倍(P<0.05)。健康保障对低龄和高龄老人的养老服务选择均存在显著影响(均P<0.05),保障水平每提高1个单位,低龄老人和高龄老人选择机构养老的概率分别增加了1.48倍(β=0.392,P<0.05)和1.44倍(β=0.363,P<0.05)。
研究结果表明,卫生资源可得性对于乡镇(β=1.433,P<0.05)和农村(β=1.850,P<0.05)老龄群体的养老服务选择存在显著影响,但对城市老龄群体养老服务选择不存在显著影响(β= –0.488,P>0.05),表明相较于卫生资源“可得”的乡镇和农村老龄群体性,卫生资源“不可得”的乡镇和农村老龄群体选择机构养老的概率分别增加4.19倍(P<0.05)和6.36倍(P<0.05)。卫生资源可达性对乡镇(β=0.619,P<0.05)和农村(β=1.084,P<0.05)老龄群体养老服务选择均存在显著影响,但对城市老龄群体养老服务选择不存在显著影响(β= –0.132,P>0.05),卫生资源可达性距离每增加1个单位,乡镇和农村老龄群体选择机构养老的概率分别增加1.86倍(P<0.05)和2.96倍(P<0.05)。健康保障对乡镇(β=0.326,P<0.05)和农村(β=0.340,P<0.05)老龄群体的养老服务选择存在显著影响,对城市老龄群体养老服务选择不存在显著性影响(β=0.438,P>0.05),保障水平每提高1个单位,乡镇和农村老龄群体选择机构养老的概率分别增加1.39倍(P<0.05)和1.41倍(P<0.05)。
使用广义估计模型(GEE)设定不同的链接函数(logit和probit)进行稳健性检验。分析结果显示,影响系数和显著性水平与基准回归估计结果基本一致,较好地验证了前文基准回归的结论,即卫生资源配置、医疗保障对老龄群体养老服务选择具有显著影响。
本研究结果显示,卫生资源配置对老龄群体养老服务选择有显著影响,卫生资源可达性和可得性越低,老龄群体选择机构养老的概率越大,这与支梦佳等[11]、吴宗辉等[12]和李长远等[13]的结论一致。卫生资源可得性和卫生资源可达性体现了获得医疗服务的效率和难易程度,可得性和可达性越低,老龄群体选择机构养老的概率越高;反之,则倾向于选择居家养老方式。在医疗保障方面,不同类型医疗保障对老龄群体养老服务选择有显著影响。相较于无医疗保险覆盖人群,城乡居民医疗保险、商业医疗保险、城镇职工医疗保险、公费医疗等医疗保险随着健康保障水平的不断提高,覆盖的老龄群体选择机构养老的概率更高;反之,随着健康保障水平的降低,老龄群体选择居家养老的概率更高,这与张博锴等人[14]的结论相符。可能的原因在于,就医的经济成本是影响老年生活质量和养老服务选择的重要因素,医疗保障的待遇水平越高,越可能分散其养老风险与压力。相较于城乡居民医疗保险,城镇职工医疗保险和公费医疗保障水平和费用报销比例更高,可以有效改善其养老预期,尝试新型的机构养老模式。
异质性方面,卫生资源可得性和卫生资源可达性对高龄老人养老服务选择产生了显著影响,对低龄老人影响不显著,说明相较于低龄老人,高龄老人受到其自身状况的影响,其医疗服务需求更高,在选择养老服务过程中对卫生资源可得性和可达性更具敏感性[15–16]。同时卫生资源可得性与可达性对城市老龄群体养老服务选择影响不显著,对乡镇和农村影响显著,说明相较于城市居民,乡镇和农村老龄群体受到交通便利程度和空间距离等影响,其对卫生资源可得性和可达性需求弹性更大,对其养老服务选择存在显著影响。健康保障对农村和乡镇老龄群体养老服务选择影响显著,而对城市老龄群体影响不显著。可能的原因在于,农村和乡镇老龄群体其养老服务供给单一,而城市老龄群体在进行养老服务选择中,社区养老更为普及,其养老服务供给更为多样,同时经济承受能力和待遇给付水平更高,因而健康保障并非显著影响养老服务选择的因素[17–19]。
综上可见,医疗卫生资源和医疗健康保障已成为影响老龄群体养老服务选择的重要因素。为实现健康老龄化与积极老龄化,应缩小城乡基本健康服务差距,切实提高实际城乡居民医疗保险待遇水平,减轻老龄群体的医疗负担,进一步推动基层医疗资源下沉,提高乡镇与农村医疗资源可得性和可达性,从而提高老龄群体养老选择的自主性。

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2025年第41卷第9期
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doi: 10.11847/zgggws1145209
  • 接收时间:2024-08-30
  • 首发时间:2026-10-25
  • 出版时间:2025-09-10
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  • 收稿日期:2024-08-30
  • 修回日期:2024-09-24
  • 录用日期:2025-04-02
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    东北大学文法学院,沈阳 110169

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满小欧,E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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