《保险研究》20230405-《医疗支出、临终痛苦与和缓医疗制度必要性研究——基于微观数据的定量分析》（张跃华、刘君毅、田燕）

［摘   要］随着中国老龄化、高龄化时代的到来，临终医疗支出的影响不仅在临终痛苦，也使得社会医疗保险基金面临巨大的压力。本研究主要分析临终医疗支出对老年人临终痛苦的影响，为和缓医疗制度的实施提供实证研究基础。研究根据中国健康与养老追踪调查(CHARLS)2013年退出样本全国追踪数据，通过普通最小二乘法(OLS)检验受访者临终前的医药费用、住院费用和总医疗费用分别对临终痛苦频率和临终痛苦症状的影响，并借助医疗报销金额作为工具变量(IV)解决内生性相应的问题。结果表明，临终前的各项医疗花销会显著加深人们的临终痛苦。本文在一定程度上弥补了中国临终医疗全国性微观数据经济学研究的不足。

［关键词］临终关怀；和缓医疗；安宁疗护；临终痛苦；医疗支出

［基金项目］本研究受到教育部人文社科规划项目（20YJA790093），国家社科基金重大项目（19ZDA117、21ZDA101），以及中央高校基本科研业务费专项资金、浙江大学文科教师教学科研发展专项项目资助。

［作者简介］张跃华，浙江大学公共管理学院、浙江大学长三角智慧绿洲创新中心、浙江大学民生保障与公共治理研究中心教授，浙江大学中国特色社会主义研究中心研究员；刘君毅、田燕,浙江大学公共管理学院研究生。

A Study on the Medical Expenditure,End of Life Pain and the Necessity of a Palliative Medical System—A Quantitative Analysis Based on Microscopic Data

ZHANG Yue-hua,LIU Jun-yi,TIAN Yan

Abstract：With the advent of China′s aging society,the impact of end of life medical expenditure is not only limited to end of life pain,but also puts tremendous pressure on the social medical insurance fund.This study mainly analyzes the impact of end of life medical expenses on the pain of the dying elderly and provides an empirical research basis for the implementation of the palliative care system.The study is based on the China Health and Retirement Longitudinal Study (CHARLS),which withdrew from the national tracking data in 2013,and examines,by the ordinary least squares (OLS) method,the impacts of medical expenses,hospitalization expenses,and total medical expenses of the respondents before the end of life on the painful frequency and symptoms of dying.It uses medical reimbursement amount as an instrumental variable (IV) to solve the problem of endogeneity.The results of the study show that the medical expenses before the end of life will significantly deepen people′s dying pain.To a certain extent,this paper makes up for the shortcomings of the national micro-data economics research on China′s hospice care.

Key words：hospice care;palliative care;peaceful and soft care;end of life pain;medical expenditure