There have seen significant improvements in public health, wealth and medical technologies for decades, contributing to improved population health and thereby longer life expectancy. It is thus of no surprise that the elderly population increases rapidly in many societies both in absolute amount and proportion. Many reports have also indicated that the Chinese population is increasingly transformed into intensified aging society. Although currently the medical expenditure growth explained by the elderly is not an issue in China yet, consider the fact that the elderly is more likely to demand medical care and thus to incur greater expenses, its possible long-term impact should not be neglected. Without appropriate assessment of how this change affects the demand and consumption of medical care, any policy-setting or reform regarding the healthcare provision for the elderly or the healthcare system as a whole is doomed to fail. The main purpose of this thesis is to examine factors that affect the demand for and use of medical care among the elderly based on Grossman's human capital theory. In order to analyze the relation between these factors and elderly self-assessed health and medical consumption, this study collected data from a questionnaire survey on the elderly located in two Beijing communities. The results of the seemingly unrelated regression model indicated that medical accessibility, insurance benefits, education and other socio-economic statuses are the main reasons why elderly reported different health statuses and medical care use. More specifically, the elderly who are protected by more generous insurance, wealthier and more educated are more likely to receive more high-quality medical care, while others only access cheaper but lower quality community health care. Although in the interview the rural elderly did not show a poorer self-assessed health status accordingly, the real differences in health status and financial burden behind this "optimistic" phenomenon is worth further discussion. Based on the results, suggestions about narrowing the differences in the demand and medical use between city and rural elderly can be made. First, a well-functioned community healthcare centre is an efficient and affordable way to provide health care and chronic follow-up services that elderly need. While the quality of community healthcare centre has been an issue of argument, more financial incentives can be offered so as to attract more better-qualified medical professionals working there. Second, differences in insurance benefits, such as coverage and refund regulation, have reportedly influence the beneficiaries' abilities and incentives to use medical services, so had the elderly. A straightforward way to mitigate this problem is, as currently the government has been doing, to increase the insurance coverage and other benefits for the rural population. Because the financial affordability is apparently lower in the rural area, however, the effectiveness of this measure remains to be seen. Key Words: The demand of medical care, Grossman's human capital theory, The elderly

公共衛生的改善、財富的增加以及醫療科技的進步不但提升人類健康,也使人們的預 期壽命(life expectancy)明顯增加。相反地,隨著婦女的生育意願與生育率的降低,老 年人佔社會人口的比例不斷增高。再者,由於老年人的醫療服務需求明顯有別于其他年齡 組,衍生的醫療費用往往是年輕人的3-5倍。雖然目前老齡人口對我國醫療費用的增長影 響尚不明顯,但其長期對我國醫療費用增長的影響不應被忽視。尤其隨著多年來生育水平 下降和人們健康水平的提高,可以預期的是,未來我國人口類型將從輕度轉變成重度老龄 化,此一轉變所反映的醫療需求與費用的變化,勢必對現有的醫療衛生體系帶來重大衝 擊。 本研究以 Grossman 健康資本理論為基礎,嘗試分析影響老年人使用醫療服務的因 素,並以北京城鎮與農村老人作為研究對象,進行問卷調查與實證分析,除描述性的分析 城市和農村老年人的基本健康情況和人口學特徵,並以非相關相似回顧模型 Seemingly un related regression 分析老人自我健康評量以及其他社會經濟背景對醫療支出的影響,希望 能為今後與老年人相關的衛生政策制定提供理論與實證基礎。 由回歸分析的結果,我們了解老人居住所在地所代表的醫療資源與保險條件、教育程 度以及社會經濟背景是造成老人在自我健康評量與之後的醫療服務使用方面差異的主要原 因。享有較“慷慨”保險給付、較富裕以及具有較佳社會經濟地位的老人,更容易接受較 多、質量較高的醫療服務。雖然相較城市老人,農村老人並沒有因此對自身的健康有較差 的評估,但是醫療服務使用的質與量上的差距,以及背後所隱含的實質健康與家庭負擔, 卻值得政府相關單位的重視。 在兼顧醫療分級、服務效率與財政負擔的考量下,我們建議一個功能健全的社區衛生 中心可以提供老年人常規保健服務以及之後的慢性病持續治療。政府可以利用增加財務誘 1 澳門大學碩士學位論文 因的方式,增加優秀醫療人員投入社區衛生服務中心工作的動機,來提升基層醫療品質。 再者,各類保險不同的給付條件、範圍與還款規範等的差異,可能會影響老年人使用醫療 服務的能力與意願。最直接的方法,當然是提高農村合作醫療的覆蓋範圍與給付水準。但 是由於農村居民的支付、風險分擔能力較薄弱,若無政府更進一步積極的介入支持,這項 做法在多大程度上能改善農村居民的醫療服務利用,尚待進一步的觀察。 關鍵詞: 醫療衛生需求,Grossman 健康需求理論,老年人 2