Page 12 - 《中国药房》2022年20期

我国老年人自我药疗对医疗支出、健康状况的影响——基于

2018年CHARLS数据的实证分析 Δ

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严小雨 ，常 峰 ，路 云，杨 奕（中国药科大学国际医药商学院，南京 211198）
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中图分类号 R95 文献标志码 A 文章编号 1001-0408（2022）20-2438-05
DOI 10.6039/j.issn.1001-0408.2022.20.02

摘 要 目的 探究我国老年人自我药疗对医疗支出及健康状况的影响，为老龄化背景下老年患者的医疗服务选择和健康状况改
善提供理论参考。方法 基于2018年中国健康与养老追踪调查（CHARLS）数据，分别利用Tobit回归模型和有序Probit回归模型
实证研究老年人自我药疗对医疗支出及健康状况的影响，并进行稳健性检验和异质性分析，以分析模型结果的稳健性和不同个体
自我药疗对医疗支出、健康状况影响的差异性。结果 9 770位受访者的平均年龄为68.8岁，74.5%为小学及以下文化程度，多居住
在农村地区或户口类型为农业户口；近半数受访者的自评健康状况为“一般”，85.0%的受访者患有慢性疾病，近半数受访者存在
不同程度的失能；有60.7%的受访者进行过自我药疗；受访者医疗支出的对数平均值为8.8。Tobit回归结果显示，老年人的自我药
疗行为会使医疗支出（取对数值）显著降低0.116个单位（P＜0.05）。有序Probit回归结果显示，自我药疗对健康状况有显著负向影
响（P＜0.01）。稳健性检验结果与Tobit回归和有序Probit模型结果基本一致；异质性分析结果表明，小学及以下文化程度、患有慢
性疾病人群的自我药疗虽能降低医疗支出，但其健康风险更高。结论 自我药疗虽能够缓解医疗负担、降低医疗费用，但在一定程
度上损害了老年人的健康状况；可通过采取鼓励合理的自我药疗、加强居民自我用药教育等措施来尽量避免其带来的健康损害，
使其在医疗保健系统中发挥积极作用。
关键词 老年人；自我药疗；医疗支出；健康状况；影响因素；实证分析

Influence of self-medication on medical expenditure and health status of the elderly in China：empirical
analysis based on 2018 CHARLS data
YAN Xiaoyu，CHANG Feng，LU Yun，YANG Yi（School of International Pharmaceutical Business，China
Pharmaceutical University，Nanjing 211198，China）

ABSTRACT OBJECTIVE To explore the influence of self-medication on medical expenditure and health status of the elderly in
China，so as to provide theoretical reference for the selection of medical services and the improvement of health status of elderly
patients under the background of aging. METHODS Based on the 2018 China Health and Retirement Longitudinal Study
（CHARLS）data，Tobit regression model and ordered Probit regression model were adopted to empirically study the influence of
self-medication on medical expenditure and health status of the elderly. In addition，a robustness test was performed to verify the
robustness of the model results，and a heterogeneity analysis was conducted to explore the difference of the influence of self-
medication on medical expenditure and health status among different individuals. RESULTS The average age of the 9 770
respondents was 68.8 years old，74.5% of whom had primary school education or less，and most of them lived in rural areas or had
a agricultural household registration type；nearly half of the respondents rated their health status as“fair”，85.0% of respondents
suffered from chronic diseases，and virtually half had varying degrees of disability. A total of 60.7% of respondents had self-
medicated，and the log mean of the respondents’medical expenditures was 8.8. Tobit regression results showed that self-medication
behaviors in the elderly significantly reduced medical expenditure （logarithmically） by 0.116 units （P＜0.05）. The results of
ordered Probit regression showed that self-medication had a significant negative impact on health status（P＜0.01）. The results of
the robustness test were consistent with the results of the Tobit regression and ordered Probit models. The results of the
heterogeneity analysis suggested that the self-medication of people with primary education or less and chronic diseases may reduce
medical expenditure，but at a higher health risk. CONCLUSIONS While self-medication can alleviate the medical burden and
reduce medical expenditure，it damages the health of the elderly to a certain extent. Therefore，it can play a positive role in the
health care system by encouraging rational self-medication and enhancing self-medication education to avoid health damage.
KEYWORDS elderly；self-medication；medical expendi-ture；health status；influencing factors；empirical analysis

Δ 基金项目 国家医疗保障局规划财务和法规司服务购买项目
＊第一作者 硕士研究生。研究方向：医疗保障政策、药物经济学。 近年来，我国人口老龄化的趋势日益加剧，2021 年
E-mail：3220040576@stu.cpu.edu.cn
国家统计局发布的第 7 次全国人口普查数据显示，2020
# 通信作者 教授，博士生导师。研究方向：药品价格与采购政策、
卫生技术评估。E-mail：cpucf@163.com 年我国总人口数为14.118亿，其中60岁及以上人口2.64

·2438· China Pharmacy 2022 Vol. 33 No. 20 中国药房 2022年第33卷第20期