在人口老齡化和老年醫療支出城鄉差異凸顯的背景下,中國醫療費用增長部分源于合理的健康需求。利用中國營養與健康調查1991—2011年的八輪數據,構造出生組跟蹤樣本,分別考察城鄉居民醫療支出的年齡效應,估算城鄉老年醫療需求導致的費用上漲,可以發現:城市居民的人均醫療支出隨年齡顯著增加,但農村居民的人均醫療支出隨年齡增長的趨勢并不明顯。而忽略出生組效應,會低估城鄉老年醫療支出的差距。城鄉老年醫療支出差距縮小,將導致醫療費用在2010—2030年年均實際增長約5.2%。在控制醫療總費用上漲的同時,醫療保險制度需根據老年醫療需求,調整醫療資源配置結構。

In the context of population ageing and the growing gap in senior citizens’ medical costs between urban and rural areas,China’s rising medical costs are partly due to rational demand for healthcare.Using data from eight rounds of the China Health and Nutrition Survey from 1991 to 2008,we created birth cohort tracking samples to study the age effect on medical costs in urban and rural areas.Estimating the rise in costs caused by senior citizens’ medical needs in urban and rural areas,we found that urban residents’ average medical costs showed a marked rise with age,but there was no clear trend in the medical costs of rural residents over the age of 65.Ignoring the birth cohort effect results in underestimation of the gap between urban and rural medical costs for the elderly.Reducing this gap would result in an average rise in real medical costs of around 5.2 percent per annum between 2010 and 2030.Population ageing exerts greater pressure on rising medical costs in China than in developed countries.The health insurance scheme should adjust the distribution of medical resources in accord with the medical needs of the elderly at the same time as it keeps medical costs under control.