背景：我国日益严重的人口老龄化问题，使得老年人群给医疗服务体系带来了严峻挑战，为了缓解“看病难、看病贵”问题，我国逐步建立起三大基本医疗保险制度，即城镇职工基本医疗保险，城镇居民基本医疗保险和新型农村合作医疗制度。由于三保并行存在着严重的失衡问题，为了提高医疗服务的公平性、可及行和可负担性，2016年1月国务院印发《关于整合城乡居民基本医疗保险制度的意见》，将城镇居民医保和新农合整合为城乡居民医保。目的：本次研究的主要目的是分析城乡居民医保制度整合对我国老年人群健康状况和生活满意度的影响，由此评价城乡居民医保整合的实施效果。方法：本研究以中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）为基础，选取2015年和2018年随访数据，以年龄≥60岁的老年人群作为研究对象，从健康状况自我评价和生活满意度等多个维度，来分析城乡居民医保制度整合对我国老年人群的影响。结果：本次研究共纳入研究对象4364人，其中城乡居民医保整合组694人（15.90%），未整合组3670人（84.10%）。城乡居民医保整合组健康状况自我评价显著优于未整合组（20.74% vs 17.41%，P=0.038），且上升幅度更大（5.74% vs 3.12%），健康状况自我评价更好（OR=1.281，P=0.021）。城乡居民医保整合组的人群生活满意度显著优于未整合组（94.80% vs 91.87%，P=0.009），生活满意度更高（OR=1.376，P=0.028）。健康状况自我评价在城乡居民医保制度整合对生活满意影响的作用中存在部分中介效应，效应值为0.050（P=0.043），中介效应在总效应中所占的比例为46.66%。结论：城乡居民医保制度整合有利于老年人群健康状况得到一定的改善，提高老年人群的生活满意度，具有积极的现实意义。未来应继续加强对城乡居民医保制度的普及，提高医保待遇水平，建立健全更加合理的筹资机制，促进农村医疗服务质量提升，进一步改善老年人群健康水平。
Background：With the deepening of population aging in China, a large number of elderly people have brought great challenges to the medical service system. In order to alleviate the problem of "difficult and expensive to see a doctor", China has gradually established three core medical insurance systems, namely urban employee's basic medical insurance (UEBMI), urban resident basic medical insurance (URBMI) and new rural cooperative medical scheme (NRCMS). Due to the serious imbalance of the three medical insurances, in order to improve the equity, accessibility and affordability of medical services, the State Council in China issued "The opinions on the Integration of the basic medical insurance system for urban and rural residents" in January 2016, integrating the URBMI and NRCMS into a unified urban and rural resident basic medical insurance (URRBMS). Objectives：The main aim of this study is to analysis the impact of urban and rural residents medical insurance system integration on the health status self-evaluation and life satisfaction of the elderly in China, so as to evaluate the implementation effect of the URRBMS integration.Methods：This study is based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2018, taking the implementation of the integration of URRBMS as the observation factor, and the elderly people over 60 years old as the research object. The impact of the integration of URRBMS on the elderly population is evaluated from the dimensions of health status self-evaluation and life satisfaction. Results：A total of 4364 subjects were analyzed in this study, including 694 (15.90%) in the URRBMS integration group and 3670 (84.10%) in the non-integration group. The results show that the self-evaluation of health status in the URRBMS integration group was significantly higher than that in the non-integration group (20.74% vs 17.41%，P=0.038), and the increase was greater (5.74% vs 3.12%). The health status self-evaluation of people with URRBMS integration is better (OR=1.281，P=0.021).The life satisfaction of the URRBMS integration group was 94.80%, which is significantly higher than that in the non-integration group (91.87%，P=0.009). The life satisfaction is better in the URRBMS integration group(OR=1.376，P=0.028). There was a partial mediating effect of the health status self-evaluation on the impact of URRBMS integration on the life satisfaction, with the effect value of 0.050 (P = 0.043), the proportion of mediating effect in the total effect accounted for 46.66%.Conclusion：The urban and rural residents medical insurance system integration is beneficial to improve the the self-evaluation of the health status and life satisfaction for the elderly, which has a positive practical significance. In the future, further actions should be taken to strengthen the publicity of the URRBMS, constantly improve the medical insurance treatment level for urban and rural residents, establish a more reasonable financing mechanism, promote the quality of medical services in rural areas, and finaly improve the health level of the elderly population.
