医疗支出不确定性与老年家庭消费

李青塬¹　易行健^1,2　杨碧云¹

（1.广东外语外贸大学；2.广东金融学院）

摘要：在加快构建“双循环”新发展格局的战略背景下，建立促进居民消费增长的长效机制具有重要意义。其中，激发老年群体的消费潜力既是畅通国内大循环的重要途径，也是积极应对人口老龄化的关键举措。本文基于预防性储蓄理论和生命周期假说，利用中国家庭金融调查2011—2021年数据，系统识别医疗支出不确定性对老年家庭消费的影响，进而剖析其作用机制与异质性特征。实证结果表明，医疗支出不确定性抑制了老年家庭消费。机制检验发现，该抑制效应主要通过强化预防性储蓄动机实现。交互效应分析表明，提高社会医疗保险报销额度能够缓解该抑制效应。异质性分析表明，在民生支出占比偏低、数字普惠金融发展水平较低的地区，以及农村、单身、金融素养与数字素养较低的家庭中，该抑制效应更为明显。本文的研究对优化城乡医保统筹、发展养老金融以及缩小老年数字鸿沟具有政策启示意义。

关键词：医疗支出不确定性；老年家庭；消费；预防性储蓄；社会医疗保险

作者简介：李青塬，广东外语外贸大学金融学院博士研究生，广州，510006；易行健，广东金融学院数字经济与金融强国建设研究院教授，广东外语外贸大学博士生导师，通信作者，广州，510521；杨碧云，广东外语外贸大学金融学院教授、博士生导师。

基金项目：国家社会科学基金重大项目“新发展格局下居民家庭财富分布研究”（23&ZD045）；国家自然科学基金面上项目“新发展格局背景下贫富差距对居民消费的影响研究：机制、效应与政策”（72273036）；国家社会科学基金一般项目“公共服务数字化促进居民消费的影响机制、效应与对策研究”（23BJL127）

引用格式：李青塬,易行健,杨碧云.医疗支出不确定性与老年家庭消费[J].经济与管理研究,2026,47(2):3-18.

Medical Expenditure Uncertainty and Elderly Household Consumption

LI Qingyuan¹, YI Xingjian^1,2, YANG Biyun¹

(1. Guangdong University of Foreign Studies, Guangzhou 510006;

2. Guangdong University of Finance, Guangzhou 510521)

Abstract: Against the backdrop of the new development paradigm featuring dual circulation, stimulating domestic consumption is pivotal for sustainable economic growth. The elderly are a crucial pillar of domestic demand, and unleashing their consumption potential is vital for smoothing the economic cycle. However, with advancing age and declining physical function, medical expenditure uncertainty (MEU) among the elderly constrains their consumption. Therefore, systematically identifying the impact of MEU on elderly household consumption and analyzing its underlying mechanisms hold theoretical value and practical significance for boosting consumption.

Utilizing micro-level data from the China Household Finance Survey (CHFS) between 2011 and 2021, this paper empirically investigates the impact of MEU on elderly household consumption and employs rigorous econometric models to identify their causal relationship. The empirical results indicate that MEU inhibits consumption among elderly households. This negative impact remains robust even after addressing endogeneity and controlling for household heterogeneity and macroeconomic trends. Mechanism analysis confirms that this inhibition primarily operates by strengthening the precautionary savings motive. Interaction analysis reveals that increasing the reimbursement rate of social medical insurance can alleviate this inhibitory effect. Crucially, higher reimbursement rates act as an effective risk-sharing mechanism, mitigating negative expectations and smoothing consumption paths. Heterogeneity analysis shows significant differences across households and regions. At the macro level, this inhibitory effect is stronger in regions with a low proportion of public welfare expenditure and lagging development of digital inclusive finance. At the micro level, rural households, single-elderly households, and households with lower financial and digital literacy experience more pronounced negative impacts.

The marginal contribution of this paper lies in its focus on Chinese elderly households from the perspective of uncertainty and systematically revealing the mitigating effect of social medical insurance by introducing the reimbursement rate as a measure of risk-sharing intensity. The findings offer clear policy implications. First, policymakers should optimize the integration of urban and rural medical insurance, specifically focusing on raising reimbursement rates and protection levels for rural residents to reduce the precautionary savings motive of rural elderly households. Second, the role of digital technology in risk management should be emphasized. It is necessary to improve the digital literacy of the elderly through age-friendly adaptations and vigorously develop digital inclusive finance to lower information costs and service thresholds, helping elderly households hedge against medical risks using digital tools. Finally, the government should increase investment in public services within the livelihood sector, establish targeted assistance mechanisms for vulnerable groups, such as the single and the oldest-old, and perfect the multi-level medical security system to effectively unleash the consumption potential of elderly households.

Keywords: medical expenditure uncertainty; elderly household; consumption; precautionary saving; social medical insurance

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