动态健康冲击下的中老年家庭金融风险评估

《财经研究》 2022年48卷第2期 页码：153 - 168  online：2022年2月2日

动态健康冲击下的中老年家庭金融风险评估

Financial Risk Assessment of Middle-aged and Elderly Families under Dynamic Health Shocks

作者（中）：张冀, 史晓, 曹杨

作者（英）：Zhang Ji, Shi Xiao, Cao Yang

作者单位：1.对外经济贸易大学 保险学院, 北京 100029

摘要：尽管健康冲击对家庭金融风险具有显著影响，但现有研究在健康类型、影响程度以及影响机制等方面还存在不同结论。文章基于家庭资产负债表，构建包含财务边际和偿付能力在内的家庭金融脆弱性指标来衡量家庭金融风险，并分析了四种健康冲击对中老年家庭金融脆弱性的影响及传导机制。研究发现：我国中老年家庭金融脆弱性上升趋势明显，而健康冲击进一步加大了中老年家庭金融脆弱性，尤其是中等收入家庭和农村家庭，但不同种类健康冲击对中老年家庭金融脆弱性的影响程度具有显著异质性。其中，重大疾病对中老年家庭金融脆弱性的影响程度是其他健康冲击的4倍。上述效应的传导机制是，健康冲击通过降低家庭收入或增加家庭支出显著提高了中老年家庭金融风险。但不同健康冲击的影响机制存在差异，一般健康冲击主要通过支出增加提高中老年家庭金融风险，而重大疾病通过支出增加和收入减少共同提高中老年家庭金融风险，表明中老年家庭应重点防范重大疾病引发的金融风险。进一步讨论发现，社会医疗保险对提高家庭应对健康风险冲击的作用有限，而商业健康保险可以显著提高家庭偿付能力，弥补社会医疗保险的不足部分，尤其是重大疾病风险。因此，我国应加大税优型商业健康险的优惠力度，放宽健康险的年龄界限，提高家庭商业医疗险的持有量，强化中老年家庭对健康风险冲击的应对能力，进而降低中老年家庭的金融脆弱水平。

关键词：家庭金融风险; 家庭金融脆弱性; 健康冲击; 重大疾病冲击; 医疗保险

Summary: Household financial risk is an important leading indicator for judging the national economic development trend and macro-financial stability, and the assessment of household financial risks is the prerequisite and basis for household economic decision-making and macro-policy formulation. At present, scholars mostly assess household financial risks from the perspective of household financial fragility, which can assess household financial risks as a whole. Among different age groups, the financial vulnerability of middle-aged and elderly families is particularly obvious, which is determined by the increase of medical expenditure caused by the decline of physical function and the decline of income caused by the decrease of labor ability. This paper uses the data from the China Health and Retirement Longitudinal Study (CHARLS). Firstly, this paper constructs household financial vulnerabilities including financial margin and solvency. Secondly, four health impact indicators including self-assessment, ADLs, common and major chronic diseases are constructed, and this paper uses the Random Effect Ordered Probit to analyze its heterogeneous impact on the financial risks of middle-aged and elderly families. Finally, this paper analyzes the impact of health shocks on the income side and expenditure side of middle-aged and elderly families with different incomes, as well as the role of medical insurance. The results show that the financial vulnerability of middle-aged and elderly households in China is on the rise, and health shocks have further increased the trend, especially middle-income and rural households. However, the impact degree and transmission mechanism of different types of health shocks on the financial vulnerability of middle-aged and elderly families are significantly heterogeneous. The impact of major diseases on the financial vulnerability of middle-aged and elderly families is four times that of other health shocks, mainly because major diseases not only increase the expenditure, but also reduce the income, while general health shocks only affect household financial risks by increasing the household expenditure. In addition, commercial health insurance can significantly improve the solvency of middle-aged and elderly families, especially to deal with the risk of major diseases. The academic value of this paper could be concluded in three aspects: Firstly, it builds household financial fragility based on the balance sheet, and expands the research on household financial fragility. Secondly, it constructs a multi-dimensional health indicator that includes the head of the household and his spouse, and more comprehensively analyzes the impact of different health shocks at the family level on household financial risks. Finally, using the Random Effect Ordered Probit model, and combined with the instrumental variable method to solve the endogenous problem, it can not only control the random heterogeneity at the family level, but also use the maximum likelihood method to estimate the parameters of nonlinear instrumental variable regression, which effectively controls endogeneity.

Key words: household financial risks; household financial vulnerability; health shocks; major disease shock; medical insurance

DOI：10.16538/j.cnki.jfe.20210813.201

收稿日期：2021-1-21

基金项目：国家社会科学基金重点项目（17AJY027）；对外经济贸易大学中央高校基本科研业务费专项资金（CXTD9-05）

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