贫困地区大病风险冲击下的农户经济行为研究
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摘要
在当前社会经济转型时期,农户作为最基本的社会经济单元直接面对着经济、社会和自然等各类风险的冲击,其中,疾病风险的危害相对更为严重和深远。近年来,随着农村劳动力流动性的提高,居民膳食和生活习惯的改变,环境污染的加重和人口老龄化加剧,农户面临的疾病风险更加复杂和多样化。与此同时,由于农村医疗保障体系不够完善,医疗费用不断攀升,疾病尤其是大病风险的冲击让农户仅仅依靠自身的资源难以应对。农村地区特别是贫困农村地区农户“因病致贫,因病返贫”的现象仍然十分严重。面对大病风险的冲击,农户利用自身拥有的以及外部可以利用的经济资源,采取一切可能的方式来实现家庭效用最大化,从而形成了农户抵御大病风险冲击的一系列经济行为。
本文运用农业经济管理、社会学、卫生经济学和发展经济学等的理论知识和研究方法,以农户为研究对象,利用较大样本的农户调查数据和丰富的案例访谈资料,考察贫困地区大病风险冲击下的农户经济行为。本文的研究旨在通过对农户应对大病风险的行为模式和动机的深入分析,了解农户的医疗保障需求,并据此为医疗服务和政府决策部门提供相关可行的政策建议,以完善农村医疗保障体系,帮助贫困地区的农户摆脱疾病和贫困。
全文共分为七章。第一章,绪论。从关于疾病的中国民谚和一个个人口述史切入,提出论文的研究问题、目标和内容;说明分析所运用的研究方法、研究程序、数据情况;明确论文的研究框架。最后指出本文的创新点和不足之处。第二章,研究的理论基础和文献回顾。首先,对论文所用的关键概念进行界定;然后,阐述本研究的理论基础;最后,对国内外关于疾病风险和农户行为的理论和相关实证研究进行了综述,并在评述国内外研究现状的基础上指出本文研究的方向和意义。第三章,理解贫困地区农户的大病风险。首先,以个体为研究对象,利用大样本农户调查数据和Probit模型考察样本人口疾病的发生状况及其影响因素,从整体上了解贫困地区的疾病发生状况;接着,以农户为研究对象,运用负二项回归模型分析贫困地区农户的大病发生状况及其影响因素;然后,通过构建农户生计资产指标,比较大病农户和非大病农户生计资产的差异来反映大病对农户生计的影响;最后,通过典型案例的分析进一步认识大病对农户经济和劳动力的影响。第四章,研究大病风险冲击下农户的就诊行为。基于农户大病就诊行为的理论分析,分地区、性别、年龄组、家庭经济状况对农户的大病就诊情况进行考察;然后,运用Heckman两阶段模型分析农户的就诊行为,找出影响农户就诊决策和就诊费用的主要因素。第五章,考察大病风险冲击下农户的筹资行为。首先,通过两个大病农户筹资过程和效果鲜明对比的案例,反映筹资对农户应对大病风险的重要性;接着,按照筹资来源渠道的不同,将大病风险冲击下的农户筹资行为分为内源筹资行为和外源筹资行为两种类型,并描述样本农户两类筹资行为;然后,考察大病农户内源筹资行为的选择和外源筹资行为的限制性因素。第六章,分析大病风险冲击下农户的劳动供给行为。基于对劳动供给行为的理论分析,运用丰富的案例资料,探讨大病风险冲击下农户劳动供给的变化。首先,考察大病风险冲击下农户劳动供给的性别调整和年龄调整;然后,对农户应对大病风险时户外劳动供给的增减变化状况进行了分析。第七章,结论和政策建议。总结本文的研究发现,并针对提高农户大病风险保障能力和完善农村医疗保障体系提出了一些政策建议。
本研究的主要发现有:(1)贫困农村地区农户大病发生状况比较严重。大病的发生主要受到家庭人口规模、家庭经济状况、健康意识、卫生服务可及性和是否有新型农村合作医疗保障等因素的影响。(2)大病对贫困地区农户的生计资产及生计策略有显著的影响。大病显著地影响农户的金融资本;对人力资本和物质资本的变化也有重要影响;而社会资本的变化较少地受到影响。(3)农户的大病就诊行为呈现出一些特点:女性大病就诊率较高,但就诊费用却低于男性;贫困农户的大病就诊率和就诊费用都比富裕户和一般户低;65岁及以上的老年人群在大病就诊中处于弱势地位;相对于非慢性病患者,慢性病患者就诊率偏低,但就诊费用却较高。(4)在应对大病风险时,农户广泛使用和依赖了内源筹资的各种行为,而对外源筹资行为的方式利用十分有限。农户对内源筹资各种行为的选择主要依赖农户所拥有的资源禀赋状况的差异而呈现不同;农户外源筹资行为受到一系列制度因素的限制。(5)遭受大病风险的农户原有的农业生产、非农劳动和家务劳动的均衡时间配置发生了变化,农户通过对劳动供给进行调整(如性别、年龄和户外劳动供给增减量)来维持生计。
本研究基于国家级贫困县的大样本农户调查数据和丰富而生动的案例资料,运用定量和定性相结合的研究方法探讨贫困地区大病风险冲击下的农户经济行为。本文的创新主要体现在以下几个方面:
选题方面:本文以贫困地区农户为研究对象,考察经济社会发展和转型时期大病风险冲击下农户的经济行为,丰富了当前主要从生产、消费、投资、技术采用等方面对农户行为研究的知识体系,为深入认识贫困地区农户大病风险处理的行为,提升农户应对大病风险能力和完善农村医疗保障制度提供基础证据。
数据利用方面:本研究利用2007年深入农村实地入户调查的6003个农户调查数据和303户深度访谈的一手资料进行分析。该数据包含的研究变量十分丰富,是当前对贫困地区农户大病风险研究数据库中较新的大规模农户调查数据。该数据中关于农户生计资产的变量以及对大病的划分等,使得本研究能够从较新的视角对农户大病风险及大病风险冲击下的农户经济行为进行深入考察。大样本的农户调查数据为实证分析和检验论文中的主要结论提供了支持;深度访谈案例、原汁原味的农户的语言,更是生动地再现了大病风险冲击下农户的行为过程。
研究方法和手段方面:本研究利用大样本农户调查的数据,运用Probit模型分析样本人群疾病的发生状况及影响因素;运用负二项回归模型分析农户的疾病发生状况及其影响因素;运用Heckman两阶段模型分析农户大病就诊行为,在研究方法和手段上具有规范性、主流性和先进性。同时,个人口述史和典型案例研究,不仅是对大样本数据定量分析结论的支持,还能使读者充分倾听来自农户的声音,真实地感受到农户的需求。
During current social and economic transition, as the basic unit, farm households are confronted directly with the economic, social and natural risks, among which, the impact of illness risk is the most serious and profound. In recent years, the illness risks confronted by farm households have been becoming more complicated and various for the acceleration of rural labor migration, the change of diet and living habit, as well as the aggravation of environment pollution and population aging. On the other hand, in the lack of rural medical care system, medical expenditure of farm households is increasing, and illness, especially the risk of major illness, makes them hardly to cope with just by their own resources. In rural areas, particularly in poverty-stricken areas, health-related poverty is still serious. Faced with the risk of major illness, farm households have formed a series of economic behavior through making use of their own and external economic resources available and adopting every possible approach to achieve the maximum of household economic interests.
Based on theories and researching approaches of agricultural economics and management, sociology, health economics and development economics, the dissertation studies economic behavior of farm households in poverty-stricken areas under the risk of major illness by using large sample sized survey data and abundant case studies and intensive interviews. It aims at finding out farm households' needs for medical care through analyzing their behavior and motivation when coping with major illness, according to which the dissertation puts forward corresponding suggestion for medical service and government policy making, in order to improve rural medical care system and help farm households to get rid of poverty and illness.
The dissertation consists of seven chapters. Chapter 1: Introduction, which puts forward issues, objectives and contents of the dissertation, as well as the researching approach, data information, framework and innovation and weakness. Chapter 2: Theoretical basis and literature review, which defines key concept used in the dissertation, expounds the theoretical basis and then conducting literature review on the risk of illness and farm households' behavior on which it points out the direction and significance of this research. Chapter 3: Analysis on major illness of farm households in poverty-stricken areas. First of all, it finds out illness occurrence in poverty-stricken areas on the whole with individual as the object using large sample sized survey data of farm households and Probit model. And then it analyzes the occurrence of major illness to farm households in poverty-stricken areas by negative binomial regression model regarding farm households as the object. With indexes of farm households' livelihood capitals established, it compares the differences of livelihood capitals of farm households with major illness and those without to find out the impact of major illness on farm households' livelihood. With analysis on representative cases, it further recognizes the impact of major illness on the economy and supply of labor force of farm households. Chapter 4: Analysis of the treatment-seeking behavior of farm households under the risk of major illness. Based on the theoretical analysis of farm households' treatment-seeking behavior, it studies their actual behavior from perspectives of regions, gender, age and household economic situation and finds out factors influencing their treatment-seeking decision and expenditure by Heckman Two-Stage model. Chapter 5: Survey on financing behavior of farm households under the risk of major illness. The importance of financing for farm households with major illness is demonstrated through comparing the financing process and effect of two farm households with major illness. It classifies the financing behavior of farm households under the risk of major illness into two categories according to different sources, which are internal financing and external financing, and makes a detailed description of these two kinds. And then it explores the selection of internal financing behavior and the constraining factors of the external financing behavior. Chapter 6: Study on labor force supply behavior of farm households under the risk of major illness. On the basis of the theory of labor force supply, it analyzes the change of labor force supply with a focus on the adjustment of gender and age, then that out of the household emphasizing the quantity change under the risk of major illness. Chapter 7: Conclusion, which summarizes the findings through the research and puts forward certain suggestions for enhancing farm households' ability to resist major illness and improving rural medical care system.
The findings in the dissertation are as follows. Firstly, the occurrence of major illness to farm households in poverty-stricken areas is rather serious, which is affected by household population and economic situation, health recognition, health service available and the existence of New Rural Cooperative Medical System. Secondly, major illness exerts a remarkable impact on the livelihood capitals and strategies of farm households in poverty-stricken areas. Further, it obviously affects farm households' financial capital, as well as human capital and physical capital, while hardly affects their social capital. Thirdly, the treatment-seeking behavior of farm households with major illness presents several characteristics that the treatment-seeking rate of the female is higher while the treatment expenditure is lower than that of the male and that the treatment-seeking rate and expenditure of poverty-stricken farm households is lower than the rich and so on. Fourthly, when coping with major illness, farm households make a wide use of internal financing and depend heavily on such behavior with a limited use of external financing. The selection of internal financing is greatly varied because of different resources endowment of farm households while the external behavior is constrained by a series of institutional factors. Fifthly, the initial equilibrium of time allocation among agricultural production, non-agricultural work and housework of farm households suffering from major illness is changed. Therefore, they have to adjust their labor force supply such as the adjustment of gender, age and quantity change of labor force supply out of household, to maintain living.
Based on the large sample sized survey data of farm households and abundant cases, the research discusses economic behavior of farm households in poverty-stricken areas under the risk of major illness through quantitative and qualitative analysis. The innovation of this dissertation is represented in following aspects.
The first innovation regards the selection of the research topic. With the farm households in poverty-stricken areas as the object, the dissertation studies the economic behavior of those with major illness under the background of social and economic development and transition. It not only enriches current theoretical system on farm households behavior which is studied from the perspectives of production, consumption, investment and adoption of technology, but also provides evidence for further recognizing treatment behavior of farm households with major illness in poverty-stricken areas, enhancing their ability to cope with it and improving rural medical care system.
With regard to the data utlization, the dissertation uses survey data of 6003 farm households and intensive interviews with 303 ones. Abundant researching variables included, the data is the latest one on farm households with major illness in poverty-stricken area. The dissertation deeply explores the risk of major illness and economic behavior of farm households from new perspectives for the adoption of variables of farm households' livelihood capital and the division of major illness. Further, large sample sized survey data of farm households supports the empirical analysis and conclusion in the research, together with the intensive interviews and folk language showing vividly the behavior of farm households under the risk of major illness.
Concerning the research approaches and means used in the dissertation, it is standardized and advanced. Using large sample sized survey data of farm households, the dissertation makes use of Probit Model to analyze illness occurrence in the sample and the influencing factors, as well as negative binomial regression model for illness occurrence of farm households and the influencing factors and Heckman Model for treatment-seeking behavior of farm households with major illness. In addition, individual oral narration and case studies well supports the conclusion educed from quantitative analysis and make readers deeply perceive farm households' demand for medical care.
本文运用农业经济管理、社会学、卫生经济学和发展经济学等的理论知识和研究方法,以农户为研究对象,利用较大样本的农户调查数据和丰富的案例访谈资料,考察贫困地区大病风险冲击下的农户经济行为。本文的研究旨在通过对农户应对大病风险的行为模式和动机的深入分析,了解农户的医疗保障需求,并据此为医疗服务和政府决策部门提供相关可行的政策建议,以完善农村医疗保障体系,帮助贫困地区的农户摆脱疾病和贫困。
全文共分为七章。第一章,绪论。从关于疾病的中国民谚和一个个人口述史切入,提出论文的研究问题、目标和内容;说明分析所运用的研究方法、研究程序、数据情况;明确论文的研究框架。最后指出本文的创新点和不足之处。第二章,研究的理论基础和文献回顾。首先,对论文所用的关键概念进行界定;然后,阐述本研究的理论基础;最后,对国内外关于疾病风险和农户行为的理论和相关实证研究进行了综述,并在评述国内外研究现状的基础上指出本文研究的方向和意义。第三章,理解贫困地区农户的大病风险。首先,以个体为研究对象,利用大样本农户调查数据和Probit模型考察样本人口疾病的发生状况及其影响因素,从整体上了解贫困地区的疾病发生状况;接着,以农户为研究对象,运用负二项回归模型分析贫困地区农户的大病发生状况及其影响因素;然后,通过构建农户生计资产指标,比较大病农户和非大病农户生计资产的差异来反映大病对农户生计的影响;最后,通过典型案例的分析进一步认识大病对农户经济和劳动力的影响。第四章,研究大病风险冲击下农户的就诊行为。基于农户大病就诊行为的理论分析,分地区、性别、年龄组、家庭经济状况对农户的大病就诊情况进行考察;然后,运用Heckman两阶段模型分析农户的就诊行为,找出影响农户就诊决策和就诊费用的主要因素。第五章,考察大病风险冲击下农户的筹资行为。首先,通过两个大病农户筹资过程和效果鲜明对比的案例,反映筹资对农户应对大病风险的重要性;接着,按照筹资来源渠道的不同,将大病风险冲击下的农户筹资行为分为内源筹资行为和外源筹资行为两种类型,并描述样本农户两类筹资行为;然后,考察大病农户内源筹资行为的选择和外源筹资行为的限制性因素。第六章,分析大病风险冲击下农户的劳动供给行为。基于对劳动供给行为的理论分析,运用丰富的案例资料,探讨大病风险冲击下农户劳动供给的变化。首先,考察大病风险冲击下农户劳动供给的性别调整和年龄调整;然后,对农户应对大病风险时户外劳动供给的增减变化状况进行了分析。第七章,结论和政策建议。总结本文的研究发现,并针对提高农户大病风险保障能力和完善农村医疗保障体系提出了一些政策建议。
本研究的主要发现有:(1)贫困农村地区农户大病发生状况比较严重。大病的发生主要受到家庭人口规模、家庭经济状况、健康意识、卫生服务可及性和是否有新型农村合作医疗保障等因素的影响。(2)大病对贫困地区农户的生计资产及生计策略有显著的影响。大病显著地影响农户的金融资本;对人力资本和物质资本的变化也有重要影响;而社会资本的变化较少地受到影响。(3)农户的大病就诊行为呈现出一些特点:女性大病就诊率较高,但就诊费用却低于男性;贫困农户的大病就诊率和就诊费用都比富裕户和一般户低;65岁及以上的老年人群在大病就诊中处于弱势地位;相对于非慢性病患者,慢性病患者就诊率偏低,但就诊费用却较高。(4)在应对大病风险时,农户广泛使用和依赖了内源筹资的各种行为,而对外源筹资行为的方式利用十分有限。农户对内源筹资各种行为的选择主要依赖农户所拥有的资源禀赋状况的差异而呈现不同;农户外源筹资行为受到一系列制度因素的限制。(5)遭受大病风险的农户原有的农业生产、非农劳动和家务劳动的均衡时间配置发生了变化,农户通过对劳动供给进行调整(如性别、年龄和户外劳动供给增减量)来维持生计。
本研究基于国家级贫困县的大样本农户调查数据和丰富而生动的案例资料,运用定量和定性相结合的研究方法探讨贫困地区大病风险冲击下的农户经济行为。本文的创新主要体现在以下几个方面:
选题方面:本文以贫困地区农户为研究对象,考察经济社会发展和转型时期大病风险冲击下农户的经济行为,丰富了当前主要从生产、消费、投资、技术采用等方面对农户行为研究的知识体系,为深入认识贫困地区农户大病风险处理的行为,提升农户应对大病风险能力和完善农村医疗保障制度提供基础证据。
数据利用方面:本研究利用2007年深入农村实地入户调查的6003个农户调查数据和303户深度访谈的一手资料进行分析。该数据包含的研究变量十分丰富,是当前对贫困地区农户大病风险研究数据库中较新的大规模农户调查数据。该数据中关于农户生计资产的变量以及对大病的划分等,使得本研究能够从较新的视角对农户大病风险及大病风险冲击下的农户经济行为进行深入考察。大样本的农户调查数据为实证分析和检验论文中的主要结论提供了支持;深度访谈案例、原汁原味的农户的语言,更是生动地再现了大病风险冲击下农户的行为过程。
研究方法和手段方面:本研究利用大样本农户调查的数据,运用Probit模型分析样本人群疾病的发生状况及影响因素;运用负二项回归模型分析农户的疾病发生状况及其影响因素;运用Heckman两阶段模型分析农户大病就诊行为,在研究方法和手段上具有规范性、主流性和先进性。同时,个人口述史和典型案例研究,不仅是对大样本数据定量分析结论的支持,还能使读者充分倾听来自农户的声音,真实地感受到农户的需求。
During current social and economic transition, as the basic unit, farm households are confronted directly with the economic, social and natural risks, among which, the impact of illness risk is the most serious and profound. In recent years, the illness risks confronted by farm households have been becoming more complicated and various for the acceleration of rural labor migration, the change of diet and living habit, as well as the aggravation of environment pollution and population aging. On the other hand, in the lack of rural medical care system, medical expenditure of farm households is increasing, and illness, especially the risk of major illness, makes them hardly to cope with just by their own resources. In rural areas, particularly in poverty-stricken areas, health-related poverty is still serious. Faced with the risk of major illness, farm households have formed a series of economic behavior through making use of their own and external economic resources available and adopting every possible approach to achieve the maximum of household economic interests.
Based on theories and researching approaches of agricultural economics and management, sociology, health economics and development economics, the dissertation studies economic behavior of farm households in poverty-stricken areas under the risk of major illness by using large sample sized survey data and abundant case studies and intensive interviews. It aims at finding out farm households' needs for medical care through analyzing their behavior and motivation when coping with major illness, according to which the dissertation puts forward corresponding suggestion for medical service and government policy making, in order to improve rural medical care system and help farm households to get rid of poverty and illness.
The dissertation consists of seven chapters. Chapter 1: Introduction, which puts forward issues, objectives and contents of the dissertation, as well as the researching approach, data information, framework and innovation and weakness. Chapter 2: Theoretical basis and literature review, which defines key concept used in the dissertation, expounds the theoretical basis and then conducting literature review on the risk of illness and farm households' behavior on which it points out the direction and significance of this research. Chapter 3: Analysis on major illness of farm households in poverty-stricken areas. First of all, it finds out illness occurrence in poverty-stricken areas on the whole with individual as the object using large sample sized survey data of farm households and Probit model. And then it analyzes the occurrence of major illness to farm households in poverty-stricken areas by negative binomial regression model regarding farm households as the object. With indexes of farm households' livelihood capitals established, it compares the differences of livelihood capitals of farm households with major illness and those without to find out the impact of major illness on farm households' livelihood. With analysis on representative cases, it further recognizes the impact of major illness on the economy and supply of labor force of farm households. Chapter 4: Analysis of the treatment-seeking behavior of farm households under the risk of major illness. Based on the theoretical analysis of farm households' treatment-seeking behavior, it studies their actual behavior from perspectives of regions, gender, age and household economic situation and finds out factors influencing their treatment-seeking decision and expenditure by Heckman Two-Stage model. Chapter 5: Survey on financing behavior of farm households under the risk of major illness. The importance of financing for farm households with major illness is demonstrated through comparing the financing process and effect of two farm households with major illness. It classifies the financing behavior of farm households under the risk of major illness into two categories according to different sources, which are internal financing and external financing, and makes a detailed description of these two kinds. And then it explores the selection of internal financing behavior and the constraining factors of the external financing behavior. Chapter 6: Study on labor force supply behavior of farm households under the risk of major illness. On the basis of the theory of labor force supply, it analyzes the change of labor force supply with a focus on the adjustment of gender and age, then that out of the household emphasizing the quantity change under the risk of major illness. Chapter 7: Conclusion, which summarizes the findings through the research and puts forward certain suggestions for enhancing farm households' ability to resist major illness and improving rural medical care system.
The findings in the dissertation are as follows. Firstly, the occurrence of major illness to farm households in poverty-stricken areas is rather serious, which is affected by household population and economic situation, health recognition, health service available and the existence of New Rural Cooperative Medical System. Secondly, major illness exerts a remarkable impact on the livelihood capitals and strategies of farm households in poverty-stricken areas. Further, it obviously affects farm households' financial capital, as well as human capital and physical capital, while hardly affects their social capital. Thirdly, the treatment-seeking behavior of farm households with major illness presents several characteristics that the treatment-seeking rate of the female is higher while the treatment expenditure is lower than that of the male and that the treatment-seeking rate and expenditure of poverty-stricken farm households is lower than the rich and so on. Fourthly, when coping with major illness, farm households make a wide use of internal financing and depend heavily on such behavior with a limited use of external financing. The selection of internal financing is greatly varied because of different resources endowment of farm households while the external behavior is constrained by a series of institutional factors. Fifthly, the initial equilibrium of time allocation among agricultural production, non-agricultural work and housework of farm households suffering from major illness is changed. Therefore, they have to adjust their labor force supply such as the adjustment of gender, age and quantity change of labor force supply out of household, to maintain living.
Based on the large sample sized survey data of farm households and abundant cases, the research discusses economic behavior of farm households in poverty-stricken areas under the risk of major illness through quantitative and qualitative analysis. The innovation of this dissertation is represented in following aspects.
The first innovation regards the selection of the research topic. With the farm households in poverty-stricken areas as the object, the dissertation studies the economic behavior of those with major illness under the background of social and economic development and transition. It not only enriches current theoretical system on farm households behavior which is studied from the perspectives of production, consumption, investment and adoption of technology, but also provides evidence for further recognizing treatment behavior of farm households with major illness in poverty-stricken areas, enhancing their ability to cope with it and improving rural medical care system.
With regard to the data utlization, the dissertation uses survey data of 6003 farm households and intensive interviews with 303 ones. Abundant researching variables included, the data is the latest one on farm households with major illness in poverty-stricken area. The dissertation deeply explores the risk of major illness and economic behavior of farm households from new perspectives for the adoption of variables of farm households' livelihood capital and the division of major illness. Further, large sample sized survey data of farm households supports the empirical analysis and conclusion in the research, together with the intensive interviews and folk language showing vividly the behavior of farm households under the risk of major illness.
Concerning the research approaches and means used in the dissertation, it is standardized and advanced. Using large sample sized survey data of farm households, the dissertation makes use of Probit Model to analyze illness occurrence in the sample and the influencing factors, as well as negative binomial regression model for illness occurrence of farm households and the influencing factors and Heckman Model for treatment-seeking behavior of farm households with major illness. In addition, individual oral narration and case studies well supports the conclusion educed from quantitative analysis and make readers deeply perceive farm households' demand for medical care.
引文
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