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英文文献：Aging and Health Financing in the US:A General Equilibrium Analysis-美国的老龄化和健康融资:一般均衡分析
英文文献作者：Juergen Jung,Chung Tran,Matthew Chambers
英文文献摘要：
We quantify the effects of population aging on the US healthcare system. Our analysis is based on a stochastic general equilibrium overlapping generations model of endogenous health accumulation calibrated to match pre-2010 U.S. data. We find that population aging not only leads to large increases in medical spending but also a large shift in the relative size of public vs. private insurance. Without the Affordable Care Act (ACA), aging itself leads to a 36:6 percent increase in health expenditures by 2060 and a 5 percent increase in GDP which is driven by the expansion of the healthcare sector. The group-based health insurance (GHI) market shrinks, while the individual-based health insurance (IHI) market and Medicaid expand significantly. Additional funds equivalent to roughly 4 percent of GDP are required to finance Medicare in 2060 as the elderly dependency ratio increases. The introduction of the ACA increases the fraction of insured workers to 99 percent by 2060, compared to 81 percent without the ACA. This additional increase is mainly driven by the further expansion of Medicaid and the IHI market and the stabilization of the GHI market. Interestingly, the ACA reduces aggregate health care spending by enrolling uninsured workers into Medicaid which pays lower prices for medical services. Overall, the ACA adds to the fiscal cost of population aging mainly via the Medicare and Medicaid expansion.
我们量化了人口老龄化对美国医疗体系的影响。我们的分析基于内生健康积累的随机一般均衡世代重叠模型，该模型与2010年前的美国数据进行了校准。我们发现，人口老龄化不仅导致医疗支出大幅增加，而且公共保险与私人保险的相对规模也发生了巨大变化。如果没有《平价医疗法案》(Affordable Care Act, ACA)，到2060年，老龄化本身就会导致医疗支出增长36:6个百分点，而由医疗保健部门扩张带动的GDP增长则会达到5%。以团体为基础的健康保险(GHI)市场萎缩，而以个人为基础的健康保险(IHI)市场和医疗补助大幅扩张。随着老年人抚养比率的上升，2060年医疗保险需要大约相当于GDP 4%的额外资金。到2060年，ACA的引入将参保工人的比例提高到99%，而没有ACA的工人比例为81%。这一额外的增长主要是由医疗补助和IHI市场的进一步扩大以及健康保险市场的稳定推动的。有趣的是，ACA通过将没有保险的工人纳入医疗补助计划(Medicaid)，从而减少了医疗保健的总支出，后者为医疗服务支付的价格更低。总的来说，ACA主要通过联邦医疗保险(Medicare)和联邦医疗补助(Medicaid)的扩张，增加了人口老龄化的财政成本。
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