Research On The Impact Of Critical Illness Insurance On Residents’ Medical Expenses

People health is an important symbol for prosperity and power of a country and a nation.In the new era for socialism with characteristics in China,people’s requirements on medical security are changing from treatment of illness to comprehensive and complete-period health security.However,after rapid expansion for a dozen years,the intended functions of the basic medical insurance for urban and rural residents have been excessively magnified.It deviates from the principle of “ensuring basic health coverage” on both design and implementation,undertaking too many additional functions and leading to great weakening on resisting against risk of major illness.In order to solve the problem of unbalanced and insufficient medical security development,the government of our country made the decision to introduce the critical illness insurance to the framework of the basic medical insurance for urban and rural residents in 2012,to solve the problem of high medical expenses caused by hospitalization,treatment of serious illnesses in outpatient services and public health crisis epidemic treatment,to avoid expenditure-type poverty by residents,so as to compensate for insufficiency in the function of serious illness security of the basic medical insurance.The critical illness insurance has been rapidly promoted after it was proposed,and covered almost the whole country in 2016.What influences are caused to medical expenses of residents by the critical illness insurance? Can it relieve residents’ burdens on critical illness effectively? There have been not profound discussions on this problem so far.The research on influences of medical expenses by the critical illness insurance contributes to evaluating the policy effect of the critical illness insurance and understanding the transmission mechanism of the effect,playing theoretical and practical roles in establishing the sustainable multilevel medical security system covering all people,with urban and rural overall development,clear rights and liabilities and appropriate security,so as to create the new situation of healthy China.This article involves in theoretical and practical research about critical illness insurance and medical expenses of residents.Firstly,the article starts from the perspective of system demand,to analyze the development changes in the critical illness insurance policy as well as medical expenses of residents.On this basis,it constructs the theoretical analysis framework for the influencing effect of the critical illness insurance and the transmission mechanism and proposes the research hypothesis.By utilizing the data of China Labor-force Dynamic Survey(CLDS)during 2014 – 2016,it conducts empirical tests with the two-part model,the logit model and the OLS regression.The article is divided into the following six parts:The first part is the introduction.It introduces the background for the topic,as well as the significance of the research on theory and practice.In addition,it proposes the research ideas,main contents,research methods and possible creations of the article based on existing researches.The second part is the theoretical basis.It illustrates the core concepts in this research including critical illness risks,critical illness insurance and medical expenses of residents,as well as health demand theories and medical service utilization theories that are taken as references,to lay a theoretical foundation for influences on medical expenses of residents by critical illness insurance.The third part is the analysis on changes in systems.According to the retrospection of the three stages of the critical illness insurance,including spontaneous exploration,popularization of experimental units and complete coverage,it arranges the changes in policy design and the reforms in practical exploration.In addition,it clarifies the functional orientation of the critical illness insurance on the theoretical layer as coordination between ensuring the basic needs and the bottom security of medical assistance.The fourth part is the descriptive statistics.The article then conducts vertical and horizontal comparisons on medical expenses of residents and medical service utilization conditions on aspects such as population mean conditions and conditions in genders,urban and rural areas,regions,economic conditions and ensured state,so as to master the medical expense conditions of residents in a comprehensive way.The fifth part is the empirical analysis on the influence effect of the critical illness insurance on medical expenses of urban and rural residents.It verifies the demand release effect and the burden relieving effect of the critical illness insurance on medical expenses of residents on three dimensions including total medical expenses,total hospitalization expenses and self-paid expenses for hospitalization.In addition,it inspects the differences of such effects in groups of different income standards.Besides,it deals with possible endogenous problems,and conducts robustness test.The sixth part involves in the empirical analysis on the transmission mechanism of the influencing effect of the critical illness insurance.Firstly,it conducts theoretical analysis on the transmission mechanism,to find out the two transmission approaches for the critical illness insurance to give rise to influences on medical expenses of residents.It then verifies the roles played by the two transmission approaches by utilizing the logit model,the OLS regression model and the treatment effect model.Finally,it conducts the robustness test.The seventh part involves in the conclusion of the research.It introduces the main conclusion of the article.On this basis,it analyzes the reasons for the conclusions and proposes suggestions on policies in a targeted way,to expect the research in the future.Based on theoretical and empirical analysis,the following conclusions are drawn in this article:Firstly,the critical illness insurance has significant medical demand release effect.On the one hand,the critical illness insurance can further stimulate residents to release their medical demands: The possibility in total medical expenses of insured residents is increased by 8% and the total actual medical expenses is increased by 3% after the overall implementation of the critical illness insurance.The critical illness expenses are in the same condition.Although the possibility of hospitalization expenses is not increased significantly,the actual hospitalization expenses are increased by 13%.On the other hand,the critical illness insurance exhibits the distinct characteristic of “priority to poor people” in demand release.The overall medical demands in groups of middle group,lower group and the lowest group as well as the critical illness medical demands in groups of middle group and the lowest group are released effectively.The basic conclusion is kept unchanged when taking endogenous conditions and robustness test with differences between urban areas and rural areas into consideration.It’s worth noting that the medical demands released by critical illness may be necessary medical demands restrained by economic conditions or excessive demands caused by increased moral hazards by the supplier due to lowered threshold for medical services.Secondly,the critical illness insurance has not given full play in burden relieving.The basic medical insurance could reduce the self-paid expenses for hospitalization effectively before the overall implementation of the critical illness insurance.However,the burden relieving effect is not significant after the overall implementation of the critical illness insurance.In addition,with respect to the estimated values of influences on self-paid expenses in hospitalization,the burden relieving ability is reduced by 12%.It may be caused because the critical illness insurance fails to fill in the gap between the total hospitalization expenses and the self-paid expenses in hospitalization at the same time of stimulating residents to release critical illness medical demands of residents.According to regression results in groups of different income standards,only the critical illness burden of the middle income group has been relieved after the appearance of the critical illness insurance,and the other income groups fail to experience sufficient burden relieving effect.When observing on the policy design prospective,it is caused mainly by uniform sectional compensation mode,which ignores the differences on purchasing abilities by different income groups and cannot restrain moral hazards of patients.It weakens the ability of the critical illness insurance in resisting against the critical illness risks,and it is difficult to realize the accurate payment to the low income groups.Thirdly,according to the transmission mechanism analysis,the critical illness insurance leads to influences on medical expenses of residents on two channels,i.e.,being insured and benefit availability.The “insured” state can promote residents to make positive decisions in seeking for medical services;especially,it motivates poor people to seek for medical services in time.The increase in benefit availability can promote residents to utilized medical services.However,when compared with the low-income group,the high-income group makes full use of medical services in the critical illness insurance.The inequality in use of medical services between different income groups is expanding,with the same reason: the critical illness insurance compensation policy has no difference and repellent.Based on the above conclusion,this research relies on construction and perfection of the multilevel medical security system and proposes the following policy suggestions: It explores the different compensation policies and improves the burden relieving ability of the critical illness insurance.It creates the dynamic adjusting financing pattern,to ensure that the critical illness insurance finance can develop in a sustainable way.It connects between the critical illness insurance and other security levels,to assist with the construction of the multilevel medical security system.The research has two creative points: Firstly,based on the research on the overall sample policy effect,it further investigates in differences on medical expenses of different income groups due to influences of the critical illness insurance,to conduct in-depth discussion on medical consumption equity caused by the critical illness insurance policy.Such contents have seldom been involved in researches about the critical illness insurance.The exploration in such contents is beneficial to enriching the research contents of the critical illness insurance policy effect and providing more comprehensive suggestions for optimizing the critical illness insurance policy.Secondly,the utilized data is not restrained in only regional data or investigation data oriented to only specific groups.The samples utilized in this research cover the whole country,with characteristics of wide territory,diversified features and large span in ages,leading to estimation results closer to overall conditions.In addition,the investigation periods were just before and after the overall implementation of the critical illness insurance,respectively,providing appropriate data conditions for the cause and effect inference.