Research On Medical Insurance And Medical Resource Decision Making

In 2020,it was proposed in the government work report that the People’s medicare level should be increased.The contradiction between supply and demand in the field of medical resources has been difficult to be solved effectively under the background of increasing the input of medical insurance subsidy year by year.How to improve the level of medicare should be discussed from the individual level of demand for in-depth analysis of the problem.Individual medical resource decision-making(whether to seek medical treatment,how to choose medical treatment(out-patient/in-patient),how to choose medical institution and how to spend medical treatment)has always been the way for each insured person to participate in the medical system,and is directly related to the individual’s medical effect.However,how to improve the utilization efficiency of limited medical resources and the level of medicare by understanding the mechanism of the influence of medical insurance on the decision-making of medical resources has not been studied.Therefore,it is necessary to analyze the real risk decision-making in order to find out the mechanism and process that the real medical resources decisionmaking is influenced by the risk management.Based on the above background,this paper chooses the medical insurance and the medical resources decision-making as the research object,and analyzes the logical relationship between them.By analyzing the influence mechanism of medical insurance on the decision-making process of medical resources,the existing research can be enriched,and then the level of medical security can be effectively improved.This dissertation analyzes the impact mechanism,heterogeneity and outcomes of medical insurance on medical resource decision-making from the theoretical and empirical perspectives.First of all,from the perspective of theoretical research,the theoretical model and related assumptions of the impact mechanism of medical insurance on medical resources decision-making provide the logical support for the following analysis.This paper combines the weight idea of prospect theory with the Expected utility hypothesis model,strictly stipulates the theoretical hypothesis,and constructs the theoretical model of health insurance and health care resource decision,which can improve the actual explanation strength of the model.The model obtains the insurance critical point of individual decision-making to seek medical treatment,and uses the comparative static analysis method,to study the influence of wealth,expenditure of medical resources,health loss,risk aversion,risk-free interest rate and risk-free interest rate on the critical point of individual medical insurance decision-making,we can draw a series of theoretical research hypotheses: Hypothesis 1: health insurance changes individual’s medical decision-making probability;Hypothesis 2: in a certain period of time,health insurance has a greater influence on the medical decision-making probability of the people with the worse health status;Hypothesis 3: health care has a greater impact on health care decision-making for people with lower income;Hypothesis 4: health care affects health care decision-making by changing subjective mediator variables;Hypothesis 5: health care expenditure for people with health care is higher;Hypothesis 6: health care is more beneficial,or more effective,to people with higher costs of funding--that is,lower incomes.Hypothesis 7: on the premise of relatively limited medical resources,medical insurance affects the result of medical resources allocation by changing the medical resources decision-making(utilization degree).Secondly,in terms of empirical research,this article successively analyzes the impact mechanism of medical insurance on medical resource decision-making,impact heterogeneity and individual and overall impact results.The results provide a realistic basis for the relevant assumptions of the theoretical model.1.In the aspect of the impact mechanism of medical insurance on medical resource decision-making,by selecting the 2015 China Health and Pension Tracking Survey(CHARLS)sample data,the structural equation model analysis of the relationship between medical insurance and medical resource decision-making can verify that medical insurance affects medical resources The effectiveness of the influence mechanism in the theoretical model of decision-making.The analysis results show that the personal resources for seeking medical care determined by medical insurance are one of the factors that significantly influence the decision-making of subjective medical care.It verifies the hypothesis that medical insurance influences medical decisionmaking through subjective intermediary variables in Hypothesis 4.The path through which medical insurance can influence medical resource decisions(subjective medical treatment decisions,medical expenditures,and choice of medical institutions)includes:Article 1 is medical insurance → personal medical resources → subjective medical decision;Article 2 is medical insurance → personal medical resources → subjective Medical treatment decision → medical expenditure;Article 3 is medical insurance →personal resources for medical treatment → subjective medical treatment decision →choice of medical institution.The impact of various types of medical insurance on medical decision-making,the selection of medical institutions,and medical expenditures in descending order are: urban employee medical insurance,public medical care,medical assistance,commercial medical insurance purchased by units,commercial medical insurance purchased by individuals,and urban residents medical insurance.The changes in personal wealth,health improvement,and medical expenditures are all reflected in the decision of medical insurance affecting medical resources,and medical insurance has an impact on subjective medical decisions.These results are completely consistent with the theoretical assumptions of this article.According to the results of the structural equation model,the different significant path results of different medical insurances and the diversified development of the medical insurance market coincide with the goal of providing differentiated medical insurance services according to the needs of different medical resources.In the future,matching personal medical resources with personal medical needs and providing differentiated medical resource services is of great significance for realizing medical insurance and promoting the efficient operation of medical resources.2.In the aspect of the heterogeneity of medical insurance influencing medical resource decision-making,this article considers the problem of sample selection bias.By selecting CHARLS 2018 data and performing propensity score matching analysis on the sample,it can be concluded that the existence of medical insurance has a specific medical resource decision(Whether to see a doctor,medical expenses,medical institutions,etc.).The research results show that:(1)Medical insurance significantly affects the decision-making of medical resources as a whole;(2)Participating in medical insurance significantly increases the probability of individual medical treatment(increased hospitalization rate by 5.7%,and outpatient visit rate by 3.5%),verify hypothesis 1;Participating in medical insurance significantly increases medical expenditures(hospitalization expenditures)by about 3.5 times,verifying Hypothesis 5;and medical insurance significantly decentralizes the choice of individual medical institutions;(3)The influence of medical insurance on medical resource decisionmaking is significantly different among people with different wealth status,The impact of medical insurance is greater and more significant among the low-wealth groups,but the role of medical insurance is in hospitalization expenditures,and the high-wealth groups are still higher than those of the low-wealth groups;(4)Medical insurance has a more significant impact on the medical resource decision-making of non-healthimproving groups.This effect is not significant for people with improved health,and hypothesis 2 is verified.Although medical insurance has a significant impact on individual medical resource decision-making,there are huge differences in the impact of different types of wealth status and health improvement groups.3.In the aspect of the result analysis of the influence of medical insurance on medical resources decision-making,this paper analyzes the result of the influence of medical insurance on medical resources decision-making from the angle of the individual and the whole,which can provide the reference for the healthy and effective development of medical insurance.At the individual level,using the sample data from the China elderly health impact tracking survey(CLHLS),the two-part model was used to evaluate whether the effect of health insurance on medical resource decision-making could reduce the individual medical burden.Overall,the study found,health insurance significantly reduces the relative spending burden on the household economy.The results show that:(1)the new rural cooperative medical system(NCMS)plays a more important role in reducing inpatient out-of-pocket expenses and in-patient out-patient expenses;However,it can not lead to effective medical decision-making,which is related to the coverage of commercial medical insurance and the design of diversified structures.(3)the goal of medical insurance for people with poor health status has not been achieved,this group has a relatively high out-of-pocket rate.The results show that:(1)the reduction of outof-pocket rate of hospitalization of the middle-and high-income group is more significant than that of the low-income group;(2)the reduction of out-of-pocket rate of hospitalization of the high-income group is more significant than that of the low-income group,this is not in line with the goal of universal and equal access to health care services,which requires appropriate expansion of health care for low-income groups;(3)the poorer the income,the worse the inpatient health care,the result of the health change shows that the inpatient medical security is more friendly to the high-income group,and the health inequity is very significant.(4)the low-income group has a lower out-patient out-of-pocket payment rate in the group with relatively poor self-rated health,middle-and high-income groups are even higher,indicating that some people may not be able to get effective medical treatment after illness due to the problem of medical price,(5)the new rural cooperative medical care system has realized the mutual aid of medical treatment among farmers through the overall planning of major diseases and the consideration of minor pathological claims,the goal of ensuring and improving the medical needs of people with poor health status has been achieved.(6)in the reimbursement of hospitalization expenses,medical insurance can effectively realize the medical security function by meeting the medical needs caused by health problems.In general,Medicare can significantly reduce the out-of-pocket rate of the insured,among which free medical care,urban workers/residents health insurance benefits the middle-and high-income groups.On the whole,based on the construction of the Coordination Index of Supply and demand of medical resources,based on the panel data on the balance of health insurance and medical resources in 31 provinces from 2010 to 2017,including China Statistical Yearbook,China Health Statistical Yearbook,China Labor Statistical Yearbook and China Demographic and Employment Statistical Yearbook,from the overall level of the impact of health care resources decision-making results were analyzed.The results show that:(1)the rate of medical insurance affects the coordination level of medical resources,but the effect is different in different regions,the eastern part promotes,the central part suppresses;(2)the education level,income and population structure are also the significant influencing factors of the coordination degree of the supply-demand coupling of medical resources.The overall evaluation results are more conducive to the improvement of the medical insurance system in terms of regional,population and health-related factors on the basis of individual medical resource decision-making,the medical insurance system is more conducive to the whole society to ease the contradiction between supply and demand of medical services and improve the efficiency of medical resource allocation.This paper makes some contributions in the following aspects:(1)analyzing the influence of medical insurance on medical resources decision-making from the perspective of subjective behavior decision-making,and discussing the behavior decision-making of the insured under different circumstances;(2)more creatively combine the decision weight thought of prospect theory with the traditional expected utility model to establish a rigorous theoretical model,and adopt the more general premium form and the derivation of expected utility condition,the medical decisionmaking under different constraints greatly expands the existing theoretical research results and enhances the reality explanation dynamics;(3)from the angle of causality between medical insurance and medical resources decision-making,using structural equation model,the subjective risk decision-making of medical insurance through influence as endogenous latent variable is logically given,and then lead to the conclusion of the medical resources decision.In the form of model path,the causal logic relationship between them is obtained;(4)it enriches the heterogeneous conclusion and result evaluation of the influence of medical insurance on the decisionmaking of medical resources,and provides powerful policy suggestions and theoretical support for the sound and effective development of China’s current medical insurance system;(5)the Coordination Index of supply and demand coupling of medical resources is constructed to examine the coordination degree of supply and demand of medical resources allocation.The results are helpful to the balanced adjustment and healthy development of our medical system as a whole.