The Impact Of Medical Insurance On The Cost Of End-of-Life Of The Elderly

With the continuous extension of the average life expectancy of the population and the decline of the birth rate,the aging degree of our country is deepening,and presents the characteristics of aging,chronic disease and disability.It is generally believed that the demand for medical services and the economic burden of diseases of the elderly in our country will increase sharply in the future,the medical expenses of the elderly will increase rapidly,and the sustainable development of the medical insurance fund is facing challenges.In recent years,more and more international studies have found that the medical expenses of the elderly have a “mortality effect”.The terminal stage is a high incidence period of medical expenses for the elderly,which depends on the time to death rather than age.The closer to death,the higher the probability of high medical expenses and the higher the medical expenses.At present,China has not only realized universal medical insurance,but also gradually improved the ability of basic medical insurance.Medical insurance reduces the sensitivity of patients to the price of medical services,which may stimulate the unreasonable growth of medical expenses.The impact of medical insurance on the terminal medical expenses of the elderly has become an important issue to be studied.According to health demand theory,as the elderly grow older,the rate of health depreciation will accelerate,and the marginal efficiency of investment is very low.To maintain a certain level of health,it needs a high cost,and the elderly are often reluctant to invest their time and money in health.Based on this theory,this paper argues that the elderly in the terminal stage,the speed of health depreciation is faster,the period of return on investment is very short,and the payment intention of medical service utilization of the elderly will be lower and lower with proximity to death.However,many international literatures have found that the medical cost of the elderly will rise sharply in the dying stage,which accounts for a large proportion of the total medical cost of the elderly in their whole life.There is a significant difference between theoretical analysis and reality.What causes this difference is the logical starting point of this paper.With the popularization of medical insurance system and the improvement of security benefits,medical insurance has significantly reduced the price of medical services for the elderly.The reduction of medical service price will produce two effects,one is the income effect,the other is the substitution effect.Both effects are reflected in the rising demand for medical services.Whether the income effect and substitution effect brought by medical insurance can improve the willingness to pay for medical consumption of the dying elderly and lead to the rise of medical expenses in the dying stage is the main problem this paper attempts to study.This paper combs the domestic and foreign literature on the elderly hospice medical expenses,and constructs the analysis framework of the impact of medical insurance on the elderly hospice medical expenses.Firstly,it analyzes the distribution law of the elderly’s hospice medical expenses in China;secondly,it examines the impact of medical insurance on the cost of end-of-life of the old people;secondly,it reveals the impact mechanism of medical insurance on the cost of end-of-life care;finally,based on the distribution law and rationality evaluation of the cost of end-of-life care,combined with the impact of medical insurance on the elderly’s hospice medical expenses Finally,the paper put forward the policy reform suggestions of reasonably controlling the hospice medical expenses of the elderly.In order to determine whether the medical expenses of the elderly in China have a terminal effect,this paper used the tracking survey data of the influencing factors of health and longevity of the elderly in China from 2005 to 2018,constructed the near death time as the independent variable,and the total medical expenses,hospitalization expenses and outpatient expenses of the elderly in the past year as the dependent variable,and empirically tests the impact of near death time on the medical expenses of the elderly The results show that the time to death has a significant positive impact on the medical expenses of the elderly.This conclusion confirms that there is a significant hospice effect in the elderly in China,and the medical expenses of the elderly are mainly concentrated in the hospice stage.It shows that the medical expenses of the elderly in China are not evenly distributed,but concentrated in the two years before death.At the same time,compared with the uninsured elderly,the insured elderly consumed more medical resources in the dying stage.Does the hospice effect of medical insurance have an upward effect on the medical expenses of the elderly? In order to answer this question,the fourth chapter uses the tracking survey data of influencing factors of health and longevity of the elderly in China from 2008 to 2018,and uses a two-part model to evaluate the impact of medical insurance on the hospice medical expenses of the elderly.The results show that:(1)medical insurance not only has a significant positive impact on the total medical expenses of the elderly,but also has a significant positive impact on the self-financing medical expenses of the elderly.The results show that medical insurance has the effect of strengthening the hospice effect of medical expenses for the elderly,which will not only promote the increase of medical insurance fund expenditure,but also increase the economic burden of individuals and their families.(2)Among them,the effect of public health care on the elderly’s hospice medical expenses is greater than that of urban workers’ medical insurance and urban and rural residents’ medical insurance on the elderly’s hospice medical expenses.(3)The effect of medical insurance on the terminal medical expenses of the elderly has certain regional and age differences.The promotion effect of medical insurance on the terminal medical expenses of the elderly in the eastern region is greater than that in the central and western regions,which may be related to the higher medical insurance benefits in the eastern region than in the central and western regions.(4)The effect of medical insurance on the cost of end-of-life of the old people with multiple surviving children is greater than that of the old people with no surviving children and only one surviving child.This may be due to the fact that the old people often suffer from disability,dementia and loss of medical consumption sovereignty in the dying stage.The medical consumption in the dying stage is often decided by their children or family members,and the families with multiple children are influenced by traditional filial piety culture It’s easier to make the consumption decision of sudden rescue for the elderly because of the influence and the consideration of "free riding".Medical insurance reduces the medical cost of the dying elderly,leading to high medical expenses.The increase of medical service utilization in the terminal stage may be caused by the income effect of medical insurance,or by the substitution effect of medical insurance.Combined with the previous theoretical analysis,this paper empirically tested the influence mechanism of medical insurance on the medical expenses of the elderly.The results show that:(1)medical insurance significantly improves the probability of timely treatment of the elderly when they are sick at the terminal stage.The main reason is that medical insurance reduces the sensitivity of the dying elderly and their relatives to the price of medical services,releases the demand of the elderly for hospice medical services,and confirms the existence of income effect brought by medical insurance.(2)Medical insurance improves the probability of the elderly choosing to die in the hospital,which is embodied in the choice of the place of death.Compared with dying at home,the insured elderly prefer to die in the hospital.(3)Medical insurance has a significant positive effect on the medical cost of the dying disabled elderly,but has a significant negative effect on the cost of care.The elderly are more likely to choose the hospice and the insured elderly.Increasing the use of medical services and reducing the use of long-term care services are closely related to the current long-term care insurance system in China is still in the pilot stage.As long-term care insurance system has not been formally established in China,the cost of care for the dying elderly is borne by the elderly and their relatives,while medical insurance shares the cost of medical services for the dying elderly.The dying elderly tend to reduce the use of family care services and use more medical services.This substitution effect is essentially a cost transfer.In fact,the body organs of the elderly,especially the elderly,tend to fail rapidly before they die,and the failure of physiological function is an irreversible natural process.Medical treatment is basically ineffective.In addition to palliative treatment,acute treatment will increase the pain of the elderly.In the dying stage,the elderly often suffer from mental retardation and loss of medical consumption sovereignty.Their children and their relatives make medical decisions instead of themselves.Influenced by traditional Chinese filial piety culture,the children of the elderly tend to try their best to treat the elderly.Although medical treatment may not be effective at this time,medical consumption will continue to increase for maintain the vital signs of the elderly.At the same time,because the function of medical insurance cost sharing mechanism strengthens this practice,the elderly will consume a lot of short-term acute treatment costs at the dying stage.However,the effect of acute medical consumption in the terminal stage is not significant on prolonging the amount of life of the elderly,but also increases the degree of pain and reduces the quality of life of the elderly.On the one hand,it brings certain economic burden to the elderly and their families,on the other hand,it increases the payment pressure of medical insurance fund.Based on the above research conclusions,this paper puts forward the following policy recommendations:(1)we should speed up the implementation of long-term care insurance system,use long-term care services instead of medical services,and realize the accurate allocation of medical resources and long-term care resources;(2)vigorously develop hospice care services to improve the quality of life of the dying elderly;(3)based on the concept of value medical care for the dying elderly;Finally,we should abolish the public medical system completely,realize the full coverage of basic medical insurance,and reduce unreasonable medical expenses.