| The competition in the 21st century is the competition of human capital.For a long time,the demographic dividend has promoted rapid economic growth in China,however,in recent years,the population growth rate in China has continued to be low,and China has entered a society with fewer children in 2006 and started to be severely underpopulated in 2016,and the natural population growth rate in 2022 has dropped steeply to-0.60‰.This means that the future total labor force is not optimistic,and the demographic dividend can hardly be maintained for a long time.In this context,the importance of the talent dividend will become increasingly apparent,and the improvement of population quality is an important weight to promote the talent dividend.Health is an important part of human capital,health promotion is an important way to enhance the quality of the population,health issues gradually become a major social issue,General Secretary Xi Jinping has pointed out that "without the health of all people,there is n o comprehensive well-off",and the national health issues are distilled into"Health China "This national strategy reflects the country’s emphasis on people’s health.In fact,with social and economic development,national health has made great progress,but due to the vast size of China,the problem of uneven development between regions persists,and social inequality and health disparities have not yet been properly resolved.The uneven distribution of health means that it is urgent to eliminate health disparities.The Health China strategy is based on the theme of"building and sharing together,health for all",which has the profound connotation of all citizens participating in the construction of a healthy China,sharing the substantial results of health,and ultimately achieving the fundamental goal of health for all.Childhood is the starting point of national life,the health level of children is the initial accumulation of individual human capital,and the health equity of children is the starting point of social justice,so the importance of the health level of children and health equity cannot be underestimated.With the economic and social development,China’s social security system and basic medical insurance system have been improved day by day,but the basic medical insurance for urban and rural residents has been built for a short period of time,and there is still some room for improvement in the system design.The basic medical insurance for urban and rural residents is for residents of all ages,and there is a strong heterogeneity in the protection target,which puts high demands on the system targeting of basic medical insurance.Children have very different physiological and psychological characteristics from adults,and basic medical insurance has not yet provided more targeted institutional arrangements,which may be an important reason for the low coverage rate of children in basic medical insurance and the gap in universal medical insurance.As an important part of the social security system,the basic medical insurance system should not only improve the utilization level of medical services for insured children and thus achieve health promotion,but also play an important role in regulating social distribution and ensuring equity as a secondary distribution tool.The basic medical insurance system has been practiced in China for more than 20 years,and most studies on its effectiveness have concluded that basic medical insurance can significantly promote the health status of the insured,but it has not achieved good economic results.Participation in basic health insurance promotes the level of individual utilization of health services,which leads to the expansion of health care expenditures,especially for low-and middle-income families,making it difficult for low-income groups to obtain satisfactory benefits from basic health insurance.The root of this phenomenon lies in the beneficiary equity of the basic health insurance system:although participation in basic health insurance can promote the health status of individuals more generally,groups with different economic incomes may end up with different levels of health promotion due to different cost-bearing capacity and different cost-benefit ratios,which ultimately leads to inequitable benefits.This suggests that the redistributive function of basic medical insurance in regulating distributional differences and promoting social equity needs to be re-examined and tested.This paper argues that benefit equity should be an important indicator for evaluating the basic medical insurance system,but existing studies have focused more on its health promotion and economic compensation effects and less on the equity effects of basic medical insurance.Based on this,this paper focuses on the health promotion effect of basic medical insurance on children’s health,breaks down the health problems of children as a population into two components:health level and health equity,and evaluates the health level promotion effect and health equity of basic medical insurance by examining the effectiveness of basic medical insurance on children’s health level and health equity,respectively,in an attempt to make a This paper aims to provide a comprehensive evaluation of the basic health insurance system and to provide a more complete system for children.The main content and chapters of this paper are as follows.Chapter 1 is the introduction of this paper.It introduces the research background and significance of the paper,composes the relevant literature,outlines the research contents and methods,builds the research framework,and refines the innovation points of the paper.Chapter 2 is a review of the concepts,theories and related policies of this paper.This chapter systematically defines the core concepts and specifically explains the theoretical origins,and outlines the theoretical logic of the article,discussing the changes,evolution and historical logic of the child health care system.Chapter 3 presents the current situation and specificity of basic health insurance and children’s health problems.The current situation of children’s participation in basic health insurance,as well as the current situation of children’s health level and health equity,is analyzed by gathering the special significance of children’s group and using descriptive statistics.Chapter 4 shows the effect of basic health insurance on children’s health level.This paper divides the health promotion effect into health level promotion and health equity promotion,and Chapter 4 examines the promotion effect of basic medical insurance on children’s health level,and conducts robustness tests,heterogeneity analysis,impact mechanism analysis,and other useful extensions.Chapter 5 presents the effect of basic health insurance on children’s health equity.It examines the contribution of basic health insurance to children’s health equity by examining the extent of health disparities within children’s groups,and conducts robustness tests,heterogeneity analysis,impact mechanism analysis,and other useful extensions.Chapter 6 examines the health promotion effects of the urban-rural integration policy of basic health insurance on children’s health.Based on the discussion of the impact of the basic health insurance system on children’s health,this chapter examines the evolution of this system and its contribution to children’s health levels and health equity.Chapter 7 presents the study conclusions and recommendations for countermeasures.It is a summary and overview of the full research findings and proposes policy implications for improving basic health insurance and promoting children’s health level and health equity on the basis of the research findings.The main innovations of this paper are reflected in the following four aspects.(1)The uniqueness of the analysis perspective:the two-way dimension of children’s health level and health equity.As an early stage in the life cycle of an individual,the health level of a child has an important impact on the individual throughout his or her life.A well-functioning,fair and orderly social policy can bring equity at the beginning of an individual’s life cycle,which not only facilitates children’s socialization and social mobility,but also is the cornerstone of outcome equity and social justice.Therefore,when formulating and changing social policies,due attention should be paid to the effects of policies on children’s groups,and social public policies should be formulated with children’s welfare in mind,which requires not only that social public policies promote children’s welfare,but also that social policies are geared to all children as equally as possible and eliminate disparities in resource appropriation to reduce disparities in outcomes as much as possible.The study uses the WHO Z score for children to measure the health status of children and the concentration index method to examine the health outcome disparities of children as a way to observe the impact of various factors on children’s health status and health equity.An important principle of the Chinese basic medical insurance system is to "cover the bottom line",which emphasizes the focus on special vulnerable groups,and previous studies have focused on the effectiveness of basic medical insurance for the elderly.This paper focuses on the other end of the life cycle,and suggests that the current basic medical insurance system should focus more on children,based on the current demographic background and policies,as well as the analysis of the current situation and demographic trends.(2)A new analytical framework is constructed to evaluate the effectiveness of the basic medical insurance system.As social development and major contradictions change and the system evolves,the evaluation indexes of the basic medical insurance system should also be gradually improved.This paper constructs a better evaluation system from both horizontal and vertical dimensions.In the horizontal dimension,this paper further expands the evaluation indexes of the system.Health improvement is usually considered as the basic goal and core effectiveness of basic medical insurance;in fact,as an important component of social security system,basic medical insurance is also a secondary distribution means to regulate social distribution.However,because the transfer function of health insurance is not obvious,it is less discussed.This paper,however,focuses more on the health improvement role of basic health insurance and its equity promotion role to show the redistributive function of basic health insurance.In the vertical dimension,this paper focuses on the dynamic development brought by the evolution of the system.The urban-rural integration policy is a major reform of the basic medical insurance system in recent years,which not only brings changes in the coverage and benefits of the system,but also breaks down the barriers of household registration and the differences in insurance benefits arising from the urban-rural duality for the first time at the legal level,and the changes in the system also bring changes in the effectiveness of the system.Therefore,this paper focuses on the development of the system,examines the changes in system effectiveness brought about by the evolution of the system,and then examines the system function of basic medical insurance.(3)A new perspective on the health promotion effect of basic health insurance on children is presented.The study focuses on the health promotion effects of the basic health insurance system and its evolution on children.This paper finds that there are inequitable health outcomes among children,and children with better financial conditions usually show better health outcomes,while the basic health insurance system not only has a significant health promotion effect on children,but also significantly reduces the health outcome gap and promotes health equity among children.Improving national health and regulating social distribution are important functions of the basic health insurance system as part of the social security system,and the results of this paper show that the basic health insurance system can be considered to have achieved the desired effect for children,despite its relatively small health promotion effect.The paper also focuses on the changes in the health promotion effect of children due to the evolution of the system as a coordinated policy.Since 2003,the basic health insurance system has been in place for two decades and has undergone several rounds of system improvements.And since the end of 2016,the integration of urban residential insurance and new rural cooperative has been required,which means that the urban-rural integration policy of basic medical insurance has broken the long-standing urban-rural dual system for the first time,and urban residents and rural residents are able to enjoy common insurance benefits,which is not only an improvement of the protection level,but also a reflection of social equity.This paper finds that the urban-rural integration policy of basic medical insurance can significantly promote the health level and health equity of children.The urban-rural dichotomy,which leads to unequal distribution of resources and disparities in insurance benefits,is an important cause of disparities in health outcomes,and thus the implementation of the urban-rural policy significantly improves the health of rural children and thus health equity.This shows that the horizontal dimension of the basic medical insurance system is the right direction for the system to move forward.(4)A new path for the health promotion effect of basic medical insurance on children is expanded.In terms of health promotion,this paper finds that basic medical insurance achieves health promotion through enhancing the medical consumption of the child sample.Improving national health is the ultimate goal of the basic health insurance system,so health promotion is the fundamental utility of the basic health insurance system,and the economic effect should be used as a process means to improve health rather than a system goal.Therefore,this paper uses children’s individual health care consumption as a mediating variable and finds that although basic health insurance increases children’s individual health care consumption,this implies an increase in individual motivation to seek medical care and health care goods and services,which in turn results in health level promotion.In terms of health equity promotion,this paper finds that basic health insurance has a more favorable insurance function for children from low-income families through differential group effects,which leads to health equity promotion.Specifically,children from low-income families showed higher health care utilization and lower health care consumption growth after enrolling in basic health insurance compared to the middle-and high-income groups,and children from low-income families also showed the greatest improvement in health status.That is,low-income groups are able to benefit more from participating in basic medical insurance,and this low-income group-friendly system design is a reflection of the equity feature. |
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