Study On The Effect Of Residents’ Basic Medical Insurance On The Health And Medical Service Utilization Of The Elderly In Rural Areas

Under the background of "healthy China" strategy,the residents’ basic medical insurance,as an important part of the rural medical and health reform,plays a decisive role in improving the medical security level and the health status of the rural elderly.At present,the academic community has conducted a number of studies on the health performance of residents’ basic medical insurance,discussed the impact of residents’ basic medical insurance on the utilization of medical services for the elderly in rural areas,and examined the mediating effect of medical service utilization on health,but due to the differences in the selection of indicators,the use of data and the research methods,the research results are not conclusive.Based on this,this study is based on the survey data of China Health and Retirement Longitudinal Study(CHARLS)in 2015 survey data,using the logit model and Propensity Score Matching Method(PSM),choosing a number of measure indicators,comprehensively analyzing the influence of residents’ basic medical insurance on the health level and the utilization level of medical services of the elderly in Chinese villages,and testing the mediating effect of medical services utilization.The results are consistent and reliable.The conclusions are as follows:(1)Residents’ basic medical insurance has a significant negative impact on the selfrated health of the elderly in rural areas,while it has a significant positive impact on their objective health: compared to the uninsured rural elderly,the insured elderly have a 13.3% lower chance of improving their self-rated health by one level(OR = 0.867)and the probability of improving their self-rated health level by one level decreases by8.6%(ATT =-0.086);also,they have a 18.5% higher chance of improving their objective health level(OR = 1.185)and the probability of improving their self-rated health level by one level increases by 55.2%(ATT = 0.522).In addition,there is heterogeneity in the impact of residents’ basic medical insurance on health: the positive impact on the objective health level of old-age(70 years old and above),male and middle-income rural elderly is relatively more significant.(2)Residents’ basic medical insurance has a significant positive effect on the medical service utilization of the rural elderly: compared with the uninsured rural elderly,the odd of the insured elderly using medical service increases by 26.1%(OR=1.261),and the probability of using medical service increases by 3.4% and 4.8%respectively under the marginal effect and the PSM method.In addition,there is heterogeneity in the impact of residents’ basic medical insurance on the utilization of medical services: the positive impact on the medical service utilization of old-age(70years old and above),women and low-income rural elderly is relatively more significant.(3)The mediating effect of medical service utilization on self-rated health is significant,while it isn’t significant on objective health:as an intervening variable,the utilization of medical services plays a mediating effect in the process that residents’ basic medical insurance affects the health of the elderly in rural areas.However,in the process that residents’ basic medical insurance affects the objective health of the elderly in rural areas,it cannot play the mediating effect as an intervening variable.Finally,in order to promote the reform and development of residents’ basic medical insurance system in China,policy suggestions are put forward based on the study conclusions of this paper,including improving the treatment level of residents’ basic medical insurance and increasing outpatient subsidies,developing supplementary commercial health insurance and strengthening preventive health care for the rural elderly.