Research On The Integration Of Medical Insurance For Urban And Rural Residents On Subjective Well-being Of Residents

Happiness is the common pursuit of human beings,and the continuous improvement of the happiness of the people has become a core objective of government policy,as well as a critical factor in policy performance evaluation.The 20 th National Congress report also reaffirmed the determination to enhance people’s well-being.Basic medical insurance scheme is a major institutional arrangement in Chinese social security system,which concerns the well-being of people and the development of economy and society.However,the previous basic medical insurance scheme was divided into urban and rural groups based on household registration,resulting in significant treatment,service,and management defects that impeded equal access to medical insurance rights and benefits for the insured.To address the disparities in healthcare benefits and medical resource wastage caused by the urban-rural dualistic structure,China has long been working on integrating the New Rural Cooperative Medical Scheme with the Basic Medical Insurance for Urban Residents and establishing a unified Basic Medical Insurance for Urban and Rural Residents.As of today,the integration of urban and rural medical insurance in various cities and regions has achieved remarkable results,creating favorable conditions for promoting the high-quality development of the universal medical security system.Studies have proved the existence of happiness effect of medical insurance.Therefore,with the trend of integrated development of urban and rural medical insurance,research on the relationship between the reform of medical insurance system and subjective well-being has become a new issue worthy of attention.Based on the data of China Health and Retirement Longitudinal Study(CHARLS)from 2011 to 2018 and local government policies,this paper empirically examines the impact of the integration of medical insurance for urban and rural residents on residents’ subjective well-being.With the “Implementation of the Integration of Medical Insurance for Urban and Rural Residents” and the specific integration modes of “Single System,Single-Standard” and “Single System,Multi-Standard” as explanatory variables,and the subjective well-being measurement index of “Life Satisfaction” and “Emotional Balance Score” as explained variables,a staggered DID model is established for regression analysis.The results show that the implementation of integration policy improves the life satisfaction of residents and has a positive effect on their positive emotions,so as to enhance the overall subjective well-being of residents.Both integration modes also have positive significance to the improvement of subjective well-being,and the effects are different in different situations.The regression results obtained from the robustness tests of PSM-DID model,redefinition of the independent variables and change of estimation methods remain robust.Then,this paper explores the heterogeneity of the samples of urban and rural areas,income and age,and finds that there are significant differences in the impact of medical insurance integration on subjective well-being of different groups.The institutional integration appears more conducive to the improvement of well-being of urban residents,upper-and-middle income groups and elderly people aged over 60 years old.In addition,this paper builds a mediating effect model and uses health status,out-ofpocket amount of medical expenses and social activity as mediating variables to gain deeper insights into the mechanism of the effect of medical insurance integration on subjective well-being of urban and rural residents.It finds out that the integrated urbanrural medical insurance can improve the life satisfaction and enhance the positive emotion,thus enhance the individual subjective well-being through improving the health level of residents,reducing the medical economic burden of the insured and boosting the enthusiasm for participating in social activities effectively.Finally,according to the empirical research results,this paper proposes relevant policy suggestions from four aspects: Firstly,further improve the integration of medical insurance for urban and rural residents to improve the living standards;Secondly,improve the mechanism of financial subsidies and encourage people to participate in medical insurance continuously;Thirdly,increase investment in the construction of medical resources in rural areas and optimize the allocation of medical resources between urban and rural areas;Last but not least,simultaneously promote the construction of spiritual civilization and enrich the spiritual and cultural life for people.