Does Urban And Rural Health Insurance Integration Lead To Ex-ante Moral Hazard?

In China,how to curb the excessive growth of medical costs has been an important governance issue for policy makers.Moral hazard is an important reason for the rapid increase of medical costs.Moral hazard includes ex-ante moral hazard and ex-post moral hazard,both of which can cause serious loss of social welfare.Compared with ex-post moral hazard,the literature on ex-post moral hazard is limited and the evidence is fuzzy.On the other hand,China’s medical and health service system faces severe challenges brought by a rapidly aging population and a sharp increase in the number of chronic diseases.Identifying the ex-ante moral hazard of the elderly population has obvious policy implications in the context of "healthy aging".Previous studies have shown that there is a non-negligible ex-ante moral hazard in the new rural cooperative medical care.In January 2016,The State Council required all parts of the country to integrate the new rural cooperative medical care system and the basic medical insurance system for urban residents into the basic medical insurance system for urban and rural residents,further improving the medical insurance benefits for rural residents.Therefore,there is still a lack of rigorous empirical evidence to test whether the improvement of medical insurance treatment for rural residents will further aggravate the ex-ante moral hazard.In view of this,this paper collected the implementation time of urban-rural health insurance integration in each region,and matched it with the China health and retirement longitudinal study(CHARLS)from 2011 to 2018.Using the time difference of policy introduction,this paper investigated the impact of urban-rural health insurance integration on the preventive investment of middle-aged and elderly people by using the Difference in Difference(DID)method.The results show that the integration of urban and rural health insurance significantly reduces the preventive investment of the elderly in rural areas.To be specific,first of all,the proportion of alcohol consumption among middle-aged and elderly people in rural areas with integrated rural-urban health insurance increased by 8.5% compared with areas without integrated rural-urban health insurance policy.By adding macro variables at the city level,changing the policy time,replacing research samples,replacing regression models,and deleting samples,the results remain robust.Secondly,this paper compares the differences in policy effects between a "single-standard" integration model and a "multiple-standard" integration model.It is found that the ex-ante moral hazard effect is mainly driven by the "single-standard" model,but there is no evidence to suggest that the "multiple-standard" model would lead to ex-ante moral hazard.Then,only the sample of "single-standard" integration model was retained,and heterogeneity analysis was conducted according to individual self-reported health,gender,and per capita household income.Heterogeneity results showed that the pooling policy of urban and rural health insurance significantly increased the probability of drinking alcohol among rural middle-aged and elderly people in good health,women and higher income,and also increased the frequency of drinking alcohol among people in good health and the probability of lack of physical activity among high-income groups to a certain extent.In conclusion,this paper shows that the integration of urban and rural health insurance further intensifies the ex-ante moral hazard,and provides new empirical evidence for the existence of ex-ante moral hazard.Based on the empirical results,this paper puts forward two suggestions: first,introduce the policy document as soon as possible,and gradually include the free physical examination service of middle-aged and elderly people into the scope of medical insurance;Secondly,the government should play a leading role,link forces from all aspects of society,build a health management network with the participation of the whole society,promote the rural middle-aged and elderly people to know more health knowledge,and constantly improve their health awareness.