Fiscal Subsidies For The New Rural Cooperative Medical System, Commercial Health Insurance, And Catastrophic Medical Expenditures Of Rural Household

With the rapid development of the economy and the continuous enhancement of people’s living standards,residents’ health demands have gradually diversified and medical costs have continued to rise,resulting in a significant increase in the financial burden of medical care.Coupled with the current serious aging of the population and the increased uncertainty of disease risk,the phenomenon of poverty due to illness cannot be ignored.For this situation,medical insurance is the best solution mechanism,which can reduce the household medical economic risk by sharing the actual medical expenditures that residents bear when they fall ill.Therefore,in order to further consolidate and expand the achievements of medical insurance against poverty,and strive to achieve the strategic goals of Rural Vitalization and Common Prosperity,it is increasingly urgent to establish and improve a multi-level medical insurance system that matches the capacity of the main funding body and coordinates with the health needs of residents.This paper proposes research hypotheses by constructing a theoretical model including insured individuals,productive sectors,and government departments,and uses the China Family Panel Studies(CFPS)and the China Household Finance Survey(CHFS)to constitute mixed cross-sectional data from 2010-2019 to test the impact of New Cooperative Medical System(NCMS)and commercial health insurance on rural households’ catastrophic health expenditures.The results show that NCMS and commercial health insurance can alleviate the financial burden of rural households to seek medical treatment,while the results of the two multipliers are significantly positive,which will increase the probability of catastrophic medical expenditures.Considering that the above results may be due to the inadequate level of coverage caused by the unreasonable medical insurance financing structure and unclear financing boundaries,this paper attempts to determine the optimal sharing ratio of financing responsibilities between the government and market sectors through a panel threshold regression model.The results show that when the ratio of per capita original premium income of commercial health insurance to per capita financial subsidies of the NCMS is 0.5591,the compensation effect and poverty reduction efficiency can be ensured,and this ratio will rise to 0.9351 under relative poverty conditions.It means that in the process of establishing and improving the multi-level medical security system,we should insist on government-led while gradually increasing the market’s share of responsibility in the financing process,and give full play to the complementary function of commercial health insurance in terms of service scope,compensation form and protection level.Based on this,this paper establishes an insurance actuarial model to forecast the future financing scale and financing trend of insurance funds until 2050.Finally,the financing ratio of individual,government and commercial health insurance locates at 18.25%,52.43%,29.32% under absolute poverty condition,and 18.25%,42.25%,39.50% under relative poverty condition.In summary,this paper proposes three policy recommendations after sorting out the findings,which provide ideas for maintaining the sustainability of financial subsidies and the long-term stability of health insurance fund operation,and provide policy reform directions for further improving the multilevel health insurance system and realizing the promising government and effective market in the future.