Study On The Pro-Poor Effect Of The Basic Medical Insurance In China

China has already established the Basic Medical Insurance for Urban Employees, the New Rural Co-Operative Medical System as well as the Basic Medical Insurance for Urban Residents, which together form the main body of the multi-level medical security system and play important roles in the protection of the health improvement of citizens. Most of the current study, however, can only explain the average effect of the basic medical insurance on health. They cannot judge whether the basic medical insurance improves the equality in health. From the view of the social sustainable development and system sustainable development, the importance of equality or equity is sometimes even greater than the importance of efficiency. Therefore, this study attempts to estimate the implementation effect of the basic medical insurance system on health and helath seeking indicators and then to provide new evidence of the effect of basic medical insurance system in China.In the empirical part of this study, it first describes the development of the basic medical insurance system in China and the achievements of the national health by using macroscopic statistical data. With the perfecting of the basic medical insurance system, more and more urban and rural residents get benefit from it. At the same time, the national health quality-reflected by the life expectancy at birth, the infant and maternal mortality, the incidence, death and mortality rates of class A and B infectious diseases-has been improved significantly. However, there are still inequalities in the field of health, which present not only between but also inside urban and rural areas, but the inequalities in health inside the urban or rural areas are rarely studied. This study tries to find the inequalities in health inside urban and rural areas, in order to make a supplement in this field.The analysis of the distribution characteristics of health and health seeking indicators in this study is mainly based on the concentration index and the corrected concentration index. Whether the health and health use indicator is pro-poor is judged according to its values of concentration index or corrected concentration index. While for the analysis of the pro-poor growth of health and health use, the growth incidence curve and other related indexes are used. The pro-poor analysis is from the static angle, while the pro-poor growth is from the dynamic angle. By using data from the Chinese Health and Nutrition Survey in waves after 2000 and by using relevant evaluation methods, this study then discusses the characteristics and its changes of health and health seeking indicators among all households, urban households and rural households, respectively. The results show that some indicators, such as the four-week-non-sick condition, four-week-doctor-seeking behavior and non-chronic-disease condition, are mainly pro-poor in distribution. While other indicators, such as self-reported health status, outpatient cost and outpatient reimbursement ratio, are mainly pro-rich in distribution. The growth incidence curve describes whether the growth of a health or health seeking indicator is weak absolute pro-poor, and its combination with the average growth rate measures whether the growth is pro-poor in the relative sense. Changes of health and health seeking indicators between adjacent survey waves and relative to the 2000 wave are all not weak absolute pro-poor, but some show pro-poor growth in the relative sense when their pro-poor interval is relatively broad.However, the pro-poor distribution and the pro-poor growth of health and health seeking indicators do not directly mean the pro-poor implementation effect of the basic medical insurance on health. Conclusion on this topic needs to consider the promotion or inhibition of basic medical insurance on health and health seeking and the characteristics of the basic medical insurance itself. By using linear regression and decomposition approach of concentration index, this study analyzes the contribution of basic medical insurance to the distribution formation of health and health seeking indicators of all residents, urban residents and rural residents, respectively. The results show that in most cases, the contribution of the basic medical insurance to the distribution formation of health and health seeking indicators, such as the four-week-non-sick condition and the four-week-doctor-seeking behavior, is pro-poor, strengthening the pro-poor distribution of these indicators or weakening the pro-rich distribution of them.In view that the basic medical insurance in China is still on the system innovation, in order to better protect the health rights and interests of people, this study also analyzes the promotion effect of the critical illness insurance on health. Relevant data is from field survey in Jiangsu province. The implementation effects are analyzed by comparing health status of two cities where the critical illness insurance is implemented in only one of them. The results show that the implementation of critical illness insurance significantly improves the health status of residents. Besides, the pro-poor characteristics and pro-poor growth of health are significant in city where the critical illness insurance is implemented.Finally, based on the above analysis, this study provides some policy suggestions in order to promote the pro-poor characteristics of basic medical insurance.