Research On Redistribution Of Basic Medical Insurance In China

Based on the efficiency,primary distribution means that it compensates elements of production,such as capital,labor,land,and technology,and so on,which is making profit relying on market forces.During mass rapid growth stage,market forces widen income inequality.It causes a series of economics and social problems.In order to correct deficiencies of distribution,social security funded by tax revenues,corporate profits and individual wages,whose goal is to improve well-being of low-income group.Social security aims to safeguards the society to be fair by redistribution.The basic medical insurance system is one part of universal social security system,improving the income distribution is also its duty.The redistribution of basic medical insurance not only has to consider different income levels,but also difference of health level and disease risks.There are two reasons to consider different income levels.One is the difference of payment capacity among members of society.The other is the diverse need of compensation level in face of the disease risk of loss.Meanwhile,it provides appropriate medical services according to different diseases and health level.Medical resources are not normal good.It is not mean the more resources,the better welfare level.Meanwhile,it provides appropriate medical services according to different diseases and health level.Empirical studies show that universal social security system is an important tool of decreasing the income gap and improving the income distribution.How the performance of basic medical insurance system is?Based on above background,the paper review the literature,in view of Income and Health,Financing of medical insurance and utilization of medical care services to establish logic relations of redistribution.On the basis of the distribution and redistribution theory,Grossman Health demand model and Rawls‘theory of justice,the main research methods in this paper include Micro-econometric methods.It research redistribution of basic medical insurance system from health needs,redistribution of intra-generational,inter-generational and lifecycle,Fairness and Medical insurance financing,and Compensation dilemmas.This paper use Representative micro data to analyze the health level distribution and medical expense level to understand the medical care need of individual.Based on this,this article research the redistribution effects of basic medical insurance system through analyzing Financing of medical insurance and utilization of medical care services.Detailed content is as follows:The paper use China Family Panel Studies data to analyze health level distribution of insured in part one of chapter three.Based on the analysis of Self-rated health(SAH),Memory and Body Mass Index,it investigates physical and mental health and the probability of chronic diseases in insured.The results show that SAH coefficient of the employee health insured(EBMI)is higher than the residents health insured(URBMI),but lower than New Rural Cooperative Medical System(NRCMS)insured.Male insured is worse than female in three indexes.SAH and the memory lapse come with age significantly,BMI has no significant effect.This is true that younger insured is more health than older insured.Married and retirement reduce health level significantly.The smoked insured has better SAH than non-smokers.In general,the results show the higher income insured are in better health level in all medical insurance samples.To go a step further,this paper use concentration index(CI)to assess the income related health inequality.The results show that the income related health inequality favor upper-income groups in all the samples,the most is in NRCMS.Based on Exact Affine Stone Index implicit Marshallian demand system,this paper uses China Household Income Projects Series(CHIPS)and Rural-urban Migration in China(RUMiC)to analyze expenditure Engel Curves of urban household and migrant household.The results show that lower income household is in low medical care expenditure level due to lack basic health care,especially migrant household.Migrant household is in sandwich class.Chapter four uses the China Health and Nutrition Survey to analyze financing of medical insurance in 2009 and 2011.The results show that financing of medical insurance increase income inequality.Comparing with 2009,redistribution's reverse of financing decrease in 2010 in EBMI and URBMI,NRCMS Conversely.Financing of NRCMS is regressive,and fairness of financial is worse,but regressive of premium burdens decreases in 2011.At the same time,the medical insurance system has a significant regional difference and the low-level co-ordination.This paper use Shenzhen EBMI samples to analyze redistribution.The result shows that EBMI has income of redistribution in city pooling level,but the rate is declining.Financing of EBMI is progressive,but the rate is also declining.There is significantly regressive in URBMI and NRCMS.There are both higher and lower income household in URBMI and NRCMS,but URBMI and NRCMS implement defined contribution.It not achieve vertical fairness.Chapter five uses CFPS to analyze redistribution of utilization of medical care services.The results show that compensation level of CI are 0.0191,0.0061and 0.0089 in total samples,EBMI and NRCMS.There are redistribution's reverse of compensation in general.This paper analyzes difference of compensation after grouping sample by household income.The results show that reimbursement of higher quartiles income group is not significant more than the lower quartiles.There is also no significant evidence in other income quartiles.The reason is the higher income quartiles cost more than the lower in hospitalization,EBMI sample supports it significantly.CI of hospital utility fees also supports these results.It means the more hospital utility fees led to more reimbursement.Meanwhile,due to limits of medical insurance,this paper analyzes the path of health insurance utilization.There is no significant difference in probability of hospital visits among all income groups,probability of inpatient conversely.Compared with lower quartiles,inpatient probability of other quartiles do not significantly increase,only when income increase to a certain threshold,both in URBMI and NRCMS.Inpatient probability is growing significantly with age and chronic disease.Compare with other two medical insurance,inpatient probability of EBMI is higher.To sum up,this paper makes some policy advice:differentiation coinsurance rate and deductible;managed care to limit irrational increase of medical expense;properly adjust contribution rate,ensure redistribution effect;narrow guaranteed level gap among all medical insurance;tilt towards the disadvantaged.