Research On Welfare Distribution Of China's Social Medical Insurance System

BackgroundFrom the reform of the basic medical insurance system for urban workers to the establishment and gradual integration of the new rural cooperative medical insurance system and the basic medical insurance system for urban residents,China's social medical insurance system has been constantly improved.The social medical insurance system plays an important role in strengthening the social welfare responsibility of the state,reducing the burden of medical treatment for the insured,enhancing the driving force of economic development and strengthening the social stability mechanism.By the end of 2019,329 million Chinese workers and 1.25 billion urban and rural residents were covered by health insurance.Social medical insurance covered 1.354 billion people in China,accounting for 96.74 percent of the total population.In 2018,the social medical insurance system raised 2,138.40 billion yuan in medical insurance funds,accounting for 2.33 percent of China's GDP that year,and the per capita expenditure of medical insurance funds was 4,722.76 yuan.What is the effect of the welfare distribution of social medical insurance system on medical insurance fund raising,hospitalization payment and medical insurance fund compensation?Is welfare distribution becoming more equitable?How does the social insurance system affect the distributive effect of social welfare?What factors affect the welfare distribution of the social medical insurance system?The above problems have become the key to evaluate the performance of China's social medical insurance system.At present,social medical insurance equity research has focused on the medical service utilization and the fairness of resource allocation from medical institutions,but given less attention to benefits redistribution on the medical insurance fund raising,hospitalization payments and medical insurance fund compensation of the worker health care as well as urban and rural residents health care(including the medical insurance system for urban residents and the new rural cooperative medical system).Through the analysis of different types of social medical insurance,the whole process and the multidimensional degree of medical insurance operation,it is helpful for the integration and development of the present China's social medical insurance,and it is beneficial to evaluate the fairness degree of social medical insurance welfare distribution from the micro level of individual insured.In distribution of social welfare as the breakthrough point,this study used welfare redistribution analysis method,combining with the operational features of the social medical insurance system in our country,and adopted household survey data in 2015 and 2017from China family financial research center of the Southwest University of Finance.According to the employee health care,residents health care and the system of new farmers,through the medical insurance fund raising,hospitalization payments and health care fund compensation it analyzed the welfare allocation fairness,explored social welfare distribution mechanism and operation mechanism of the social medical insurance system and provided a scientific reference for the development and perfection of social medical insurance system in China.ObjectivesThe overall goal of this study is to analyze the fairness of welfare distribution in China's social medical insurance system through theoretical analysis and empirical research,explore the factors affecting the distribution of social medical insurance benefits,and put forward policy suggestions to improve this benefits distribution.The specific research objectives include:Construct a theoretical framework suitable for analyzing the welfare redistribution effect of China's social medical insurance system through literature review;through empirical study,the welfare redistribution effect of the three social medical insurance systems in the three links of medical insurance fund raising,hospitalization payment and medical insurance fund compensation is calculated,and the recent changes are analyzed;the influence mechanism and degree of social medical insurance system on family medical expenses and individual hospitalization expenses are analyzed by means of propensity score matching analysis Quantile regression is used to analyze the effects of individual's initial income,age and physical condition on the net benefit distribution of social medical insurance compensation.Design And DataThe study takes the distributive effect of social medical insurance system on social welfare as the main policy variable and focuses on the operation mechanism of social medical insurance.Through literature review at home and abroad,the methods,results and conclusions of the research on social medical insurance welfare distribution were summarized and analyzed to provide theoretical and methodological support for this research.On the basis of literature review and theoretical analysis,the research questions are put forward.Then the research framework is constructed by the welfare concept of welfare economics,social welfare function,compensation principle and medical insurance benefit utility.The data were obtained from China household finance survey(CHFS)in 2015 and 2017.The data were collected from prefecture-level cities,counties,communities(villages)and families in 29 provinces in mainland of China in a probabilistic sampling survey.After applying for the open database of China family financial investigation center,this study cleaned and sorted out the data,selecting 12 683 individual samples from employees' medical insurance,12 549 from new rural cooperative medical care system,4 213from residents' medical insurance and 11 742 who did not participate in social medical insurance for research.Statal6 and Exce12010 were used for database collation,data analysis and data expression.Gini coefficient and Musgrave and Thin measure(MT)were used to measure the benefit redistribution effect of medicare fund raising,hospitalization payment and medicare fund compensation,and AJL decomposition model proposed by aronson et al.was used to analyze the benefit redistribution effect of each link of social medical insurance operation.The factors influencing the welfare distribution effect of social medical insurance system were studied by means of propensity score matching analysis and quantile regression analysis.First of all,linear regression was used to preliminarily screen the influencing factors,and propensity score matching analysis was used to compare the family medical expenses and individual hospitalization expenses of residents who participated in the social medical insurance system or not.Quantile regression analysis was used to explore the influence direction and degree of individual initial income,age and physical condition of net benefit of hospitalization compensation of medicare fund.Results(1)The redistribution of the new rural cooperative medical system.In terms of the specific operation of the new rural cooperative medical system(NCMS),in 2015,the per-capita compensation cost for inpatients was 129.38 yuan,and the per-capita payment amount was 102.40 yuan,accounting for 126.35%of the payment.The average hospitalization compensation cost of the new rural cooperative medical system insured is 3,352.38 yuan,and the average payment of the new rural cooperative medical system insured is 105.58 yuan,and the degree of compensation income is 31.75 times.The average cost of hospitalization was 9,929.57 yuan,and the effective compensation ratio was 33.76%.The actual burden of hospitalization was 6,577.19 yuan for the new rural cooperative medical system insured,and 22,444.41 yuan for the insured,and 25.21 percent for the insured.The overall contribution rate was 0.98%in 2015 and 1.42%in 2017.In 2015,the overall payment rate was 0.98%,and in 2017,the overall payment rate was 1.42%.In 2015,the overall improvement rate was 1.79%,and in 2017,the overall improvement rate was 0.60%.The improvement rate and compensation rate decreased with the increase of income grouping in two years.In 2015,the Gini coefficient of initial income of new rural cooperative insurance participants was 0.3889,and in 2017,it was 0.3901.The MTB index of welfare redistribution effect after the financing of NCMS medical insurance fund in 2015 was calculated to be-0.0115,and-0.0020 in 2017.The MTC index after hospitalization payment was-0.0254 in 2015 and-0.0282 in 2017.The MTD index after reimbursement for medicare funds was-0.0208 in 2015 and-0.0170 in 2017.The KaKwani value of NCMS was-0.3650 before and after financing in 2015,and-0.3695 in 2017.The redistributive effects of the financing of the new rural cooperative medical insurance fund,the payment of hospitalization and the compensation of the medical insurance fund were vertical effect,horizontal effect and reranking effect.From the analysis of tendency score matching,we can see that under the control of age,gender,household type and health status and other factors,the hospitalization expenses of new rural cooperative medical insurance participants are 404.09 yuan higher than that of those without medical insurance.From the quantile regression analysis,it can be seen that the net benefit of hospitalization fund compensation of NCMS insured has no significant change in the effects of individual initial income,age and physical condition.(2)The redistribution of worker medical insurance.In terms of the specific operation of medical insurance for employees,the per capita contribution rate was 4.42%in 2015 and 2.08%in 2017.In terms of the contribution rate of each income group,it was lower in 2017 than that in 2015.In particular,the contribution rate of the low-income group reached 12.91%in 2015,far higher than the average of 4.42%per capita in 2015.The Gini coefficient of initial income of the insured in 2015 was 0.3927 and that in 2017 was 0.4144.The gini coefficient changed after the raising of medical insurance fund,the payment of hospitalization and the compensation of medical insurance fund.By analyzing the MT index of China's medical insurance for employees in 2015 and 2017 after medical insurance fund raising,hospitalization payment and medical insurance fund compensation,all of them were negative.By analyzing the K value of employees' progressive medical insurance financing,it can be seen that the data in 2015 and 2017 were both less than 0.From the V value,H value and R value of the redistribution effect of employee insurance financing,V value was negative,but the absolute value was small.H value accounted for 84.66%of RE in 2017.According to the matching analysis of the propensity scores of employees participating in medical insurance and those who do not,the family medical expenditure of employees participating in medical insurance is 3211.70 yuan more than that of those who do not.From the analysis of the factors affecting the net compensation benefits of employees insured by medical insurance,the influence before the initial income q40 quantile was statistically significant,and the influence of age was statistically significant on the whole.Before the age of 41,the influence gradually decreased with the age;after the age of 44,it increased with the age,and the overall trend was u-shaped.The physical condition was statistically significant except for the extremum at both ends.(3)The redistribution of residents' medical insurance benefits.In terms of the overall operation of resident medical insurance,the average amount of fund raised per capita in 2017 was 930.55 yuan,the average amount of medical insurance contributions for low-income groups was 712.45 yuan,and that of high-income groups was 1775.90 yuan.In 2017,the per capita contribution amount of each group showed an increasing trend compared with that of 2015.In 2015,the average hospitalization cost of residents insured by medicare was 667.42 yuan,and in 2017,it was 800.67 yuan.The average hospitalization cost per capita in the group decreased first and then increased from the low-income group to the high-income group.The Gini coefficient of initial income of residents participating in the medical insurance was 0.4253 in 2015 and 0.4507 in 2017.According to the analysis of MT index and R coefficient of redistribution of residents' medical insurance benefits,MTB,MTC and MTD in 2015 and 2017 are all less than 0.From the measurement of R coefficient,the most serious reverse redistribution effect occurred in the payment of medical expenses in 2015,with RC being-3.7621%;in 2017,the most serious reverse redistribution effect occurred in the compensation,with RD being-3.7465%.The MTDB was positive in both 2015 and 2017.Kakwani values from medicare fund raising,hospitalization payments,and medicare reimbursement were all negative.The V values of the three links were all negative,and the absolute value of 2017 was greater than that of 2015.H value and R value were positive,and both values in 2017 were greater than those in 2015.There was no significant regulation in the initial income,age and physical condition in the net benefit quantile regression analysis of medicare compensation.ConclusionsThe country,the society and the individual use the effective fund raising method,and realize the social welfare effective redistribution through the social medical insurance system.The social medical insurance system's welfare redistribution approach is completed through the medical insurance fund raising,hospitalization payment and medical insurance fund compensation.On one hand,the government fiscal subsidy can effectively reach the sick residents who need it most.On the other hand,there should be a redistribution of social benefits between high and low earners,the healthy and the sick.However,from the analysis of this study,the medical insurance fund raising,hospitalization payment and medical insurance fund compensation of three social medical insurance groups with different income in China were all regressive,and the regressive nature of 2017 was worse than that of 2015.It also suggests that although our country's social medical insurance coverage is almost universal,for low-income groups,on one hand,the health care financing increased their economic burden,on the other hand their raise also provides extra help for high-income participants,which is abhorrent from the progressive principles of the social medical insurance.In terms of the difference between the family medical expenditure and the hospitalization medical expenditure of the three social medical insurance participants,the medical expenditure from individual and family participating in social medical insurance is higher than that of the individual and family without social medical insurance.Through social medical insurance system in our country,participants will enable the future uncertainty of medical service consumption into deterministic payment of medical treatment insurance compensation,effectively promoting medical service expenses and hospitalization expenses of insured families.This can show that to a certain extent,social medical insurance system in our country,promoted the effective demand of families and individuals.According to quantile regression of compensation fund net benefits from personal initial income,age and physical condition,the initial income of different range of low-income groups has statistical significance in the three kinds of social insurance,and has a negative correlation,which is consistent with former redistribution effect measurement and redistribution effect decomposition.However,with the increase of income quantile,the effect of initial income on fund compensation net benefit is not statistically significant.The age of employees'medical insurance first decreases and then increases with age,and the low point is about 41 years old,but the age basically has no effect on the new rural cooperative medical system and the resident medical insurance.Policy ImplicationsChina's social medical insurance system plays an important role in the redistribution of social welfare and promotes social fairness and justice.By analyzing the medical insurance fund raising,hospitalization payments and regression of medical insurance fund compensation and welfare reverse redistribution,we suggested that in operation of the health care system in China,health policy makers and health care fund managers increase government financial support for low-income groups,to improve the reverse redistribution of social medical insurance.Through the analysis of the three links among three social medical insurances in this paper,it is found that the basic medical insurance system for urban workers is the next evolution step of China's medical insurance system.Our country can further merge the new rural cooperative medical insurance system with the urban residents medical insurance system into the urban and rural residents medical insurance system.With the improvement of economic development level and the level of governance,we can implement "a third gear system" to "a system of two gears",after miho unity overall goal,and realize our country's social medical insurance system integration,to achieve universal coverage of welfare distribution fairness and improve the overall welfare level of the whole society.Innovation and shortageThe innovation of this study is embodied in the following three aspects:(1)Research perspective innovation:Based on the national survey data,this research analyzes the welfare distribution effect of the three social medical insurance systems in China from the perspective of fairness and justice,with a new perspective;(2)Analysis of process innovation:This study analyzes the welfare distribution of China's three social medical insurance systems in three links:medical insurance fund raising,hospitalization expenses payment and medical insurance fund compensation.(3)Innovation of analytical methods:The impact of social medical insurance system on welfare distribution in China was found by using propensity score matching analysis;Quantile regression analysis was used to find the distribution of net medical fund compensation benefits among different insured groups Limitations and research prospects of this study:Based on the analysis of three types of medical insurance system in China at the national level,this study doesn't cover all the parts of 29 provinces,autonomous regions and municipalities directly under the central government,which will cover up the differences between different regions in China,and to a certain extent limit the policy recommendations based on local conditions.The next procedure of this paper is to make an in-depth analysis of the provinces in China and put forward more targeted policy recommendations.