Research On The Impact Of Direct Settlement Of Medical Treatment In Different Places On The Expenditure Of Medical Insurance Funds

Under the circumstance of unbalanced quality medical resources allocation and increasingly frequent population flow in China,it has become an irreversible trend that basic medical insurance applicants go to places beyond the insurance-covered area for medical treatment in case of referrals,long-distance resettlement or residence,and migrant work.However,due to limitations on city or county-level system conditions in China's basic medical insurance,previously basic medical insurance applicants had to pay all medical expenses in advance,and then claimed from medical insurance agency of the insurance-covered areas.The pressure arising from the advance payment and all the efforts involved have become an important livelihood issue for the insured people.Since from 2016,the Chinese government has determined to promote nationwide medical insurance network,requiring to basically solve the problem of remote settlement for medical treatment in the same province within 2016,and striving to realize direct settlement for long-distance medical treatment across provinces.Obviously,this reform of settlement for long-distance medical treatment has alleviated the pressure on the insured people who have to get medical treatment beyond insurancecovered area.However,we should not only see the convenience that the policy has brought forward,but should also consider the impact of direct settlement policy for long-distance medical treatment on the behavior of insured people,as well as on the basic medical insurance fund expenditure,and sustainable development of the mentioned system.By application of A City's panel data for direct settlement on long-distance medical treatment within the province during three years,this paper has studied on the impact of direct settlement for long-distance medical treatment on medical insurance fund expenditure from both macro and micro perspectives.At macro level,an analysis has been made on the development trend of data for local and remote medical treatment,average medical cost and average medical insurance fund expenditure per time.At the micro level,the paper has analyzed the heterogeneity of insured peopled who are remotely hospitalized based on cross-sectional data in 2013 after implementation of direct settlement in A City.Beyond that,the paper has also made an analysis on the influence mechanism of direct settlement for remote medical treatment on insurance people's medical treatment behavior as well as on the medical insurance fund expenditure by use of benchmark regression,propensity score matching(PSM),and difference-in-difference(DID)measurement.Through the above analysis,the paper discovers:1.Both the population who get long-distance medical treat and the expenditures of medical treatment have increased year by year,and the gap between expenditures of long-distance medical treatment and local medical treatment has increasing expanded.2.Impacts of direct settlement for long-distance medical treatment are heterogeneous.Insured people who are under the age of 60,women,employees in state-owned enterprises,and retirees are more likely to seek long-distance medical treatment.Among them,the number of retirees and state-owned enterprise employees who seek long-distance medical treat drop away from average long-distance medical treatment insurance expenditure.3.Direct settlement policy for long-distance medical treatment has increased the medical insurance funds expenditure by 23.86%.By application of micro-measurement method of PSM-DID,empirical results have shown the above-mentioned phenomenon.4.There are three mechanisms behind this phenomenon-direct settlement increase the expenditure of medical insurance funds: firstly,direct settlement policy reduces the self-pay proportion for insured people who seek long-distance medical treatment,thus inducing more long-distance medical treatment under the circumstance of increased disposable income of residents and the convenience brought forward by high-speed rail transportation;secondly,disguised serious illnesses have increased the pressure on fund expenditure.Due to the unbalanced structure of high-quality medical resource allocation in China and immature grading diagnosis and treatment pattern,the implementation of direct settlement policy has resulted in that the insured people seek for long-distance medical treatment in neighboring big cities even with minor illnesses or diseases.Insured people under the age of 40 contribute the most to the increase of medical insurance expenditure.However,seeing that the average age of major diseases such as malignant tumors normally occurred to people at an average of 58.3 years old in A City,immoral behaviors such as disguise of serious illness is highly doubted among insured people under the age of 40.Thirdly,under the policy of direct settlement of medical treatment in different places,the insured have poor fairness in the utilization of medical services.Based on the above research conclusions,this paper proposes the following policy advice: Firstly,Strengthen digital-driven medical service innovation,improve online medical treatment and AI smart medical technology,so as to alleviate the shortage of high-quality medical resources in economically underdeveloped areas;Secondly,Promote methodology revolution in the context of Internet+,which means to perform tiered diagnosis and treatment on the basis of medical insurance information standardization and implement payment standard reform in addition to payment method revolution via DRGs,in this way,medical insurance compensation proportion for those insured people who do not meet the referral requirements should be reduced and moral behaviors shall also be rated into the social integrity system;Thirdly,Establish an incentive and restraint mechanism to improve the comprehensive management capacity of medical insurance,and integrate the medical insurance fund balance level and effective supervision of long-distance medical treatment into the capacity evaluation system of the relevant agency.Two innovations are adopted in this paper:1.The first one is the innovation of research content.As a convenient policy,direct settlement for patients seeking medical treatment in different places relieves the pressure of advance payment and running errands for patients seeking medical treatment in different places,which is a problem widely concerned by experts and scholars.However,there is almost no relevant research on the impact of the convenience policy on the expenditure of the health insurance fund in the insured areas.On the basis of theoretical analysis,this paper makes an empirical analysis of the impact of direct settlement policy on fund expenditure by using the full sample data of A city,which is an innovation in research content.2.The second is the innovation of research methods.The impact mechanism of the direct settlement policy for medical treatment in different places on the expenditure of medical insurance funds is mainly qualitative analysis.This paper uses the panel data of sample A city for three years before and after the implementation of the policy,and uses the quantitative analysis of PSM and DID econometrics to study the impact of direct settlement for medical treatment in different places on the expenditure of medical insurance funds.This method of data selection and quantitative research avoids the problems of self-selection and sample selection bias caused by sample data,makes causal analysis more accurate,and provides accurate data reference for the evaluation of China's policy implementation.