Health And Medical Expense Under Urban-Rural Integrated Medical Insurance System From The Perspective Of Urban-Rural Differences

The risk of disease is uncertainty and serious harmful to health.Medical insurance can not only protect people's health,but also reduce the economic loss caused by diseases for residents,and it has the function of income distribution from the perspective of society.The establishment of Urban Employees Basic Medical Insurance,New Rural Cooperative Medical System and Urban Resident Basic Medical Insurance System is a symbol of the initial formation of China's basic medical insurance system.However,there are many defects in the management system of binary urban and rural division system.China is promoting the exploration of integrating urban and rural medical insurance system actively.The purpose of this study is to investigate the impact of the urban-rural medical insurance pooling system on residents' health and medical expense from the perspective of the heterogeneity of urban and rural residents,and to discuss the mechanism and reasons.Firstly,the paper analyzes the impact of Urban-Rural Integrated Medical Insurance System on residents' health,and verifies the impact mechanism.Then investigate residents'medical expense change under the comprehensive impact of increased medical service utilization and improved security level.At last,investigate the utilization gap of medical resource between urban and rural residents from perspective of total.medical cost,reimbursement expense and reimbursement ratio.For the different in health awareness and medical resource distribution between urban and rural,rural residents are in a disadvantage side in divided insurance system.After the implementation of integrated medical insurance system,urban and rural resident have different response to the change,as a result,the above analysis is carried out from the perspective of urban and rural comparison.The main research contents and relevant conclusions are as follows:Content 1:The effects of Urban-Rural Integrated Medical Insurance System on healthIn this part,we used the CLDS data to establish a Difference-in-difference regression model,which was used to test the effect and mechanism of urban-rural integrated medical insurance system on health.The mechanism was verified from the two directions of"promoting medical treatment after illness" and "improving medical insurance treatment".Regression results show that the urban and rural medical insurance can reduce the extent to which rural residents are affected by illness,mainly by changing the rural residents' health consciousness and reducing the phenomenon of rural residents not seeking medical treatment after illness.The positive effect on the health of urban residents is mainly to improve the subjective self-assessment health of residents,but the impact is small.Overall,the positive effects on the health of rural residents are stronger than urban residents.Therefore,in order to improve the health status of residents,we should make effort to change the behavior of medical treatment and encourage residents to take active treatment after getting sick.Content 2:The influence of urban-rural integrated medical insurance system on the utilization of medical services and medical expenseBased on the Chinese Labor-force Dynamic survey data in 2014 and 2016,First of all,descriptive statistics were conducted for residents of different insured types in terms of disease,medical treatment and reasons for not seeking medical treatment.Then we built the Difference-in-difference model to analyze the impact of Urban and Rural Medical Insurance System on the medical expense of residents.Statistical results show that,the proportion of integrated insured residents who fail to take treatment measures due to heavy economic burden is the lowest.The results show that the implementation of the Urban and Rural Medical Insurance System will increase the medical expenditure of low-income rural residents and families with insufficient medical services.However,medium and high income community and urban residents are less subject to economic constraints,their medical consumption is hardly affected by the medical insurance.The improvement of medical insurance treatment has alleviated the medical expense of the medium-to-income rural residents.The regression results by medical expenditure group also showed that the medical expenditure of families with high medical expense was mainly affected by the health condition of family members and the accessibility of medical institutions,and the current medical insurance system could not share the pressure of medical treatment for them.Therefore,from the perspective of policy making,we should improve the medical insurance treatment for serious diseases and reduce the pressure of medical treatment for people with heavy burden to avoid the occurrence of poverty caused by diseases.Content 3:The difference of medical resource utilization between urban and rural residents under the background of integrated medical insuranceIn this part,we compare the utilization of medical resources between rural and urban residents from aspects of total medical expenses(including reimbursed and unreimbursed part),reimbursed expenses and actual reimbursement ratio.We first construct the determination equation of medical expenses.Then Oaxaca-Blinder method is used to decomposition the differences of medical expenses and reimbursement expenses between urban and rural residents who carry out Urban-Rural Integrated Medical Insurance System.Results show that after other factors controlled,there are significant differences in the utilization of medical resources between urban and rural.The utilization of urban residents is far higher than that of rural residents due to urban residents usually choose hospitals above the county level.Rural residents fail to enjoy equal access to medical resources with urban residents.However,compared with regions that do not implement the integrated insurance,the integrated insurance helps to narrow the differences between the total medical expenses and reimbursement expenses,but not actual reimbursement ratio.Based on the above several aspects,the following conclusions can be drawn:In terms of health performance,the implementation of the urban-rural integrated medical insurance system is conducive for residents to seek medical care after falling ill,and then gain better health.But the total medical expenditure payed by individual increases.While rural residents medical service utilization has improved,there is still a gap compared with urban residents,urban residents occupy more medical insurance resources.The actual reimbursement ratio of urban residents is higher.Compared with the residents without overall planning,the integrated medical system can narrow the difference of medical utilization between urban and rural residents.In view of the fact that urban and rural medical insurance cannot reduce residents' morbidity rate,the medical insurance compensation scheme should focus on prevention rathan than treatment.From the perspective of improving residents' health,the medical insurance policy should lower the threshold of medical treatment and encourage the patients to receive early treatment.The high proportion of urban residents in senior hospitals is the main reason for higher medical costs.Therefore,in order to avoid the waste of medical resources,the hierarchical medical system should be promoted rapidly.