Research On The Anti-poverty Effect Of Basic Medical Insurance System

According to the data released by the Poverty Alleviation Office of the State Council and the poverty standard set in 2011,the number of rural poor people decreased from 98.99 million at the end of 2012 to 5.51 million at the end of 2019,and the incidence of poverty decreased from 10.2% to 0.6%.Among them,the number of poor people caused by illness decreased from 28.5 million in 2014 to 5.16 million by the end of 2018,and the proportion of the poor people decreased from 41% to 31%.It can be seen that although the problem of "poverty caused by illness" has been alleviated in recent years,it is still a prominent part of the task of poverty alleviation.The government established China's Urban Employees Basic Medical Insurance(UEBMI)in 1998,piloted China's New Cooperative Medical Scheme(NCMS)in 2003,and launched China's Urban Resident Basic Medical Insurance(URBMI)in 2007,covering urban employment population,rural population and urban non-employed population respectively,which is an important part of the basic medical insurance.With the improvement of medical insurance coverage and medical security,it has a policy effect on restraining the problem of "poverty caused by illness".And with the proposal of medical insurance to help out of poverty,it is of great significance to reduce the poverty population based on the absolute poverty line from the perspective of income.But what is the anti-poverty effect of medical insurance system? What is the impact on poverty breadth,poverty depth and poverty severity,long-term poverty index and poverty vulnerability? Does it have a significant alleviation effect on "poverty caused by illness" ? Is the effect of anti-poverty heterogeneous among different characteristic groups? With the reform and improvement of the medical insurance system,it has a significant role in promoting the utilization rate of medical services and improving the health status.What is the effect on the health poverty index based on multi-dimensional health indicators? Considering the time dimension,is the effect on the long-term multidimensional health poverty index obvious? The answers to these questions not only enrich and expand the theory of insurance anti-poverty,but also have practical guiding significance for the stability of the follow-up poverty alleviation achievements.Therefore,it needs in-depth research.Based on the health demand theory and poverty theory,this research establishes an asset accumulation model in the aspect of anti-income poverty,and analyzes the probability of asset losses caused by disease shocks to cause poverty and lift out of poverty in both insured and uninsured situations.Then it constructs a theoretical framework in the aspect of anti-health poverty,which shows that there is income heterogeneity in the aspect of improving the level of medical insurance to reduce health poverty,and the “rich” are the main beneficiary group.Based on China Health and Retirement Longitudinal Study(CHARLS)data,this paper makes an empirical analysis on the following contents:(1)using the propensity score matching(PSM)method and the difference in difference method(DID),this paper studies the poverty reduction effect of URBMI.Poverty indicators include poverty breadth,poverty depth,poverty intensity,poverty vulnerability,future poverty incidence and long-term income poverty,as well as multiple health poverty and log-term income poverty.In addition,it further analyzes the poverty reduction effects of URBMI in different health conditions,age groups,and disease groups.The impact mechanism and lag effect are also analyzed;(2)it analyzes the poverty alleviation effect of NCMS,and evaluates whether it is due to age,health status and other factors;(3)it studies the effect of NCMS and URBMI on "poverty caused by illness";(4)it analyzes the impact of actual reimbursement proportion on the anti-poverty effect of medical insurance by using fixed effect model and limit dependent variable model,and tests the impact of improving the level of security on income poverty for groups with different ages,different health conditions and chronic diseases.Then it tests the impact of raising the security level on health poverty for groups of different economic conditions,different ages and whether suffering from chronic disease groups.The conclusions of this paper include:First,participating in URBMI has significantly reduced the income poverty of the insured persons,such as the breadth of poverty,the depth of poverty,the intensity of poverty,the vulnerability of poverty,and the incidence of future poverty.It also has a significant negative impact on the long-term poverty index and the incidence of longterm poverty.The lagging effect is stronger than that of the same period.The increase in education expenditure is one of the intermediary channels for medical insurance to reduce the long-term poverty index.However,its impact on multi-dimensional health poverty and long-term multi-dimensional health poverty is limited.Mainly because the improvement of health status requires a certain process and time,and its impact on health poverty has a certain time lag.Second,the poverty reduction effect of URBMI is heterogeneous in different age groups,health groups,urban and rural groups,and disease groups.For different age groups,medical insurance significantly reduces the long-term poverty index and the incidence of long-term multidimensional health poverty of middle-aged people,but has no significant effect on the long-term poverty index of the elderly.Compared with the middle-aged,the negative impact of URBMI on the(short-term)poverty index of the elderly is more obvious.For urban and rural residents,URBMI has a significant impact on the(short-term)poverty index of the urban population and the long-term poverty index of rural population,the incidence of long-term poverty,and the incidence of longterm multidimensional health poverty.For people with different health status,the effect of URBMI on the poverty reduction of unhealthy individuals is more significant.Insurance helps to reduce the income poverty of patients with chronic diseases,but for those without chronic diseases,insurance helps to improve their long-term multidimensional health poverty.Participating in URBMI will reduce the poverty status of those who are not affected by serious illness.Although it has no significant impact on the income poverty of those affected by serious illness,it will improve their longterm health poverty status.Third,the NCMS has a certain poverty alleviation effect,which significantly reduces the income poverty of the insured.The improvement of health status is the intermediary channel of poverty alleviation.For different health groups,the NSMC has a significant effect on the poverty alleviation of the better health groups.Fourth,the effect of the NCMS and URBMI on "poverty caused by illness" is significant in the long run.Heterogeneity analysis shows that medical insurance has a better effect on middle-aged people and people with poor health.Fifth,improving the level of medical insurance can significantly reduce income poverty,but not health poverty.There are differences in the influence of improving the level of medical security in different age,different health status,different economic status and whether suffering from chronic patients.It can significantly reduce the incidence,depth and intensity of poverty of individuals with good health.It can improve the health level of the rich and improve the poverty status of middle-aged people and individuals with chronic diseases.However,there was no significant difference among the individuals with poor health and without chronic diseases,the elderly and the poor.