The Willingness To Insure Of Residents And Its Influencing Factors After Integration Of Urban And Rural Medical Insurance System In Shandong Province

BackgroundDue to the influence of the urban and rural dual economic structure,the construction of the initial urban and rural medical security system has gradually diversified and fragmented.Elimination of urban and rural differences,to achieve the integration of urban and rural health insurance system has become one of the main tasks of health system reform.January 3,2016,the State Council issued a document,requiring the establishment of a unified urban and rural medical insurance system.As we all know,Shandong Province as an early pilot area has been completed the integration work in 17 cities in 2014.However the current experiences of urban and rural medical insurance integration are less,we still facing the system construction and institutional development issues.As a resident's voluntary public policy,the residents' willingness to insure and the recognition of the policy are directly related to the expansion and sustainable development of the system.Therefore,it is necessary to carry out empirical research on the integration,analyze the current status of urban and rural health insurance integration.Understand the real wishes of urban and rural residents and the factors that affect the wishes.So as to find out the problems in the implementation of policy,provide the empirical basis for the reform of the policy and the improvement of the policy rationality,and provide some experience for the promotion of the system in other places.ObjectivesThe main purpose of this study is to understand the current situation of residents' insured and the willingness to continue to insure.Analyzes the factors that affecting the residents' willingness to insure and the influence path and degree of influence on their willingness from the individual dimensions,the family dimension and health insurance policy.Then we can provide the empirical basis for the reform of the policy and the improvement of the policy rationality,and provide some experience for the promotion of the system in other places.MethodsAccording to the situation of the integration,the level of economic and social development and the representation of the region,we adopt the method of stratified random sampling to select Weihai,Zibo,Jining,Jining and Dongying as the sample area.A total of 1,200 questionnaires were issued.This study used descriptive analysis to describe prevalence of illness and hospitalization,social economic characteristics,the degree of policy understanding and the willingness to insure.The method of single factor and multiple factors Logistic analysis was used to analyze main influencing factors.Main Results and Conclusions(1)After the integration 97.5%of the residents participated in the healthinsurance,82.4%of the residents expressed willingness to continue to insured.The overall level of willingness to insure is at a high level,but there is still room for improvement.The proportion of residents expressed satisfaction with the medical insurance system was 68.5%.41.5%residents are not fully understood.Residents say that there are three areas that need to be improved,increase reimbursement(56.0%),expand reimbursement(34.9%),and lower pay lines(16.5%);(2)Multivariate analysis shows that the seven variables,the education level,the annual income of the family,the incidence of chronic diseases in the first half of the year,the situation of family hospitalization,satisfaction,degree of understanding and burden assessment after reimbursement,have an significant impact on the willingness to insure.Low satisfaction and low degree of understanding of the crowd is more reluctant to continue to insured.Highly educated,the high annual incomes,and people with chronic illnesses and hospitalizations at home are more willing to continue to insure;(3)Multiple factors Logistic analysis was used to analyze main influencing factors of rural residents and urban residents.Common factors are the prevalence of chronic diseases in the family,burden assessment after reimbursement,satisfaction and the degree of understanding.But the annual household income and family hospitalization have no significant effect on urban residents' willingness to insure.The impact of education on rural residents' willingness to insured is not significant.Policy Suggestions(1)Further develop the level of urban and rural economic and social development,vigorously develop the rural economy,improve the income of rural residents,and narrow the income gap between urban and rural areas;(2)The government should increase the propaganda of urban and rural health insurance system,using different publicity methods,targeted to urban and rural residents to teach,strengthen the residents' insured awareness;(3)The government should understand the needs and satisfaction of the urban and rural residents to the system and improve the scientific and rationality of the system design.The government should establish a sustainable financing mechanism based on the level of income of the residents.In the reimbursement policy,we should further simplify the reimbursement procedures.Currently,the outpatient reimbursement program should be retained.