Research On The Measurement Of The Economic Risk Level Of Diseases Of Rural Residents In Ningxia Under The Integrated Medical Insurance System For Urban And Rural Residents

BackgroundIn the past 10 years,our medical and health services have achieved a leap-forward development.People's demand for medical services has been effectively met and health services have been significantly used.While the growth rate of total cost on health in China is inharmonious with the growth rate of disposable income(DI)of residents.In addition,the average income level of rural residents is lower than that of urban residents,which means they will suffer a larger economic risk of diseases when sick.Through the participation of all social members,the medical insurance system disperses the economic risk brought by medical behaviors which cannot be afforded by some families or individuals and reduces the appearance of “poverty caused by illness and poverty returned by illness”.Initial basic medical insurance system in China is diversified,hierarchical and fragmented.This rural-urban separation mode of the medical insurance system is far behind the rapid development of urbanization.Therefore,only by realizing the integration of urban and rural medical insurance can the differences in health security between urban and rural residents which is led by the structure system of urban and rural areas be narrowed.Before the official announcement of the Opinions on the Integration of the Basic Medical Insurance System for Urban and Rural Residents of the State Council,Ningxia has already passed the relevant opinions on the establishment of basic medical insurance for urban and rural residents in October 2010.The opinions suggest to integrate the basic medical insurance system for urbanand rural residents with the new rural cooperative medical insurance,and unified into the integrated medical insurance system for urban and rural residents.After the integration,the population participating in the medical insurance system has increased rapidly.The “law of large numbers” of medical insurance system can be better used to realize mutual support of funds in a larger range and improve the risk-resisting ability of funds.As an important management and control mechanism for disease economic risks,the medical insurance system plays a key role in sharing the economic risks of residents' diseases and alleviating the economic burden.Therefore,it is necessary to investigate the effect of coordinating the basic medical security system for urban and rural residents on alleviating the economic risks of farmers' diseases.It has theoretical guidance value for understanding the current situation of farmers' economic risks in Ningxia and reducing the economic burden of farmers' diseases.This can provide policy advice to enhance the capacity of the rural health care system to withstand the economic risks of disease.ObjectivesThe purpose of this research is to analyze the economic risks of diseases faced by rural residents in Ningxia under the Integrated Medical Insurance System for Urban and Rural Residents.According to the broad definition of economic risk of disease,this paper assesses the economic risk level of disease of the sample population in 2013 and 2016 from absolute economic risk(the probability of medical risk,the loss of medical risk)and economic risk(relative risk,catastrophic health expenditure)these two aspects,analyzes the change degree,relevant influencing factors and fairness change degree of economic risk level of disease.Policy recommendations are proposed in order to enhance the ability of urban and rural residents' medical insurance system to resist disease economic risks and promote the sustainable development of this medical insurance policy.Methods1.Data collection: by referring to literature to obtain qualitative data and by second-handdata collection and self-designed questionnaires to obtain quantitative data.2.Literature research: define the economic risk of disease,define the index and make a summary on the impact of medical insurance on the theoretical basis of economic risk of disease and burden.3.Statistical analysis: by using descriptive statistical method to analyze the demographic characteristics and economic risk indexes of disease of sample population;by using binary logistic regression to analyze the probability of medical risk and the influencing factors of catastrophic health expenditure,and carry out Omnibus test and Hosmer-Lemeshow test to judge the goodness of fit of the model;by using multiple linear regression model to analyze the influencing factors of the loss of medical risk and diagnose the effect of the model(including D-W test,multicol linearity diagnosis,influential observation diagnosis);by using concentration index and concentration curve to analyze the distribution fairness of economic risk of disease in families with different income.Results1.Absolute Economic Risk Level:(1)Probability Index of Medical Risk:The research result shows that the prevalence rate of chronic disease and the hospitalization rate of the sample population in 2013 are higher than that in 2016.While the two-week visiting rate of the sample population in 2016 is higher than that in 2013.All the differences above have statistical significance.Multivariate analysis showed that the two-week prevalence factors were income level,age,education level,and employment status.The influencing factors of the prevalence of chronic diseases are income level,age,gender,ethnicity,and employment status.The influencing factors of the two-week visit rate were income level and age.The influencing factors of hospitalization rate are income level,age,gender,ethnicity,marital status,education level,and employment status.Through the analysis of fairness,it is found that the concentration indexes of the sample population in 2013 and 2016 are negative.In addition,the unfairness of two-week prevalence rate,two-week visiting rate tends to lowincome group it has been improved.(2)loss Index of Medical Risk:The research result shows that the average out-patient out-of-pocket expenses in 2013(508.03 yuan)is higher than that in 2016(320.03 yuan).The average hospitalization out-of-pocket expenses in 2016(5684.11yuan)is higher than the 2013(2787.99yuan).According to multi-factor analysis,the influencing factors of out-patient out-of-pocket expenses are the unit of treatment,whether the drug is used,and the number of days of disease.The influencing factors of hospitalization out-of-pocket expenses are hospitalization,age,surgery,and marital status.Through the analysis of fairness,it is found that the concentration indexes of out-patient out-of-pocket expenses in 2013 is-0.0572 and in 2016 it is-0.0446.It shows that the out-of-pocket expenses of the outpatient service have improved.The concentration indexes of hospitalization out-of-pocket expenses in 2013 is-0.0014 and in 2016 it is 0.0045,which were similar to 0and was fair.2.Relevant Economic Risk Level:(1)Relative Risk Index:In 2013,the proportion of sample families with low,moderate,high and extreme risk was 94.76%,2.76%,0.27%,and2.21% respectively.In 2016,the proportion was 94.49%,4.14%,0.00%,and 1.38% respectively.From the perspective of the economic risk of diseases in different income groups,the adjustment rate of relative risk of the low-income group was the highest in 2013 and 2016,which were 2.22% and 4.76%,respectively.From the perspective of the economic risk of diseases of outpatients and inpatients,the adjustment rate of relative risk of outpatients was0.24 in 2013 which is higher than 0.21 in 2016.While the adjustment rate of relative risk of inpatients was 1.79 in 2016 which is higher than 1.36 in 2013.(2)Catastrophic Health Expenditure Indicators:Under the 40% threshold,the incidence of catastrophic health expenditures for sample households in 2013 was 17.69%,with an average gap of 3.10% and a relative gap of 17.55%.In 2016,it was 14.10%,3.58%,and 25.40% respectively.According to multi-factor analysis,the employment status of the head of household,the size of the family,the level of family income,whether there is any hospitalization in the family,whether thereare chronic diseases in the family,and whether the elderly are 60 or older at home is a significant factor affecting the incidence of catastrophic health expenditure of the family.Through fairness analysis,it indicates that the incidence of catastrophic health expenditure,average disparity,relative disparity concentration index are negative in 2013 and 2016.And the absolute value of the concentration index in 2016 is lower than that in 2013,and the degree of poverty is decreasing.ConclusionsAs the most important safeguard mechanism to cope with the economic risk of disease for rural residents in Ningxia,the integrated medical insurance system for urban and rural residents has improved its insurance ability but still need to be strengthened.The current insurance ability cannot help rural residents to cope with the economic risks of disease effectively.Although most rural families are at low economic risk,a small portion of rural families at high economic risk will suffer heavy losses and a high risk of poverty.More attention should be paid to the protection of these families.Rural residents with low income will suffer a significantly higher possibility and severity of the economic risk of disease than those with high income.Moreover,they will face a higher economic risk of disease.The economic risk of hospitalized patients is higher than that of outpatients,and the use of inpatient services is more concentrated in the low-income group,suggesting that we should strengthen the compensation for the use of inpatient services.Whether there is someone in hospital or someone gets a chronic disease in a family will greatly affect the occurrence of family catastrophic health expenditure,which suggests that we should pay attention to the families with patients or a person with a chronic disease to protect them from the economic risk of disease.Besides,it is found that,although the initiative of rural residents to seek medical treatment has been improved,there are still some problems in the process of seeking medical treatment.For example,there is lack of use of primary medical units,residents tendto seek medical treatment in higher-level institutions,residents cannot trust the primary medical and health institutions,the cost of medical and health are much expensive,etc.Recommendations1.Vigorously develop rural economy in Ningxia and enhance residents' income ability.2.Enhance the capacity building of rural primary health services in Ningxia to meet the medical needs of residents.3.Enhance the risk sharing ability of Ningxia urban and rural medical insurance policies and increase the protection of low-income people.4.Enhance the government's macroeconomic regulation and control of medical expenses.5.Proactively guide residents to the first floor of the primary clinic.6.Implement health management and improve the management mechanism of chronic diseases.