Research On The Dynamic Changes Of The Impact Of Medical Insurance Policy Adjustment On Rural Residents' Medical Expenses

Objective This study analyzes the impact of medical insurance policy adjustments on rural residents' medical expenses in the pilot counties from both the outpatient and inpatient aspects,calculates the net effect of the medical insurance policy adjustments on the medical expenses of all residents and residents of different economic income levels,and explores the adjustment of medical insurance policies The multi-stage dynamic changes and the phasic effects and progressive effects in the adjustment process provide a reference for promoting the healthy and sustainable development of the Ningxia urban and rural integrated medical insurance system.Methods Utilizing Ningxia's "Innovative Payment System and Improving Health Benefits" Pilot Projects in 2009,2012,2015 and the National Natural Science Foundation of Ningxia's "Ningxia Medical Reform Pilot Counties" Dynamic Research on Health Service Utilization,Cost Burden and Equity of Rural Residents Data from the “Relationship Research” project in 2019,screening rural residents over 15 years old as the research object,matching the propensity scores of the policy adjustment project intervention group(Hayuan County,Yanchi County)and control group(Pengyang County),Based on the matching,a multi-stage dual difference model was established to analyze the impact of medical insurance policy adjustments on rural residents' medical expenses.Results(1)Medical expenses: The total average outpatient cost of the intervention group and the control group is increasing year by year.By 2019,the two groups have increased by 4.04 times and 4.11 times compared with 2009.The average out-patient out-of-pocket expenses per year were 387.404 yuan and 243.639 yuan,respectively.Over time,the average out-patient out-ofpocket expenses of the control group increased year by year,increasing to 890.520 yuan by 2019,while the intervention group showed fluctuations.,But it is higher than the base period,an increase of 2.55 times;the outpatient out-of-pocket ratios of the base intervention group and the control group are 90.29% and 86.82%,respectively.By 2019,the outpatient out-of-pocket comparison group of the intervention group and the control group is compared to baseline During the period,they were reduced by 15.74% and 6.56% respectively.In 2015,residents in the intervention group and the control group had the highest total per-hospital expenses and per-hospital out-of-pocket expenses,which were both reduced by 2019.The pay ratios were 61.96% and 41.90%,respectively,and the hospitalization deductible ratio of the intervention group showed a year-onyear decrease trend,which decreased by 26.76% by 2019,while the control group showed a volatile trend,but also decreased compared to the base period,a decrease of 7.78.%.(2)Influencing factors of medical expenses: In outpatient and inpatient medical institutions,the ratio of out-of-pocket expenses and out-of-pocket ratios increase with the increase of the level of medical institutions;self-perceived health status and out-of-pocket expenses and out-patient expenses The pay ratio is negatively correlated,the worse the self-perceived health status,the higher the self-pay and the pay ratio;the per capita income level is positively related to the total cost of outpatient and hospitalization,and the higher the per capita income level,the higher the average cost.(3)The multi-stage double-difference results of the overall sample residents show that the rural residents' average out-patient out-of-pocket payments and out-patient out-of-pocket ratios decreased by 52.73% and 7.63% after 3 years of policy adjustment,but the effect of the adjustment was not significant.Regarding the average cost per hospitalization,the initial adjustment effect was not significant.Six years after the policy adjustment,the average cost per hospitalization payment decreased by 53.55%,and the effect disappeared after the adjustment of 10.In 2012,2015,and 2019,the rural residents in the intervention group were reduced by 3.71%,4.40%,and 4.09% in comparison with the control group,respectively.(4)The multi-stage doubledifference results of residents with different incomes show that the impact of the adjustment of medical insurance policies on the medical expenses of residents with different income levels is mainly reflected in the low-income group and the middle-income group.For low-income rural residents,the average out-patient out-patient expenses and out-patient out-of-pocket ratios of the income group residents were reduced by 65.71% and 9.65%,respectively,at the beginning of the policy adjustment.However,the policy effect did not continue in the later period;policy adjustments The effect on the per-hospital out-of-pocket expenses was significant only after 6 years of adjustment,which was a reduction of 85.18% compared with the control group;the policy adjustments for in-patient out-of-pocket payments after 3,6,and 10 years of policy adjustments decreased by 3.65%,3.81%,and 0.44 respectively.%.For middle-income rural residents,the adjustment of medical insurance policy has no significant effect on the out-patient out-of-pocket ratio and out-patient out-of-pocket ratio;the effect of in-patient out-of-pocket payments has only decreased after 6 years of policy adjustment,a decrease of 4.50%,But did not improve in the initial adjustment period and the sustainable period;it has a continuous impact on the hospitalization deduction ratio,and decreases year by year.Conclusion(1)The adjustment of the medical insurance policy reduced the average outpatient out-of-pocket expenses and out-of-pocket ratio of rural residents in the intervention group,but the impact was short-term.(2)The adjustment of the medical insurance policy reduced the per-hospital out-of-pocket expenses of rural residents in the intervention group,but the effect was short-lived.(3)After adjustment of the medical insurance policy,the rural residents' hospitalization deduction ratio in the intervention group decreased,and the policy effect was rapid and lasting.(4)For rural residents with different income levels,the net effect of the medical insurance policy adjustment on medical expenses is mainly reflected in low-and middle-income residents.