Study On The Impact Of Medical Insurance Compensation Policy Adjustment On Catastrophic Health Expenditure And Equity Of Families With Chronic Diseases In Mountainous Rural Ningxia

Objective: Combined the medical reform project of "innovative payment system,improve the efficiency of the health reform",to understand the current situation of catastrophic health expenditure of households with chronic diseases in rural areas of sample counties,analyze the main factors affecting catastrophic health expenditure of households with chronic diseases,and concentration index and its decomposition method is used to further analyze health-care reform pilot project compensation policy in the implementation of continuous adjustment,sustainable and subsequent period of rural family catastrophic health expenditure and fairness of chronic diseases,in order to provide demander data support for the healthy sustainable development policy and scientific reference basis.Methods: Adopting the unbalanced panel data of before implementatio(2009),middle(2012),termination(2015),and the project follow-up period(2019)of families with chronic diseases in the pilot counties(Haiyuan and Yanchi)and control counties(Pengyang and Xiji)in four time nodes,the random effects binary Logistic model was used to understand the influencing factors of catastrophic health expenditure of rural households with chronic diseases in sample counties.The concentration index and its decomposition method were used to compare the changes of the equity of catastrophic health expenditure in four years,and analyze the contribution of various factors to the equity of catastrophic health expenditure.Results:(1)In 20%,30%,40%,50%,60% threshold,the baseline of 2009 and 2012,2015,2019,follow-up survey of the incidence of catastrophic health expenditure and average gap gradually with the increase of the threshold is reduced,the relative gap with increased with the rising of the threshold,and three times in the follow-up investigation after reimbursement incidence of catastrophic health expenditure,the average gap and relative gap below before reimbursement.Under the 40% threshold,the incidence of catastrophic health expenditure after reimbursement for baseline survey and three follow-up surveys was 13.79%,10.41%,7.62% and 12.72%,respectively.The average differences were 11.30%,8.36%,6.41% and 10.37%,respectively.The relative differences were 81.96%,80.24%,84.04%,81.54%,respectively.The incidence rate and average difference after reimbursement of the three follow-up surveys showed a trend of decreasing and then increasing,while the relative difference showed a trend of increasing and then decreasing.The decreasing rate of the incidence of catastrophic health expenditure basically showed a decreasing trend,and the decreasing rate of the occurrence intensity of catastrophic health expenditure decreased in2015 compared with 2012,but showed a slowly increasing trend in 2019.(2)Insurance compensation policies,household,head of household,and chronic disease patients are the main factors affecting catastrophic health expenditures.Specifically,the incidence of catastrophic health expenditure decreases with the setting of the threshold and the higher the reimbursement ratio,with the per capita annual income and the size of the family population.The incidence of catastrophic health expenditure increased with the number of people over 65 and under 5 in the household,the number of people with chronic diseases in the family,and the types of diseases suffered by chronic diseases in the family.When the head of the household is female,the elderly,the patients with chronic diseases,the illiterate,the farmer,the marital status is not in marriage,the incidence of catastrophic health expenditure is higher.The incidence of catastrophic health expenditure is higher when patients with chronic diseases are treated for diabetes and to see a doctor.(3)Concentration index and its decomposition method the result shows: the four survey the incidence of catastrophic health concentration index respectively-0.0372,-0.0389,-0.060,-0.0308,are negative,indicating a close the inequality of the poor,but its overall showed a trend of rise and fall of the absolute value,that catastrophic health expenditure fairness is better,still have a tendency to shift to low-income families.Among the key elements of medical insurance compensation policy,the starting line,reimbursement ratio,family economic status and family population size are the main factors affecting the fairness of catastrophic health expenditure for families of patients with chronic diseases.Conclusion:(1)The adjustment of medical insurance compensation policy has reduced the incidence and intensity of catastrophic health expenditure of families with chronic diseases in rural Ningxia to a certain extent,but there are still limitations.(2)Starting line and reimbursement ratio in health insurance compensation policy,a family annual per capita income,family size,the number of people under 5 in the household,the number of patients with chronic diseases in the home,the home with a chronic illness disease species number,the marital status and occupation of the head of the household and the incidence and medical treatment of the patients with chronic diseases are the main factors of catastrophic health expenditure.(3)The four-year catastrophic health expenditures were generally unequal in favor of the poor,but the equity was better than in the 2009 baseline survey.(4)The starting line and reimbursement ratio,family size and family economic status are the main factors that affect the equity of catastrophic health expenditure.