The Impact Of The Integration Of Medical Insurance For Urban And Rural Residents On The Economic Burden Of Family Medical Care

The dual separation of urban and rural areas has been a major feature of China for a long time,and the medical insurance system is no exception.New rural cooperative medical insurance and urban residential insurance have been set up for rural residents and urban residents to help them resist the economic risks of diseases.With the development of the economy,the differences between urban and rural areas are gradually narrowing.The system of separate management and operation of the New Rural Cooperative Medical System and urban residential insurance has begun to show various disadvantages.Before 2016,many regions have begun pilots for the integration of urban and rural residents' medical insurance.Providing some policy suggestions for regions that have not yet been integrated,and also provide some ideas for improving the existing integration system is necessary.The existing research on the integration of urban and rural residents' medical insurance is mostly qualitative analysis,and most scholars believe that integration is necessary and has a positive effect on improving equity and efficiency.In some literatures that quantitatively study the effect of integration,conclusions is integrating is effective,for example,it can improve health and increase the use of medical services.However,the academic community has not formed a unified view on whether medical insurance will reduce the family's medical financial burden.Some scholars believe that the medical financial burden of the insured will be reduced because the medical insurance foundation pays part of the medical expenses.Some scholars believe that the existence of moral hazard is a problem that cannot be ignored.Therefore,after participating in medical insurance,because of the reduced sensitivity to prices,it may increase unreasonable medical expenses and cause medical economic burden increase.This article studies the integration's impact on the family's medical economic burden.In the context of rising medical costs,expensive medical treatment is an issue that needs to be resolved.Since the integration of medical insurance between urban and rural residents,the medical insurance benefits are higher than the previous.Therefore,it is of great significance to study whether the integration will have an impact on the family's medical economic burden.Based on the above background,this paper uses the data of CHARLS 2011,2013,and 2015 to study the impact of urban and rural residents' medical insurance integration on family medical economic burden through difference in difference model and fixed effect model.Among them,the family medical economic burden is measured by the family's medical expenditure in the past year / consumption expenditure in the past year.Whether the urban and rural residents' medical insurance is integrated is a virtual variable to be judged by relevant local policy documents.In addition,it also specifically compares the impact of integration on rural and urban residents,the impact on different income strata,the impact on outpatient and inpatient groups,and the impact on patients with chronic diseases.The study found that the integration can significantly reduce the family's medical economic burden,but its role is limited.The results also show that integration have a greater role for rural residents,but they have no significant effect on the urban residents.This result is reasonable because the benefits of the integrated medical insurance have been significantly improved compared to the NCMS.In addition,the impact of integration on different income groups is different.It has a significant effect on reducing the family medical economic burden of low-income groups and middle-income groups,but has no effect on high-income groups.This is because the medical economic burden is low for highincome groups.Comparing outpatient and inpatient groups,it is found that the integration has a significant effect on reducing both group's burden,and has a greater impact on the inpatient group.This is because the hospitalization expenses are large,which makes the family medical economy burden is heavier.The study also found that integration can reduce the medical economic burden of chronic disease groups.In order to further improve the integration of urban and rural residents' medical insurance policies,this article studies several typical integration models in China and specific integration cases abroad,and draws a few experiences for reference such as the government's responsibilities are clear and the integration process is gradual.Finally,based on the conclusions of this article,five countermeasures are proposed.The first is to strengthen the primary health service system,make full use of primary health care resources and reduce unnecessary medical expenses;the second is to make medical and health resources continue to be tilted to rural areas to reduce the medical economic burden on rural residents;third,we must promote medical insurance policies to favor low-income groups.The fourth is to strengthen the protection of outpatient groups to make up for the current lack of protection for them.Fifth,we must attach importance to the management of chronic diseases,interfering with the prevention,treatment and follow-up of chronic diseases.Because the existing related literature mostly uses small sample data and uses a standard DID model to quantitatively analyze the impact of integration on the family medical economic burden,the possible innovation of this article is based on a large sample at the national level,which uses heterogeneous DID and the fixed effect model to eliminates the influence of some unobservable variables,making the research results more accurate.In addition,this article studies the integration effect on different people.