Influencing Factors Of Family Catastrophic Health Expenditure And Policy Choice Of Medical Assistance

The convening of the national health and health conference and the release of the outline of healthy China 2030 plan indicate that China has raised the construction of "healthy China" to the national strategy,put the health of all the people in an important position of development,and put forward that "without national health,there will be no overall well-off society".On this basis,the 19 th National Congress also further put forward an important conclusion: only by realizing people’s health can we better realize national rejuvenation and contribute to national prosperity.According to the opinions on deepening the reform of medical security system: a medical security system with basic medical insurance as the main body,medical assistance as the foundation,supplementary medical insurance,commercial health insurance,charitable donation and medical mutual assistance should be fully established.The medical assistance system is a medical security system for the state to ensure that people in difficulty have access to basic medical and health services.The goal is to build a solid guarantee for people’s livelihood.However,at present,the phenomenon of poverty caused by illness and returning to poverty due to catastrophic medical and health expenditure still occurs from time to time,and there are difficulties in the sustainable development of medical assistance.Under the background of rural revitalization,this paper explores the influencing factors of catastrophic medical and health expenditure and the policy choice of medical assistance,in order to provide help for the healthy development of medical assistance system.The main body of this paper mainly includes two parts: micro analysis and macro analysis.In the micro analysis part,the data of charls2013 and charls2018 are used to study the influencing factors of catastrophic health expenditure:(1)what aspects will have a significant impact on household catastrophic health expenditure;(2)Further analyze whether the occurrence of catastrophic medical and health expenditure is unfair;(3)What are the leading factors causing this unfairness.Measure whether the medical assistance system can reduce the incidence of catastrophic medical and health expenditure,and further explore the policy improvement direction of the future medical assistance system,so as to realize the treatment of people in difficulty and alleviate the burden of medical expenses.From the three aspects of the overall analysis of the medical assistance policy and the operation of the medical assistance system in Sichuan Province:(1)from the three aspects of the overall analysis of the medical assistance policy and management;(2)From the perspective of system,this paper analyzes the sustainability,system function and overall planning level of medical assistance system in Sichuan Province;(3)From the perspective of management,this paper analyzes the aspects of fund management,rescue planning and management manpower in Sichuan Province.The study found that: first,the incidence of catastrophic medical and health expenditure increased from 2013 to 2018,and there were differences in family income and urban-rural differences in the occurrence of catastrophic medical and health expenditure;At the same time,the incidence of catastrophic medical and health expenditure of poor marginal households is the highest.The incidence of catastrophic medical and health expenditure is biased towards the inequality of the rich,and the inequality expands with time;Second,the incidence and severity of catastrophic medical and health expenditure of rural families are much higher than those of urban families.Basic medical insurance has not effectively alleviated the unequal incidence of catastrophic medical and health expenditure.Third,the coverage of medical assistance continues to expand.In the use of policy tools,environmental policy tools rely too much and demand policy tools are not used enough;Fourth,there are some problems in the operation of medical assistance system,such as insufficient sustainability,single system function and low overall planning level;Fifth,there are some problems in medical assistance management,such as low efficiency of fund management,fragmentation of assistance management system and weak staffing of handling management personnel.According to the above contents,the suggestions provided in this paper are:first,maintain economic support for the poor and alleviate the pressure of large medical expenses.Bring poor and marginal families into the coverage of medical assistance,carry out employment guidance services for vulnerable groups,and improve their access to income,so as to reduce the income gap;Second,improve the frequency of using demand-based policy tools and introduce social forces to participate in medical assistance handling;Third,choose the mode suitable for medical assistance commercial insurance agency,weigh the advantages and disadvantages from the modes of entrusted management,joint insurance and insurance contract,and choose the best mode;Fourth,enrich the functions and means of medical assistance management,realize the separation of management and office,and provide full-cycle medical assistance services for the poor,so as to realize the benign and sustainable development of medical assistance,and truly let the poor people feel at ease and optimistic about the disease.