A Study On The Influence Of Social Medical Insurance On The Equalization Of Residents’ Access To Medical Services

Medical services play an important role in promoting the overall development of the economy,society and people.At the same time,"Social fairness and justice are the basic conditions for a harmonious society ",and "What we now face is the contradiction between the unbalanced and inadequate development and the people’s ever-growing needs for a better life." Therefore,an idea that "basic equalization of basic public services should be basically realized" was provided in the report adopted at the 19th National Congress of the Communist Party of China."Health is the foundation for people’s all-round development." Since the reform and opening up in 1978,china has scored outstanding achievements in medical and health services.In addition to establishing the medical and health service systems basically covering both urban and rural residents,China has made a continuous improvement in the capabilities of preventing and treating diseases,and a significant advancement in the residents’ health.However,it should be noted that there are still various problems in medical and health services in China.For example,there are still an imbalance in medical and health service development and an inequitable allocation of medical and health resources between its urban and rural areas.Meanwhile the imbalance and inequality has not only led to an inequitable medical and health resources for the residents in different regions,but also caused strong public resentment.Therefore,this thesis is designed to answer the following questions:Can social medical insurance improve the level of medical services for residents?What are the theoretical basis for the answer of the aforesaid question?Do the empirical results support such an answer?Furthermore,will social medical insurance provide different improvement of medical services for residents of different groups?Finally,because social medical insurance is an important part of medical service system and both of them are based on regional economic development,a question arises:can social medical insurance and medical service be developed in a coordinated way as a whole system?Firstly,this thesis combed the existing literatures about social justice,and applied them to the field of residents’ medical services to clarify the necessity of equalization of medical services.After clarifying the necessity of the equalization of residents’ basic medical services and its possible path,this thesis focused on the impact of social medical insurance on residents’ medical services and their equalization from the macroprovincial level.This chapter firstly analyzed and combed the development process of social medical insurance;then,it constructs a comprehensive index for the provincial residents’ medical services through entropy weight method to measure and analyze the level of residents’ medical services in each province and the development and evolution of their inequality.Finally,the spatial econometric model is used to empirically analyze the impact of social medical insurance on the provincial residents’ medical services and their equalization.Then,the thesis analyzed the impact of social medical insurance on the equalization of residents’ medical services at the micro-individual level by using CHNS data.This chapter firstly used the Gini coefficient and the kakwani index to measure the level of medical service equalization and its evolution characteristics of individual residents.Then,the logit regression model is used to empirically analyze the impact of social medical insurance on the equalization of residents’ medical services.Thirdly,the Concentration Index is used to quantitatively analyzing and describing the differences of residents’ individual medical services among different groups,and using the Wagstaff-decomposition method to explore the factors that may cause the equalization of residents’ medical services.Finally,using different micro-survey data,through the analysis of the New Rural Cooperative medical care to analyze the impact of social medical insurance on the equalization of residents’ medical services.Then,the thesis took social medical insurance,medical services and regional economy as a whole to analyze the coordinated development of social medical insurance and residents’ medical services,and expected to analyze the relationship between social medical insurance and the equalization of residents’ medical services according to the Systems Theory.This chapter firstly analyzed the relationship among social medical insurance,medical service and regional economy.Then,the comprehensive evaluation value for each subsystem was calculated by using the entropy-weight method,and a coupling coordination degree model was constructed to analyze the coupling harmonious degree of the overall system containing social medical insurance,medical services,as well as regional economy and its spatial-temporal differentiation characteristics.Finally,some recommendations were put forward,such as improving social medical insurance benefits,narrowing the income gap,and further improving urbanization to promote the equalization of residents’ medical services.Through the above research,some interesting results were concluded as follows.Overall,not only from macro-provincial level,but also from micro-individual level,there are significant differences in residents’ medical services.However,from a longitudinal perspective,the equalization has been improved significantly.At the macro-provincial level,an alleviation of medical service inequality between the provincial administrative regions has been made in recent years in China,and although its role has not been seen in some aspects in a significant way.At the micro-individual level,social medical insurance has significantly improved residents’ access to medical services;meanwhile,it has also narrowed the gap between different groups’ access to medical services,and promoted the equalization of residents’ access to medical services.The whole system was composed of Social medical insurance,medical service system and region economy.And the system’s coupling harmonious degree has made a fluctuating achievement.This thesis analyzes the impact of the social medical insurance on the equalization of residents’ medical services from both the macro perspectives and the micro perspectives by taking all the social medical insurance as a whole.There are some important theoretical inspiration and some practical inspiration for promoting the equalization of public services and alleviating the contradictions such as "unbalanced and insufficient".The possible innovations in this thesis are the research perspective and the research methods.A comprehensive perspective including both the marcoperspective and the micro-perspective was applied to study the impact.And a spatial econometric model was applied to study the impact.Besides,considering the relationship between the medical service and the regional economy,according to the system theory,this thesis applied the coupling coordination model to analyze the spatial-and-temporal characteristics of "the regional economy-social medical insurance-medical service system",so as to analyze the impact of the social insurance on the medical service.