Study On The Regulating Effect Of Income Gap Of The Urban And Rural Resident Basic Medical Insurance

The Report to the 20th National Congress of the CPC pointed out that the central task of the Party and the country in the future is “comprehensively promoting the great rejuvenation of the Chinese nation through Chinese-style modernization”,and“achieving common prosperity for all the people” is the essential requirement of promoting Chinese-style modernization.At present,the income gap is relatively large and the income distribution is not reasonable,which has become one of the main obstacles to promoting common prosperity,and hence narrowing the income gap is the concrete manifestation and realization path of promoting common prosperity.The high cost of out-of-pocket medical care and the increasing complexity of individual income sources pose significant challenges to narrowing the income gap.As a key institutional arrangement to ease the medical burden,basic medical insurance can directly increase the disposable income of the insured by reducing the out-of-pocket medical expenses,and indirectly expand the income source of the insured by reducing preventive savings.Then,does basic medical insurance directly or indirectly narrow the income gap through the above paths? After reviewing the literature,it is found that existing studies seldom pay attention to the regulating effect of basic medical insurance on the income gap,and the mechanism of basic medical insurance regulating the income gap has not been clarified theoretically,and empirical evaluation has not been carried out scientifically.Since social security is an important means and key system for the country to narrow the income gap and basic medical insurance is an important part of social security,the income gap regulating effect of basic medical insurance is a topic worthy of in-depth study.Because the Urban and Rural Resident Basic Medical Insurance(hereafter URRBMI)covers most Chinese citizens,this paper studies the regulating effect of the income gap of URRBMI.It intends to focus on the following aspects: First,demonstrate that regulating the income gap is one of the institutional functions of URRBMI.Second,analyze the theoretical mechanism of the income gap regulating effect of URRBMI.Third,carry out the empirical evaluation of the income gap regulating effect of URRBMI based on the influence mechanism analysis.Finally,put forward some policy suggestions to improve the income gap regulating effect of URRBMI based on the empirical evaluation results.This paper follows the analytical paradigm of "theoretical research-empirical research-applied research".First,this paper demonstrates the legitimacy and necessity of regulating the income gap by URRBMI under the support of the western classic theories on income distribution and the new era of common prosperity theory proposed by Xi Jinping.Meanwhile,combined with the existing literature and related policies,this paper proves that regulating the income gap is one of the goals of URRBMI.Then,based on the existing studies,the theoretical mechanism of the direct and indirect income gap regulating effects of URRBMI are analyzed.Then,an empirical evaluation framework is built from the direct and indirect regulating effects,and specific methods such as the Gini coefficient method,regression analysis method,and Kakwani individual relative deprivation index method are used to evaluate the real results of the income gap regulating effects of URRBMI.Finally,based on the analysis of the research conclusions,this paper puts forward some policy suggestions to improve the regulating effect of the income gap of URRBMI.Theoretically,URRBMI has direct and indirect regulating effects on the income gap.The direct regulating effect refers to the effect of URRBMI on the income gap by directly regulating people’s income levels.Specifically,in the three links of medical insurance financing,medical treatment and reimbursement of URRBMI,the first two will cause the outflow of funds,while the last one will cause the inflow of funds,which will cause the change in the income level of insured people and change the relative income among them,namely the income gap.The indirect regulating effect means that URRBMI indirectly influences people’s income level and the income gap among them through human capital,material capital,and financial capital.Specifically,URRBMI will reduce the preventive savings for the treatment of diseases and thus increase consumption,investment,and borrowing in human capital(including health,education,training,etc.),physical capital,and financial capital.These behaviors will improve their initial endowments and competitiveness,thereby increasing their income levels and changing the relative status of their incomes,known as the income gap.This paper conducts empirical evaluation from two aspects of direct and indirect regulating effects based on the above theoretical analysis,and the main conclusions are as follows:First,URRBMI generally plays a positive role in regulating the income gap.Based on the counterfactual framework,this paper finds that URRBMI plays a positive role in regulating the income gap.The Gini coefficient is 0.6604 under the factual situation(i.e.,the existence of URRBMI),while the Gini coefficients fitted with OLS and PSM are 0.6740 and 0.6801 respectively under the counterfactual situation(that is,there is no URRBMI).The Gini coefficient of the factual situation is even smaller,suggesting that URRBMI narrows the income gap.Second,the positive regulating effect of URRBMI on the income gap is not enough to reverse the trend that medical insurance-related expenses widen the income gap.Following common practices in existing studies,this paper compares the income gap before financing and the income gap after reimbursement.The empirical results show that the Gini coefficient is 0.5405 before financing and 0.6604 after reimbursement.This evidences that the positive regulating effect of URRBMI is not enough to reverse the trend of medical insurance-related expenses widening the income gap.Specifically,the income gap has widened in the financing link and the medical treatment link of URRBMI,and the latter is bigger.When it comes to the reimbursement link,the income gap has narrowed,but not by as much as the first two combined.Third,the outpatient pooling for URRBMI(hereafter the outpatient pooling)fails to achieve the expected effect of narrowing the income gap.The outpatient pooling fails to reduce medical expenses as expected and thus does not narrow the income gap.On the contrary,the empirical results show that medical expenses increase after the outpatient pooling,which further widens the income gap.The reason is that the low level of outpatient security and the lack of primary medical resources lead to the failure of the outpatient pooling to reduce the burden of medical treatment and narrow the income gap.Fourth,URRBMI can positively regulate the income gap indirectly through human capital,material capital,and financial capital.The income gap(capital gap)among individuals is represented by income deprivation(capital deprivation)of individuals.This paper uses Kakwani individual relative deprivation index to analyze the difference between the deprivation of the insured group and that of the uninsured group.This paper shows that compared with the uninsured group,urban and rural residents who participate in URRBMI face lower deprivation of human capital(including health capital,education capital,and training capital),material capital,and financial capital,which leads to lower deprivation of income.Fifth,the integration of medical insurance for urban and rural residents(hereafter the integration)widens the health gap,which indirectly widens the income gap.And this phenomenon mainly exists between rural residents and urban residents.The empirical results show that the integration only has a significant impact on the health path,and to be more precise widens the health gap,which indirectly widens the income gap.In other words,compared with the un-integration situation,the health gap and the income gap among insured residents have widened after the integration.In a further analysis,the study finds that the health gap and the income gap increase mainly between rural residents and urban residents.Based on the above findings,this paper puts forward policy suggestions to improve the regulating effect of the income gap of URRBMI: First,the principle of voluntary participation in URRBMI should be revised to compulsory participation.Second,improve the revenue-related financing mechanism of URRBMI.(1)Need to increase government financial input and raise the standard of financing subsidies.(2)Need to increase the skew of government financial subsidies and widen the degree of policy differences.(3)Need to revise the current fixed-amount contribution model of URRBMI into a proportional contribution model.Third,continue to strengthen the effect of URRBMI on controlling unreasonable increases in medical fees.(1)Need to improve the bargaining power of medical insurance agencies.(2)Need to advance the reform of medical insurance payment methods.Fourth,improve the management level of the medical insurance reimbursement process of URRBMI.(1)Need to improve the level of medical insurance reimbursement of URRBMI.(2)Need to increase the degree of policy tilt of medical insurance reimbursement of URRBMI.(3)Need to streamline the operation process of medical insurance reimbursement of URRBMI.Fifth,accelerate the transformation of URRBMI for both inpatient and outpatient care.Sixth,give proper preference to rural residents in the policies of URRBMI.Seventh,coordinate the contribution of URRBMI with non-institutional factors.The innovation of this paper is mainly reflected in the following four aspects: First,no literature has been found to study the regulating effect of the income gap of URRBMI,while this paper comprehensively discusses the regulating effect of the income gap of URRBMI,namely not only theoretically clarifying the influencing mechanism of URRBMI regulating the income gap,but also systematically constructing the empirical evaluation framework of URRBMI regulating the income gap,which in a certain sense,supplements the relevant research.Second,most of the existing literature examines the direct regulating effect of the income gap of basic medical insurance based on the link of financing-medical treatment-reimbursement,while the paper evaluates the direct regulating effect of the income gap of URRBMI based on not only the above perspective bout also the counterfactual framework.Third,no literature has been found to discuss the impact of the outpatient pooling of basic medical insurance on the income gap,while this paper analyzes the effect of the outpatient pooling of URRBMI on the income gap.Fourth,there are few works of literature to analyze the indirect regulating effect of basic medical insurance on the income gap,while based on the human capital path,the material capital path,and the financial capital path,this paper analyzes and evaluates the indirect regulating effect of the income gap of URRBMI from two perspectives,namely the comparison between the un-integration and the integration,and the comparison between the insured and the uninsured.