The Effect Of Medical Insurance On The Elderly’s Outpatient Service Utilization

Health care is one of the basic needs for every citizen, which has received attentions from most countries. The reform of medical insurance system has been going on for many years in China, resulting in a "universal coverage" frame recently, which is formed by three basic medical insurances, including basic medical insurance for urban employees, basic medical insurance for urban residents and the new rural cooperative medical insurance (NRCMI). With a rapidly ageing population, medical insurance for the elderly becomes an important issue in social development. In order to further improve the medicare for the elderly, it is necessary to conduct the evaluation of the effect of these medical insurances. A number of domestic scholars have conducted such researches mainly on topics around rates or expenses of hospitalization. However, this paper analyzes the effect from a different perspective by evaluating the effect of various kinds of medical insurances on outpatient services, considering the high incidence of chronic illness among the elderly.This paper is divided into five chapters. Chapter1introduces the background, lit-erature reviews, research methods, innovations, etc. Chapter2introduces the statistical models used in the empirical analysis, including PSM (Propensity Score Matching) and regression models for count data. Chapter3introduces the source and basic information of the data, followed by a detailed descriptive statistical analysis on the medical insurance and outpatient expenses of the sample. Chapter4studies the effects of different kinds of medical insurances on the rates and numbers of outpatient services, then classes the population into three groups by different range of ages to further analyze the effect in each group. Chapter5summarizes the whole paper and puts forward some suggestions.The main conclusions of this paper include:(1)The basic medical insurances have remarkable effects on the increase of the rates and numbers of the outpatient services of the elderly, but the influences are discrepant among different kinds of medical insurances. (2) By establishing a finite mixture model it is found that two latent classes exist in the population: low users (ordinary) and high users of the outpatient services.(3)Medical insurance for urban employees and for urban residents have significantly improved the numbers of outpatient services among the younger elderly, while the NRCMI has signifi-cantly improved the numbers of outpatient services among the whole elderly, whose lift is increasing with age.(4)The supplemental medical insurance has no significant influence on both the rates and numbers of the outpatient services of the elderly.(5)The variance among the outpatient expenses of the elderly is huge, and the ratios of out-of-pocket ex-penses to the outpatient expenses are generally high. Thus it can be seen that the basic medical insurances did raise the outpatient service utilization of the elderly, but there are still a lot to be improved.