Measurement Of Long-term Catastrophic Health Expenditure And Disaster Reduction Effect Of Basic Medical Insurance

Through the implementation of health poverty alleviation policies such as file establishment and basic assistance,China has achieved comprehensive poverty alleviation of the rural poor,which marks a change in the focus of my country’s poverty alleviation work in the future,from solving absolute poverty to alleviating relative poverty in order to achieve common prosperity and happiness of the people.However,after the elimination of absolute poverty and overall regional poverty,some people who have escaped from poverty still face vulnerable poverty and return to poverty due to illness.General Secretary Xi Jinping further emphasized that "returning to poverty due to illness and causing poverty due to illness is the main direction of poverty alleviation.This is a long-term matter that will not disappear with the eradication of absolute poverty in 2020." This means that building a moderately prosperous society in an all-round way to the stage of socialist modernization,and the strategic center of poverty alleviation is transformed into the governance of relative poverty,medical expenditure poverty has become an important component of relative poverty.Preventing and resolving poverty caused by illness and returning to poverty on a large scale are still the key links that need to be solved urgently in the future.The lack of research on the comprehensive attribute of long-term catastrophic health expenditure in the previous literature leads to the lack of long-term target planning of relative poverty governance and medical security policy.In this paper,the process of family medical expenditure increasing year by year and repeated occurring catastrophic health expenditure is defined as long-term catastrophic health expenditure.Combined with the multidimensional poverty measurement method of Alkire and foster and the duration analysis method of Foster,this paper constructs an index reflecting the change of time dimension,such as the incidence,depth and time of long-term catastrophic health expenditure,which comprehensively describes the occurrence degree of long-term catastrophic health expenditure,and uses the data of China’s families tracking survey from2010 to 2018（CFPS）for dynamic measurement and decomposition.Finally,taking the rural family sample as an example,Cox duration model is used to overcome the problem of data merging,empirically analyze the disaster reduction effect of basic medical insurance on family long-term disastrous health expenditure,further analyze the disaster reduction effect of different types of basic medical insurance on residents,and evaluate the long-term disaster reduction effect of basic medical insurance.The study has found that the occurrence of family sustained catastrophic health expenditure has strong stickiness.Although fewer families have long-term catastrophic health expenditure,once they fall into long-term catastrophic health expenditure,the longer the duration,the more difficult it is to get rid of it.In any case,by adjusting the critical value and standard of long-term catastrophic health expenditure,the level of long-term catastrophic health expenditure of rural families is higher than that of cities.However,with the growth of the duration of long-term catastrophic health expenditure,the gap between urban and rural families in long-term catastrophic health expenditure is gradually narrowing,but rural families are still the top priority in the governance of medical expenditure poverty in China.The long-term catastrophic health expenditure index itself is highly compatible with the concept and attributes of multidimensional relative poverty.It can constitute a main index of multidimensional relative poverty index and one of the key dimensions of long-term relative poverty in Chinese families.Compared with families which do not participat in the new rural cooperative medical system,the incidence of long-term catastrophic health expenditures of the families insured by the new rural cooperative medical system are lower.Basic medical insurance can effectively reduce the extent of long-term catastrophic health expenditures of urban and rural families.The basic medical system has a long-term disaster reduction effect on the long-term catastrophic health expenditure of families,and the longer the families participate in the basic medical system,the greater the long-term disaster reduction effect of the families.It means that basic medical insurance has a long-term sustainable disaster reduction effect.The conclusions of this article provide an empirical reference for the government to take targeted measures to implement high-quality health poverty alleviation.Incorporating medical expenditure-based poverty into the overall framework of relative poverty governance,adhering to the prevention-oriented health and health work policy,exploring socialized and multi-channel medical insurance fund financing models,and continuing to improve the level of basic medical insurance coverage,which are still the governance directions for my country’s relative poverty governance and the optimization of the medical insurance system in the future.