Research On The Impact Of Basic Medical Insurance On Catastrophic Health Expenditure And Its Inequality In Rural And Urban China

The Basic Medical Insurance(BMI)system has been developed and improved in terms of medical expense protection and equity in the past decade.However,the occurrence of Catastrophic Health Expenditure(CHE)of our country is still much more serious than that of other developed countries.In view of this,this study intends to adopt an empirical analysis to explore the changes of CHE and BMI in the past decade.What’s more,how BMI affects CHE in urban and rural China should be considered.In order to verify whether BMI is truly effective in alleviating the occurrence and inequality of CHE,this study will continue to explore how BMI affects the development of CHE inequality in contributions of urban and rural China.The aim of this study is to offer more precise advices on how to optimize BMI and alleviate the occurrence of CHE.Ensure that all residents can enjoy the rights and welfare of BMI fairly.Furthermore,it hopes to relieve the economic burden of disease in China.Constitute panel data from the China Family Panel Studies(CFPS),conducted in the years from 2010 to 2018.CHE and its inequality-related variables in urban and rural China were selected.STATA software version 15.1 were used to conduct statistics and analysis.The random effects panel Logit model is used to analyze the role of BMI in household out-of-pocket(OOP)health expenditure.What’s more,it can analyze the impact of BMI and other related factors on the occurrence of CHE in urban and rural families in our country.Using inequality decomposition is to explore the contribution and changes of BMI to CHE inequality in urban and rural China.Research shows that: 1.OOP health expenditure was significantly different due to different types of BMI(P<0.05),but BMI could not reduce the OOP health expenditure in urban and rural China,and the regression results were not statistically significant(P>0.05).2.The overall incidence of CHE in China dropped from 12.71%in 2010 to 8.05% in 2018.The incidence of CHE in urban areas decresed from 11.25%in 2010 to 6.45% in 2018,and the incidence of CHE in rural areas fell from 14.10% in2010 to 9.93% in 2018.CHE incidence in households insured by three medical health insurances all showed overall downward trends,but the consequences of CHE in rural areas were more serious.3.CHE incidence of households covered by New Rural Cooperative Medical Scheme(NRCMS)was the highest,which has dropped from13.53% in 2010 to 9.00% in 2018.Followed by CHE incidence of households with Urban Resident Basic Medical Insurance(URBMI)jumped from 14.59% in 2010 to8.99% in 2018.4.In urban areas,CHE incidence of households covered by Urban Employee Basic Medical Insurance(UEBMI)dropped by 26.70%(P<0.05).However,CHE incidence of households with URBMI and NRCMS were not statistically significant(P>0.05).Furthermore,residents insured by UEBMI,URBMI and NRCMS had no statistically significant association with CHE incidence in rural areas.5.Age of household head,having chronic disease members,inpatient service usage,outpatient service usage,household size,per capital income,health status and diagnosis medical institution were important factors that influence the occurrence of CHE.However in urban areas,marital status,household members >65 years were extra factors affect the occurrence of CHE.6.The concentration curves were all above the fairness line,and CHE incidence in both urban and rural low-income households were higher.The concentration curves of rural households deviate further from the fairness line,thus the degree of CHE inequality was higher than that of urban households.7.From 2010 to 2018,the contribution to CHE inequality with BMI in urban areas dropped from 10.50% to-1.68%.In 2018,BMI changed from increasing CHE inequality to alleviating CHE inequality in urban households.The contribution to CHE inequality with BMI increased from-3.03% to 1.05% in rural areas.It has changed from alleviating CHE inequality to exacerbating CHE inequality since 2014.However,the overall contribution of BMI to CHE inequality in rural households has been at a relatively low level.8.The majority of the observed inequalities in CHE incidence in urban households can be contributed to age of household head,education level of household head,household size,health status,and per capital income.The inequalities in CHE incidence in rural areas can be contributed to age of the household head,household size,health status,and per capital income.9.CHE incidence of households insured by Commercial Medical Insurance(CMI)was the lowest in 2010-2018,which was reduced from 4.79% to 2.66%.CMI would significantly increase OOP health expenditure for both urban and rural households(Urban Coef.=0.089,Rural Coef.=0.169)and reduce the possibility of CHE occurrence(Urban OR=0.516,Rural OR=0.494).The contribution percentage of CHE inequality in urban areas increased from-4.69% in 2010 to 10.83% in 2018,and the contribution percentage of CHE inequality in rural households fluctuated from 2.43%in 2010 to 6.33% in 2018,which was the key factor to CHE inequality.Discuss whether BMI can alleviate the occurrence of CHE and its inequality based on the results,and propose some suggestions for the disadvantages of medical insurance policies: The situation of CHE was more serious in rural and low-income families.So it’s necessary to continue to standardize BMI for urban and rural families,promote the construction of BMI system that integrates urban and rural areas,and decrease the welfare differences between them.Our study also revealed that individual characteristics may affect the likelihood of experiencing CHE and its inequality.CHE is relative to each family.Therefore,it is necessary to be more targeted when providing benefit packages,especially for elderly,chronic patients and other vulnerable people.BMI system remains at a relatively lower level,it caused limited relief for CHE occurrence and its inequality.While CMI can effectively alleviate the urban and rural CHE occurrence,it will increase CHE inequality at the same time.Therefore,policy efforts should further focus on overall level and protection coverage.It should promote the development of multi-level medical insurance system and CMI vigorously.In order to further relieve the economic burden of disease and protect residents from CHE.