Influence Of "Two-in-One Medical Insurance" Policy On Residents’ Medical Expenditure And Medical Burden

The policy of "two-in-one insurance" combines the basic medical insurance for urban residents and the new rural cooperative medical insurance as a whole,which is an important reform measure made by China to solve the problem of "expensive and difficult medical treatment".The policy of "two-in-one insurance" aims to promote urban and rural residents’fair enjoyment of medical insurance rights.Studies have demonstrated the relationship between medical insurance and medical service utilization,but its impact on medical expenditure and medical-burden is still controversial.Based on this,this paper adopts the mixed research method of quantitative and qualitative analysis.Firstly,using the data of 2012,2014 and 2016 China Labor Force Dynamic Survey(CLDS),the double difference method is used to estimate the effect of the two-in-one policy,and the PSM-DID method is used to test the robustness of the two-in-one policy,so as to analyze the heterogeneous influence of the two-in-one policy on medical expenditure and medical burden of different groups,so as to explore whether the two-in-one policy can really reduce residents’ medical expenditure and alleviate medical care.Further qualitative research methods are used to conduct in-depth interviews and research from three stakeholders involved in the reform of the two-in-one policy,namely,the policy target groups,medical and health service institutions and government departments,to investigate whether there is any deviation in the actual policy implementation effect of the two-in-one policy,so as to verify the empirical analysis results and explore the internal influence mechanism of the two-in-one policy on residents’ medical expenditure and medical burden.The empirical research finds that:firstly,at the level of medical expenditure,the policy of "two-in-one insurance" can significantly reduce personal out-of-pocket expenditure and total outpatient expenditure,but can’t reduce personal out-of-pocket expenditure,outpatient expenditure and family medical expenditure;Secondly,at the level of medical burden,it can significantly reduce the proportion of total outpatient burden,but can’t reduce the personal hospitalization burden,outpatient out-of-pocket burden and family medical burden,and has no significant impact on people’s visiting probability.Thirdly,at the heterogeneity level,after the implementation of the policy,the family medical expenditure and family medical burden of rural groups and poor health groups have decreased,while the medical burden of low-income groups and middle-aged and elderly groups has not improved significantly.This policy partially reduces the medical expenditure and medical burden,and promotes the fairness among different groups to a certain extent.The reason may be that the policy of "two insurances in one" improves the medical insurance reimbursement,expands the medical insurance catalogue,reduces the drug price,and strengthens the investment in primary medical and health institutions.However,there are some deviations in the implementation of the policy,which may be due to the fact that the "two-in-one insurance" policy has raised the deductible line of payment and reimbursement,the true reimbursement ratio of patients is difficult to reduce,and the convenience and accessibility of reimbursement and medical treatment are insufficient.Medical institutions may take strategic actions to deal with the government’s fee control policy and shift the burden to patients.Based on this,the article proposes to improve the top-level design of the two-insurance-in-one system and coordinate multiple stakeholders involved in the policy;Optimize the allocation of medical resources and improve the ability of primary medical services;Establish possible policy suggestions such as special medical service policies for vulnerable groups and marginal groups,so that all groups can enjoy basic medical insurance treatment equally and promote people’s livelihood and well-being.