Research On The Impact Of Medical Insurance On The Utilization Of Medical Services For Migrant Population

Since the reform and opening up,the floating population has made important contributions to China’s economic and social construction,urbanization and industrialization.According to the communique of the seventh national population census,the national floating population in 2020 was 375 million,and one in four people is the floating population,among which the inter-provincial floating population was 124 million,and the inter-provincial floating population was 251 million.Compared with the six basic data,the floating population increased by 69.73 percent.Over the past decade,the size of the floating population has continued to expand.At present,China has established a medical security system covering the whole people,which has basically achieved the goal of universal medical insurance,and has effectively promoted the improvement of the health level of the whole people.Subject to China’s special urban and rural dual household registration system,it is difficult for the floating population to enjoy the same public medical services compared with the local residents.On the one hand,the participation rate of the floating population is lower than the national average level,and still more than 10% of the people do not participate in any medical insurance,and most of the floating population participate in the medical insurance for urban and rural residents with low treatment level.On the other hand,the medical insurance of the floating population is mainly covered by the domicile area,while China’s medical insurance implements localized management and low pooling level,resulting in the medical service utilization level of the floating population is far less than that of the inflow residents.Based on this,this paper discusses the influence of the current medical insurance system from the two aspects of insured types and insured places.Based on Grossman health demand theory and equality of opportunity theory,this paper examines the effect of medical insurance on the medical service utilization of floating population by using multiple linear regression model and nonlinear regression model to monitor the floating population from the two periods of 2017 and 2018.The tendency score matching and the Heckman two-stage model were also used to carry out the robustness test.The empirical findings of this paper mainly include:First,from the perspective of insurance types,no matter what kind of medical insurance system they participate in,the medical service utilization level of the floating population is significantly improved.Compared with the uninsured group,participation in the medical insurance for urban and rural residents increased the probability of receiving outpatient services by 24% and the probability of receiving inpatient services by 35%.Participation in urban workers’ medical insurance increased the probability of outpatient service utilization of the floating population by 34%,and the probability of receiving inpatient service utilization increased by 25%.In terms of the out-of-pocket proportion of medical expenses,compared with the medical insurance for urban and rural residents,the out-of-pocket proportion of hospital expenses for urban employees participating in the medical insurance is 17.4% lower than that of the former.The medical insurance for urban workers plays a much higher role in improving the utilization of medical services and reducing medical expenditure than that for urban and rural residents,and there are great differences in the treatment levels among medical insurance systems.Second,from the perspective of the location of medical insurance,participating in medical insurance in the place of residence significantly reduces the use of inpatient services for the floating population,and participating in medical insurance in the place of residence significantly increases the utilization of outpatient services and inpatient services for the floating population.In terms of the utilization of outpatient services,participating in urban and rural residents’ medical insurance in the place of residence increased the probability of the floating population receiving outpatient services by 52%,and the probability of participating in urban workers’ medical insurance to receive outpatient services increased by 39%.In terms of inpatient services,participating in urban and rural residents’ medical insurance in the place of residence increased the probability of using inpatient services for the floating population by 45%,and participating in urban workers’ medical insurance increased the probability of using inpatient services by 49%.In other words,what really affects the medical service utilization level of the floating population is not the difference of system type,but the choice of insurance places.Third,the results of heterogeneity analysis show that whether it is outpatient or inpatient services,the farther the scope of mobility,the lower the level of medical insurance utilization of medical services for the migrant population.This is mainly due to the "geographical segregation" problem of the current health insurance system,that is,the farther the range of movement,the lower the level of medical insurance benefits and reimbursement rates.The robustness test results of the propensity score matching and Heckman two-stage model method are consistent with the previous paper.Based on the above empirical conclusions,this paper puts forward some policy suggestions in terms of promoting the equity of medical insurance benefits and ensuring the health and well-being of the floating population.First,promote the improvement of the overall level of medical insurance and gradually break the "system barrier" of the current medical insurance.Second,further improve the national unified medical insurance information management system,uniformly promote the deployment and service application of the national medical security information platform,and accelerate the improvement of the real-time settlement mechanism for medical treatment in different places.Third,gradually improve the medical insurance treatment for urban and rural residents seeking medical treatment in different places,accelerate the improvement of health service policies for the floating population,and ensure the utilization level of basic medical services for the floating population.Further eliminate the difference in the level of medical security caused by the dual urban-rural household registration division.Fourth,strengthen health education for the floating population and enhance the health awareness of the floating population.Adopt diversified publicity methods to strengthen publicity and education on medical insurance related knowledge for migrant population groups,and enhance the awareness of migrant population to participate in insurance.