Assessment Of Social Insurance Policies Impacting On Health Service Utilizations

As the new healthcare reform are carrying forward, China’s basic medical insurance system reform make the major breakthrough. By the end of2010, the enrollments in the three major the basic medical insurance are more than1.25billion, and complete the target of universal health care, but the level of reimbursement is low. From the hospitalization expenses, the reimbursement ratio of the inpatient expenditures in Urban Employee Basic Insurance (UEBMI), Urban Residents Basic Insurance (URBMI), New Rural Cooperative Medical Insurance (NCMI) is66.2%,49.2%and66.2%, respectively, but the outpatient health expenditures compensation ratio in the URBMI and NCMI is only33%. As the population aging process, under the background in the era of universal health care, more and more people pay attention to design the reasonable fund-raising system, payment system and management system of medical insurance in the premise of limited resources, so as to improve both the level of health insurance benefits and the efficiency of medical insurance funds.The governments around China are actively exploring the collective fund for outpatient scheme, supplementary medical insurance system, medical insurance payment reform; how to establish the reasonable sharing mechanism of medical expense in the demand-side, in order to protect the financial risk of the residents and reduce the moral hazard, To explore how to establish the supply-side payment mechanism of medical expenses, reduce the number of the supplier induced demand, increasing the service efficiency of medical funds.Under the background of a universal health insurance system reform in China, this research establish econometric model to assess the effects of the collective fund for outpatient scheme, supplementary medical insurance system, medical insurance payment reform, analyzed different policy on health services accessibility, hierarchical referral, medical expenses, out-of-pocket medical expenditure, catastrophic health expenditure and the satisfaction of patients, to provide suggestions for the design of medical insurance system. The full text of the main structure is as follows:Chapter1is the introduction. It mainly introduces China’s historical evolution and the problem of insurance of primary medical treatment, then put forward the topic, the topic of theoretical and practical significance, research methods and technical route, research content, put forward the innovation and contribution of this study, the research limitations and deficiencies are pointed out.Chapter2is the basic definition and theoretical basis. Mainly introduces the theoretical basis for analysis of medical insurance risk theory, insurance theory, market failure of medical insurance, the optimal design theory.Chapter3, the status quo of China’s basic medical insurance system and the pilot city policy is introduced. This chapter mainly introduces the composition of China’s basic medical insurance system, the present situation and main problems of the medical insurance fund raising, payment and management, finally introduces nine pilot cities policy of URBMI.Chapter4, the social medical insurance policy impacts on urban residents’ medical services utilization. This chapter mainly introduces the impact of the collective fund for outpatient scheme on the urban residents’health services accessibility, medical expenditure and medical care satisfaction.Chapter5, the social medical insurance policy impacts on the medical service utilization of residents enrolled in the UEBMI. This chapter mainly assesses the collective fund for outpatient scheme impacting on the utilization and medical expenses of the residents with chronic diseases, the supplementary health insurance impacting on catastrophic health spending, different payments reform impacting on medical service.Chapter6, conclusions and policy recommendations.The main conclusions are:First, after the implement of the collective fund for outpatients scheme in the URBMI, urban residents visit doctors in two weeks significantly increased, especially the elderly and people with chronic illnesses, reduced the number of visiting doctors; raised the rate of self-medication, especially the residents whose family members enrolled in the UEBMI, self-reported health and life quality significantly improved. The scheme reduced the outpatients’ total medical expenses, medicine expenses, out-of-pocket expense, waiting time, and inpatients’ traffic costs. It reduced catastrophic health expenditures of people aged over65, with chronic patients and poverty-stricken family. The scheme decreased the satisfaction of URBMI, but the satisfaction of inpatients’ improved significantly. Especially for the elderly aged65, patients with chronic diseases, low-income residents.Second, The collective fund for outpatients scheme in the the UEBMI promote patients with chronic diseases utilization of the community health service institutions, average numbers of visiting doctors has increased0.41times, the rate of visiting doctors increased by32.8%.The scheme reduced the average out-of-pocket medical expenses of patients with high blood pressure, diabetes, and both the two disease by1.58%,2.16%and1.49%, respectively, the ratio of out-of-pocket medical expense was reduced by3.8%.Third, after the supplementary health insurance scheme in the UEBMI implemented, the inpatients’out-of-pocket expenditures fell down19.8%, the percentage of out-of-pocket expenses dropped out2.80%, the incidence of catastrophic health expenses bent down41%. The insurance scheme has a positive effect to protect the urban employees’ medical financial risk, and then the government should combine the payment innovation to improve the efficiency of medical insurance fund.Fourth, under the scheme of total global budget, the patients hospitalized more than2times increased year by year, inpatients costs of three tier hospitals grew higher than the secondary tiers, the regression results found that the growth management2model helps to control hospitalization expenses and costs paid by insurance, the proportion of out-of-pocket expenditures dropped down2.63%.The main innovation in the present study:First, on the research Angle view, the research study the hotspot issues about the health insurance should covered severe disease or mild diseases, based on the theory of optimal design of medical insurance. Then Econometric models were constructed to assess the policy effect, which is few reports in the literature.Second, on the research design and methods, this study analysis the social medical insurance policy to the urban residents’ medical service utilization by the study design of DID (difference in difference). Medical expenses regressed based on OLS regression analysis, further consider the sample selection, omitted variables and latent variables, using heckman two-step method, the IV regression and Tobit regression method for robustness testing, overcame the sample endogeneity problem.Third, unique advantages in the aspect of research data, this study has both basic household survey data of urban residents, and health insurance database, combining with the advantages of two kinds of database, the system to evaluate effect of health insurance policy, it does not see more in existing research.