Research On The Welfare Distributional Effects Of The Coordinating Urban-Rural Medical Security System

China’s medical insurance system was established in the early1950s, after a series of institutional reforms and reconstruction,has formed a basic medical insurance system dominated by the basic medical security for workers(WMS), the new rural cooperative medical system (NCMS), and the urban resident basic medical security (URMS),covering94.6%of the population.Although the government set up medical insurance system for different groups has played a certain role in safeguarding health and medical burden for urban and rural residents, the fairness and risk-sharing of the system is increasingly being questioned. Based on this, the coordinating urban-rural medical security system (CURMS), with its superiority on the support ability and financial sharing ability, has been widely promoted in practice.The coordinating urban-rural medical security system (CURMS) can be seen as a reform of the current health insurance system. Improvements and changes of a social policy necessarily involves the assessment of welfare effects and the opportunity cost in order to prove the effectiveness of the social policy, or how to improve more effective. From the traditional support capabilities perspective to evaluate the welfare effects of the coordinating urban-rural medical security system (CURMS), there will be basically no different from any improvements for rural medical security system.This article believe that the effectiveness of the coordinating urban-rural medical security system (CURMS) is reflected in its distributional effects:on the one hand, narrowing the gap between the level of protection in urban and rural areas, increase the intensity of price subsidies for rural residents, intervention in rural residents in health care spending decisions, improve its sick is not medical andmedical needs, to achieve an equitable distribution of medical resources between rural and urban areas; to improve the health insurance fund, on the other hand, only the limitations of rural internal transfers and allocation aims at treating the scope within the urban and rural areas of different types of insurance expanded to urban and ruralbetween risk sharing and income distribution between urban and rural areas, narrowing the income gap between urban and rural areas. Thus, we study the distributional effects of the coordinating urban-rural medical security system (CURMS) from the two aspects including health care resource distribution and income distribution.This study was base on the investigation of692households and2173urban and rural residents in Yixing,Taicang, Xinghua of Jiangsu Province,this study investigated the distributional effect of the the coordinating urban-rural medical security system (CURMS) on two aspects, including the distributional effects of health care resources and income distributional effects among different income groups, between the urban and rural areas. With the differents in the mode of financing, compensation model, the fund transfers mode in differents regions, to analyze the distributional effect difference on the selection mode.The results shows that:(1) The empirical research results of the medical resource distributional effects show that:under the control of other factors, there is a high-income groups, urban residents occupy a greater number of better-quality medical resources phenomenon. But the actual distribution of contrast, the reason from the medical needs of different groups of health of the poor or more serious diseases. Although the coordinating urban-rural medical security system (CURMS) does not completely eliminate the medical resources between urban and rural areas, between rich and poor use of the difference, the basic protection to people with medical needs have access to appropriate medical resources in the model for health and medical resource utilization.It is negatively related to health and health care resource utilizationin the model performance.Studies have shown that the distributional effects of the different modes:both in the probability of access to medical resources, or enjoy the total health care resources, co-ordinate high-level pattern matching co-ordinate low level mode is more conducive to the use of medical resources between urban and rural areas, different groups of peoplea reasonable distribution; free to choose the mode of the insured level more conducive to rational insured to select the appropriate payment standard of compensation according to their needs, and promote the rational allocation of health care resource utilization in urban and rural areas.(2) Income distribution effects of the empirical results show that:the coordinating urban-rural medical security system (CURMS) protect the distribution of income and risk-sharing between the different disease-risk populations. The sample orientation grass-roots "of the difference between the price subsidy mechanism", more rural residents to benefit from the health insurance fund compensation, which indicates that the consolidated fund would not bring"the rural help the urban" phenomenonin to our medical insurance system. And thus,area not to join the co-ordinate fund can try to gradually increase the Fund’s overall level, in order to improve its support capabilities and ability to resist risks.By controlling the impact of the funding amount for co-ordination mode, vulnerable tilt mode and the insured optional mode enables the insured masses more, a higher proportion of Medicare subsidies. These two models to narrow the rich and poor populations, urban and rural populations Medicare compensation difference has more advantages, and therefore more conducive to urban and rural areas, a reasonable distribution of income between different groups of people.The policy implication is that after the coordinate the urban and rural medical security system, the freedom to choose the insured mechanism makes better economic conditions or poor physical condition of the rural population to participate in a higher level of reimbursement of medical insurance system, but may bring in fund risk due to adverse selection. Thus in a multi-level free choice of the insured at the same time, increase subsidies for low-income farmers and concerns, and gradually increase the level of co-ordination of the Fund will be more conducive to urban and rural areas, between the effect of income distribution between rich and poor.(3) Empirical regression results also show that:the use of medical resources to the lack of price elasticity, and the compensation ratio and the impact of health care resource utilization is not obvious.This shows that the current level of medical care has been relatively too high, further increase the reimbursement of little significance.And the level of medical care"never downward" welfare rigid is often the focus of the next phase of system improvements, and thus should not raise the level but to be shifted to the pursuit of more equitable distribution of welfare results. From this perspective, the survey areas in the system allows the case, gradually raising the level of expansion of the fund transfers range and ability to resist risks, to set up multiple protection level for the insured person free to choose, to better promote the health care resources use of distributive justice, to narrow the gap between urban and rural, rich and poor populations, thus contributing to the health fair.(4) The comparativestudy of three place’s welfare effects shows that:different regions in different aspects of the welfare distributional effects differ. Due to the existence of regional heterogeneity, we could not determine which region the distribution of effect better, only to find out the improvements in some areas. Urban and rural health care co-ordinate system should fully take into account the level of local financial resources and the payment of the insured person’s ability, selected in accordance with the urban and rural health care co-ordination mode. The less economically developed areas with low level of urbanization can be freely chosen to co-ordinate mode, first ensure that the urban and rural residents equal enjoyment of the medical insurance, then consider the diverse needs of different groups, the differences in income levels and fund the ability to pay factorto develop appropriate multi-level security programs, and differences between different situations without losing the fair treatment of urban and rural residents; do the convergence of the various systems, and gradually raising the level.The coordinating urban-rural medical security system (CURMS) is a recent reform, although there are scholars affirmedthe positive welfare effect of the co-ordination by using the typical areas of experience, butnot from the perspective of demander side’s welfare and the distributional effects of an empirical analysis and inferences.This study based on the medical insurance system for urban and rural welfare between different groups of people distributional consequences of the three different co-ordination mode micro-survey data,includes not only the effects of redistribution of income between rich and poor populations, but also the allocation of medical resources between urban and rural areas and income effects, sothe conclusion is more objective and comprehensive than the resulting policy improvement that using the macro-level findings. It also provides a reference for the next step in other parts of coordinate development. In addition, previous analysis of the effect of the medical insurance system, may be more from the use of medical services to insured persons, health care and reducing the burden, improvement of the health effects of aspects.As a special compensation policy, the purchase of medical insurance for a single individual may not have access to the positive welfare effect:the cost consumers pay to participate in the medical insurance system, but only by the impact of the disease risk to be insured during the periodcompensation only to consider the welfare effects of the medical insurance system of the sick may underestimate the effectiveness of the medical security system.This study constructed from the perspective of the distributional effects of medical security system to measure the welfare effects of reference of the idea of an analysis framework for future evaluation of the effect of other social policies.