Research On Poverty Reduction Mechanism And Policy Effect Of Rural Medical Security System

As an institutional arrangement to deal with the impact of disease risk,the medical insurance system plays a role of alleviating poverty from two aspects: first,to provide financial protection,to avoid or reduce poverty due to medical expenses,and second,to promote the utilization of medical services,and to avoid or reduce poverty due to health human capital damage.Therefore,alleviating the poverty effect is the internal function of the medical insurance system since 2003.China has established a government led universal medical insurance system mode.Rural areas have been covered by the universal social medical insurance system and the preferential medical assistance system.The three guarantees system arrangement of basic medical insurance,serious illness insurance and medical assistance has played a positive role in reducing the burden of medical expenses,improving health and promoting well-being for rural residents.It has produced a good effect of alleviating the poverty.Further enhancing the poverty reduction effect of the rural medical security system is not only one of the underpinning safeguards for winning the battle against poverty and building a well-off society in an all-round way,but also one of the important institutional paths that must be relied upon to consolidate the achievement of poverty alleviation and realize the strategy of poverty reduction after 2020,and to build healthy China and revitalize the countryside.However,the path and mode of poverty alleviation in China’s rural medical security system is facing a sustainable predicament.First,under the constraint of resources,the realization path of alleviating the poverty effect of the universal social medical insurance system is facing a downward effect of marginal effect by raising the level of institutional protection.Second,the preferential medical assistance system has played a certain role in helping the poor.However,it is also facing difficulties in raising the level of compensation.Third,the policy of tilting the poor is conducive to improving the pro-poorness of the medical insurance system,but it also produces a "cliff effect",which leads to new social injustice and social contradictions.First of all,based on the analysis of the mechanism of poverty reduction in the medical insurance system,This paper defines the functional orientation of different levels of medical security system in poverty alleviation in China’s rural areas,and expounds the transmission mechanism of giving play to the effect of poverty alleviation.Secondly,based on the function orientation and transmission mechanism,it analyzes and analyzes the poverty reduction effects of China’s rural social medical insurance and medical assistance respectively under the goal of poverty alleviation.Based on the analysis of the practical difficulties faced by China’s rural medical security system and the international experience,this paper puts forward some policy recommendations to enhance the poverty alleviation effect.The research contents and main points of this paper include:The first chapter describes the background and significance of the study.Based on the existing research results,it puts forward the objectives,ideas,methods and contents of the study,points out the research priorities,difficulties and possible innovations and deficiencies,and holds that it is of great practical and theoretical significance to further study the poverty alleviation effect of the rural medical security system.The second chapter is the theoretical analysis of the effect of the medical security system on poverty effect alleviation.First,from the perspective of poverty research in the historical perspective and the shift of China’s poverty alleviation strategy in the new era,the background of enhancing the poverty alleviation effect of the rural medical security system in China is analyzed.Secondly,the theoretical basis of the research on the medical insurance and poverty alleviation is elaborated,and the following two aspects are analyzed.It includes the theory of redistribution of state intervention,the theory of feasible ability,the theory of human capital of health and the theory of social equity and justice.It also points out the significance of these theories.Thirdly,it analyzes the general mechanism of the effect of medical insurance system on poverty alleviation from four aspects: internal mechanism,pro-poorness and basic basis,logical motivation and institutional conditions.From the two aspects of function orientation and conduction mechanism,this paper analyzes the mechanism of poverty alleviation in China’s rural medical security system.First,it defines the functional orientation of different levels of medical insurance system in poverty alleviation,and holds that the social medical insurance system should enhance the poverty alleviation effect in improving pro-poorness.Medical aid should play the supporting role of "Leveling arena" and supporting effect in the poverty alleviation.Second,it analyzes the "Poverty Relief" and "Poverty Prevention" mechanism of multi-level medical insurance system.The third chapter is the analysis of the path and effect of poverty alleviation in rural social medical insurance system in China.First,on the basis of explaining the changes of the rural social medical insurance system in China,it analyzes its important contribution in the rural poverty alleviation.Second,it elaborates the path of redistribution of social medical insurance to alleviate poverty effect.This paper puts forward the viewpoint that the social medical insurance system should enhance the poverty alleviation effect in improving the pro-poorness,and empirically evaluates the pro-poorness improvement of the rural social medical insurance system in China under the institutional change.The results show that pro-poorness is deteriorating in the institutional change,and fund-raising and payment links are aggravating the reverse redistribution,which is not conducive to promoting fair poverty alleviation.The rural medical assistance did not play an effective "Leveling arena" effect.Third,we used CFPS(2016)data to measure the security gap of China’s rural social medical insurance under the goal of poverty alleviation.The results showed that rural social medical insurance in institutional change did not effectively reduce the incidence of catastrophic medical expenditure of low-income groups.However,the incidence of catastrophic medical expenditure of non low-income groups has been reduced,and the rate of catastrophic medical expenditure of rural low-income households is still up to 30%to 50% after social medical insurance compensation,which is 10 to 20 percentage points higher than that of non low income households.The fourth chapter is the analysis of the path and effect of poverty alleviation in China’s rural medical assistance system.First,the implementation path of the poverty relief effect of China’s medical assistance system is analyzed.Second,the poverty alleviation effect of rural medical assistance in China is empirically assessed based on the poverty reduction objective.Under the goal of poverty alleviation,the coverage rate of rural medical assistance to the low insured households and the low marginal households is 58.02% and 47.66% respectively,while the overall level of protection is far from the protection needs of the poverty alleviation target.That is,80.46% of the medical assistance rural households should receive more than 60% of the compensation funds for medical expenses.In fact,only 19.75% of medical assistance to rural households is in this proportion.Third,the empirical analysis of the factors affecting the demand for medical assistance in rural areas.It points out that there may be problems in the identification of actual salvage objects.Fourth,it calculates the size of capital demand for rural medical assistance under the goal of poverty alleviation.The results show that in 2016,for example,Under the goal of poverty alleviation,the national low-income households need 80 billion 500 million yuan for medical aid,44 billion 600 million yuan for the lowest security families,and 100 billion yuan for the poor people due to illness.If we can increase the medical aid expenditure to the government medical security expenditure ratio from the current 5% to 10%,we can achieve the full protection of the low-income households.The fifth chapter analyzes the realistic dilemma of enhancing the poverty alleviation effect of rural multi-level medical security system from the following aspects: the dilemma of medical insurance utilization caused by the unbalanced allocation of medical resources,the dilemma of redistribution of the reverse income of rural social medical insurance,the insufficiency of compensation for rural medical assistance,the structural predicament,the plight of the development of the supplementary medical insurance system in rural areas,and the dilemma of convergence between different levels of medical insurance system.The six chapter analyzes the necessity of strengthening the multi-level medical insurance system in rural areas.The realistic predicament of poverty alleviation effect.The sixth chapter deeply analyzes the institutional characteristics of the typical international medical insurance system to play the role of poverty alleviation effect,and sums up experiences,lessons and methods.It is manifested in the following aspects: enhancing the progressiveness of financing of medical insurance system,increasing the inclination of social vulnerable groups,improving the quality of primary health care services,improving the level of medical insurance system governance.The seventh chapter,from a clear definition of poverty alleviation function,strengthens the synergy effect of multi-level medical insurance system,strengthens the basic medical and health system as a whole,assists the rural medical security system to reduce poverty,promotes the balanced allocation of medical resources,improves the quality of primary medical and health services in rural areas,enhances the positive income redistribution effect,improves the pro-poorness of social medical insurance,and increases financial expenditure and optimize the structure.In order to enhance the poverty alleviation effect of the rural medical security system,we put forward six specific policy recommendations to enhance the function of medical relief underpinning,to develop complementary medical insurance system,and to expand the strength of medical security and poverty reduction.The main innovations of this study include the following three aspects:First,based on the current medical insurance system in China,the mechanism of multi-level medical insurance system is innovatively reviewed and explored.The functional differences and simultaneous interpreting mechanisms of the "Poverty Relief" and "Poverty Prevention" system are analyzed.We also try to widen the research scope of the poverty alleviation effect of medical security.Based on the assessment of the current rural medical insurance system designed based on catastrophic medical expenditure,we find that the poverty alleviation effect of the current rural medical security is not sensitive to low-income groups,and there may be crowding out of low-income groups,that is,poverty alleviation and pro-poorness are limited.Therefore,the concept of “Pro-poorness” in medical insurance is introduced.It is suggested that improving the pro-poorness character as the direction of the optimization of the medical insurance system so as to achieve the goal of preventing poverty and alleviating poverty for the wider population.Second,it proposes that social medical insurance should enhance the effect of poverty alleviation in improving pro-poorness.This study argues that there is a reverse income redistribution effect in rural social medical insurance in China,so it only has the effect of "trickle down" poverty alleviation.We should improve the pro-poorness as the way to enhance the rural social medical insurance and alleviate the poverty effect,and then evaluate the poverty alleviation effect of rural social medical insurance in China.Third,based on the goal of poverty alleviation,the poverty alleviation effect of rural medical assistance was evaluated by micro data.This study used CFPS(2016)data to calculate the coverage gap,security level and capital demand scale of China’s rural medical assistance under the goal of full poverty reduction,and analyzed the factors influencing the demand for rural household medical assistance by using econometric model.Especially from the relationship between the government’s medical aid expenditure and the government’s medical security expenditure,the paper points out that the development of the medical insurance system in China has not shown a good pro-poorness.