Research On Basic Medical Insurance And Residents' Subjective Well-Being From The Perspective Of Public Policy

The basic medical insurance is the basic institutional arrangement to ensure that the members of the society have access to medical care,and the basic goal is to protect people's health.Since 1883,Germany promulgated the disease social insurance law and established the medical insurance system in the form of law,the system has played an important role in protecting human physical and mental health,reducing the economic burden of individuals and families,promoting the development of medical and health services,and actively coping with the aging process,which has been widely concerned by governments and ordinary people all over the world.China's basic medical insurance system has made remarkable achievements in the past decades.By the end of 2020,the number of urban employees basic medical insurance,urban and rural residents basic medical insurance(including urban residents basic medical insurance and new rural cooperative medical insurance)has reached 1.36 billion,the insurance coverage rate has been stable at more than 95%for many years,the system integration and integration have been accelerating,the level of financing and treatment has been continuously improved,and the "universal medical insurance" has basically been realized,and the absolute solution has been solved Most people's "medical treatment" has become one of the great achievements in building a well-off society in an all-round way.The research on subjective well-being has been rising since the 1950s.Domestic and foreign scholars mainly focus on the.definition of subjective well-being and related influencing factors,carry out a lot of theoretical discussion and empirical research,and obtain a considerable number of research results.At present,subjective well-being has become one of the hot topics in multi-disciplinary research.With the increasing attention of the state and government to people's livelihood issues,improving people's happiness and quality of life has become an important theme of the government's current work.With the common concern of the academia,the government and the general public,the results of subjective well-being research began to be gradually applied to the field of public administration,and became a new way and means to monitor and evaluate the effect of public policy.So,as one of the most extensive and important public livelihood security systems,does the basic medical insurance system play a role in improving residents' subjective well-being?How does it work?This is the core of this dissertation.Based on the above research problems,this dissertation summarizes the relevant research literature at home and abroad:Foreign research is mainly based on the background of welfare state reform and combined with the actual operation of medical insurance policy to carry out theoretical discussion and empirical analysis;Domestic research mainly appeared after 2010,mostly empirical research on specific policies.Generally speaking,the existing domestic and foreign related research has carried out some exploration and analysis on the relevant issues,but there are few studies directly focusing on the relationship between basic medical insurance and subjective well-being.There are still some obvious deficiencies in the theoretical logic analysis,mechanism discussion and practical problem focus,and some core problems need to be discussed in depth.In view of the lack of existing research,based on the current Chinese social background,this dissertation mainly focuses on the relationship between basic medical insurance and residents' subjective well-being and the influencing mechanism to carry out theoretical and empirical research.The significance of this dissertation is:at the theoretical level,it helps to enrich the research on the influencing factors of subjective well-being from the perspective of public policy,and also provides a new theoretical perspective for the analysis and evaluation of the basic medical insurance system;in practice,through the analysis of the mechanism of basic medical insurance affecting residents' well-being,it can provide important basis and suggestions for improving residents' subjective well-being and optimizing the practice of basic medical insurance policy.This dissertation systematically combs the theoretical concept,related research and policy practice of subjective well-being and basic medical insurance.On the definition of the concept of subjective well-being,this dissertation focuses on the definition of the concept of subjective well-being from the perspective of the core content of subjective quality of life,and uses the existing research results for reference;in terms of the definition of basic medical insurance,this disstertation mainly studies the current basic medical insurance system for urban workers and the basic medical insurance for urban and rural residents in China,and uses the existing research methods for reference,and uses the existing research methods for reference to operationalize the concepts of participation,accessibility,satisfaction,demand satisfaction,fairness and sense of improvement.According to the basic functions of the basic medical insurance system,such as protecting residents' health,preventing security risks,adjusting income distribution,promoting social equity,promoting social integration and maintaining social stability,this disseratation comprehensively reviews five basic theories on the relationship between basic medical insurance and subjective well-being in public administration,sociology,psychology and economics,they are:public goods theory,need satisfaction theory,social stratification theory,social integration theory and capability approach theory.Based on the above main theories,combined with the research results and conclusions of the relevant literature at home and abroad,this dissertation constructs five theoretical models of basic medical insurance affecting residents' subjective well-being,which are the direct impact effect model based on public goods theory,indirect influence mechanism model based on social stratification theory,indirect influence mechanism model based on social integration theory,the indirect influence mechanism model based on the need satisfaction theory and the indirect influence mechanism model based on the capability approach theory are proposed,and the specific research hypotheses are put forward respectively.Based on the data of CGSS(2012)(mainly verifying the income stratification mechanism and social integration mechanism)and the data of Shandong Province Residents'Well-being Survey(2020)(mainly verifying the need satisfaction mechanism and functionings mechanism),through the difference analysis,correlation analysis,multiple regression analysis and structural equation model,this dissertation analyzes the current situation of urban and rural residents in Shandong Province The main conclusions are as follows:(1)The direct effects of basic medical insurance on residents' subjective well-being are as follows:?The direct effect of basic medical insurance on residents' subjective well-being has been confirmed by CGSS data and Shandong survey data;?Based on CGSS data,participation in basic medical insurance has a more significant effect on the subjective well-being of rural residents,female residents and young and middle-aged residents aged 35-59,while it has no significant effect on urban residents,male residents and residents of other age groups.This result may be related to the policy adjustment changes of the implementation of basic medical insurance in the year of data survey.In addition,gender and age differences in subjective well-being are also important factors;?Based on the survey data of Shandong Province,the residents who participate in both basic medical insurance and commercial insurance have higher subjective well-being than those who only participate in basic medical insurance,which shows the complementary role of commercial medical insurance in improving residents' subjective well-being.(2)The indirect influence mechanism of basic medical insurance on residents'subjective well-being is as follows:?The mechanism of income stratification effect based on social stratification theory has been confirmed in the CGSS data,which shows that basic medical insurance plays a positive role in improving residents'subjective well-being by adjusting income distribution;?The mechanism of social integration effect based on social integration theory has not been confirmed,but the basic medical insurance and social integration are positively correlated with the subjective well-being of residents,but the interaction is not significant.The relevant theoretical models need further study and verification;?The mediating effect mechanism of health,security and fairness based on the need satisfaction theory has been confirmed in the survey data of Shandong Province.It can be seen that the current basic medical insurance has played its due role in meeting the needs of residents' health,reducing life risks and maintaining social equity,and through these mechanisms,the residents' subjective well-being has been improved;?The mediating effect mechanism of functionings based on the capability approach theory has been confirmed in Shandong survey data,that is,residents with higher subjective evaluation of basic medical insurance accessibility,satisfaction,demand satisfaction,fairness and improvement have higher level of functionings(including social participation,leisure participation and social trust)than residents with lower level of functionings(including social participation,leisure participation and social trust),the higher level of functionings has played a significant positive role in improving resident's subjective well-being.(3)The basic situation of residents' well-being is as follows:? CGSS data shows that the average scores of residents'subjective well-being(including physical and mental health experience index,enjoyment experience index)and 10 dimensions are above the theoretical median.However,the scores of contentment,mental health and physical health in 10 dimensions are lower than other dimensions,while Shandong survey shows that the level of residents'subjective well-being is generally stable,but the mental health index and physical health index are more than the theoretical median the situation also needs to be improved.It can be seen that the current residents'subjective well-being is generally stable,but the experience of physical and mental health needs to be improved;?The analysis results of CGSS data and Shandong residents survey data basically show that the level of subjective well-being of female residents is significantly higher than that of men,the level of subjective well-being of farming group is significantly higher than that of other occupational groups,but the level of subjective well-being of college and above education group is lower,which is basically consistent with the results of most current studies.(4)Based on the survey data of Shandong residents,this dissertation analyzes the residents' evaluation of the implementation of basic medical insurance:? The basic insurance coverage rate of the sample residents was over 95%;? The survey sample residents have a higher evaluation on the accessibility,satisfaction,demand satisfaction and fairness of basic medical insurance,but the improvement of basic medical insurance is relatively low,which reflects the lag of policy implementation effect and residents' experience to a certain extent;?On the whole,the elderly group,male group,low education group and non married group have higher accessibility,satisfaction,demand satisfaction,fairness and improvement of basic medical insurance than other groups,while the scores of individual and private enterprise employees are lower.The improvement of basic medical insurance of agricultural population is significantly higher than that of non-agricultural population.To some extent,the above results reflect the direct effect of the greater investment in basic medical insurance for rural groups and elderly groups in recent years,but also remind the relevant departments to strengthen the investment and guarantee of basic medical insurance for non-public economy employees such as individual employees,private enterprise employees,and flexible employees in new industries.Based on the conclusion of theoretical and empirical analysis,this dissertation starts with three main restrictive factors:public value,institutional structure and handling mechanism of the basic medical insurance policy function,and focuses on the key problems existing in the current policy.On this basis,the dissertation puts forward policy suggestions for the optimization of basic medical insurance policy based on the improvement of residents' subjective well-being,including institutional structure(focusing on fair and well-being value orientation),policy implementation(focusing on demand analysis and optimization of institutional supply),institutional efficiency(highlighting shared development and capability orientation)and management services(reflecting accurate standard services and informatization).There are 11 suggestions in four aspects.