The Impact Of Medical Insurance Policies On Health Improvement And Financial Performance

The government attachs importance to the medical system and the people’s health.Since the 18th National Congress,President Xi has put forward a series of new concepts on medical and health care,and the reform of the universal medical security system has continued to advance.The Fifth Plenary Session of the 19th Central Committee even put forward the requirement of "a sound multi-level social security system",which will fully implement the healthy China strategy.The social medical security system has become an important channel to reduce the people’s medical burden and spread the impact of health risks,and it is a major livelihood system arrangement for improving people’s welfare..At present,our country’s aging population is numerous.The elderly are at the end of their life cycle and are vulnerable to disease risks.They are the most intensive medical consumer group.The social medical insurance fund expenditure is in a state of rigid and rapid growth,and the medical burden of the elderly is increasing.In particular,the impact of the"COVID-19" major epidemic has revealed that there are still many shortcomings and deficiencies in the social medical security system,and it has aroused great attention from the society on the health and economic performance of social medical insurance.Our country’s elderly population is large,and a large proportion of medical resource has been consumed for the elderly.In the future,the control of the scale of medical expenditure and the improvement of health performance and economic performance will focus on the elderly.At the same time,realizing the scientific evaluation of medical insurance policies is an important aspect of the construction of the national public health modernization governance system,and it is an inherent requirement for optimizing policy effects.This is conducive to improving the scientific nature of medical insurance policy reform and optimizing the efficiency of medical insurance policy resource allocation.Therefore,the study of social medical insurance policy has important practical significance on the health performance and economic performance of the elderly and its mechanism.However,due to the existence of country’s urban-rural dual economic system and the differences in urban and rural,three distinct social medical insurance systems have been generated.The three major medical insurance systems have large gaps in funding standards,security levels,payment standards,reimbursement policies and so on.This form has caused the imbalance in the utilization of medical services and the unequal benefits of medical insurance between urban and rural areas,regions,and different groups.Although the three major medical insurance systems have achieved universal coverage,the problem of unbalanced and insufficient development is very prominent.In January 2016,the State Council implemented the urban and rural social medical insurance policy.The integrated Urban-Rural medical insurance has always been an important reform of the social medical security system.It has become an inherent requirement for implementing the new concept of shared development and establishing a more equitable and sustainable medical insurance system.Improving the overall level of social medical insurance is an important policy to solve the problem of uneven and inadequate medical insurance development,which is conducive to allowing the people to enjoy fair medical opportunities.In view of the limited time for the implementation of the urban and rural medical insurance coordinating policy,the current health performance and economic performance evaluation literature on the implementation of this policy is scarce.At present,although domestic and foreign researchs have conducted more discussions on the health improvement and economic performance of medical insurance policies,there are still some shortcomings.Domestic literature discusses the health performance and economic performance of medical insurance policies.It mainly evaluates the extensive marginal effect of medical insurance,that is,the process of changing from no medical insurance to insurance.However,we find few papers that discuss the intensive margin of the medical insurance,that is,the impact of changes in medical insurance levels.Existing parts of the literature have tested the mechanism of health and economic performance of medical insurance,but they still need to be improved.An in-depth discussion of the health improvement and economic performance mechanism of medical insurance policies will help to present the mediating channels.As an important measure to promote the fairness of the urban and rural medical insurance system,the overall urban and rural medical insurance policy,what is the health and economic performance of the overall urban and rural medical insurance policy in my country?What is the impact mechanism of its health performance and economic performance?Will the overall urban and rural health insurance policy help reduce residents’ health inequality?The scientific answers to these important questions are of great significance for promoting the equalization of my country’s social medical insurance system and the implementation of the healthy China strategy.This article uses a variety of econometric models and popular policy evaluation methods to evaluate the health improvement and economic performance of medical insurance policies.This article has 7 chapters.Chapter 1 is an introduction.Chapter 2 is the literature review and theoretical basis,mainly combing the literature related to the health performance and economic performance of medical insurance policies,and discussing the theory of health economics.Chapter 3 is about the development of my country’s medical insurance policy,mainly combing and analyzing the development context of social medical insurance policy.Chapter 4 is the analysis of the health improvement of social medical insurance policies and its mechanism of action.It is based on the Grossman health demand theory.From the perspectives of the marginal effect of extension of social medical insurance and the marginal effect of intensive,the impact of medical insurance policies on the health of the elderly is studied.Its mechanism of action has identified the heterogeneous characteristics of its health performance according to different income levels,urban and rural areas,regions and ages.Chapter 5 is the analysis of the economic performance of social medical insurance policies and its mechanism.We investigate CLHLS and CHARLS micro data to study the utilization of medical insurance policies for the elderly’s medical services,Medical burden,income,poverty and other economic indicators and their mechanism of action.We also identify the heterogeneous characteristics of their economic performance,to provide a basis for accurately improving the efficiency of social medical resource utilization.Chapter 6 is the analysis of the income-increasing and poverty-reducing effects of the medical insurance policy and its mechanism.Chapter 7 is the conclusion and recommendations.Through the above research,the main conclusions are as follows:First,from the perspective of the extensive marginal effects of social medical insurance,research has found that social medical insurance has achieved significant health improvement,significantly improving the self-rated health,mental health,Instrumental Activities of Daily Living(IADL)and objective cognition of the elderly.Based on mediating effect model,it shows that social medical insurance improves the health status through channels such as increasing the probability of timely medical treatment,reducing the probability of serious illness expenditure,and increasing the probability of physical examination.The health performance of medical insurance policies has significant heterogeneity among different regions and ages.The empty nesting of rural areas and the miniaturization of family scales have increased the barriers to medical treatment for the elderly in rural areas.Therefore,we should pay attention to the differences between urban-rural areas and between regions,accelerate the expansion of medical resources and the balanced distribution of regions,and increase the protection of low-income senior citizens.Supporting Policy should be made for vulnerable elderly groups in rural areas to improve the health performance of the social medical insurance system and to promote social equity and justice.Second,from the perspective of the intensive marginal effect of social medical insurance,the use of the DID model found that the integrated Urban-Rural medical insurance has significant health improvement,significantly improving the self-rated health,mental health and objective health of residents,while significantly reducing health Inequality caused the Kakwani relative health deprivation index to drop significantly by 0.0532 points.The analysis of the mechanism of action shows that the reduction in the proportion of out-of-pocket medical expenditures and the increase in residents’ awareness of health risks are important intermediary channels for the urban and rural medical insurance policies to improve health performance.There is heterogeneity in the health performance of the urban and rural medical insurance overall policy,which has a more significant impact on the health of relatively disadvantaged people with higher ages,lower levels of education,and rural residents.This is conducive to promoting the equalization of basic medical and health services in the new era.It is recommended to continue to improve the national health policy,enhance the level of public health governance,improve the overall level of urban and rural medical insurance,and promote the construction of a social medical security system.Third,from the perspective of the marginal effects of social medical insurance,the study finds that social medical insurance policies have significant economic performance.While effectively releasing the demand for medical service utilization of the elderly and promoting medical expenditures,it also significantly reduces out-of-pocket medical expenditures and self-paid medical expenditures.The proportion of medical expenditures paid;the social medical insurance policy has significantly reduced the financial burden of family medical expenditures,effectively solved the problems of "poverty is caused by illness”and "medical treatment is difficult and expensive",and focused on shifting the risk of serious illness medical expenses.However,social medical insurance has greater economic performance for young people,and there is obvious age heterogeneity;social medical insurance has relatively greater economic performance for the elderly in urban areas,and there are obvious urban-rural differences.In the next step,it is necessary to provide policies that are more preferential for the more disadvantaged rural elderly.It is necessary to pay more attention to the fairness of benefits of medical insurance policies,and solve the problem of unfair benefits among regions,between urban and rural areas,and between different groups.It is necessary to implement more precisely medical insurance policies.The government especially should establish a dynamic mechanism for accurately identifying vulnerable groups,to provide more policy support,to make the social medical insurance system more equitable,and to solve the problem of uneven and inadequate development of the medical insurance system,in order to make the medical insurance policy more effective.Fourth,from the perspective of the intensive margin effect of the social medical insurance,using the Heckman selection model,the study finds that the integrated Urban-Rural medical insurance has significantly increased the hospitalization expenditure by about 24.26%(2637.85￥)and reduced the residents’ out-of-pocket hospitalization expenditure by 35.58%(2234.6￥).However,the impact of this policy on outpatient medical expenditure is not significant.The overall urban and rural medical insurance policy mainly addresses the impact of major illness risks.This policy not only helps release residents’ demand for medical services,but also relieves residents’financial burden on their own medical care.The policy has significant income and urban-rural heterogeneity in the utilization of inpatient medical services,which is more conducive to increasing the medical expenditures of low-income and rural residents and reducing their medical burdens,significantly promoting the fairness of the medical insurance system.The integrated Urban-Rural medical insurance policy has improved the medical insurance reimbursement rate,the probability of seeking medical care,and the level of medical care through integration,significantly releasing residents’demand for hospitalized medical services.These three channels are the key mechanism to promote the utilization of hospitalized medical care.The the integrated Urban-Rural medical insurance has a significant poverty reduction effect on residents.The overall planning of urban and rural medical insurance has a significant effect on poverty alleviation for residents suffering from serious health impacts.It can effectively reduce the occurrence of "poverty is caused by health shock" in rural areas and contribute to targeted poverty alleviation.However,the overall effect of urban and rural medical insurance on poverty reduction and income increase for the more vulnerable elderly groups vulnerable to health risks is not significant,which deviates from the goal of precise poverty alleviation.Further testing shows that reducing the proportion of out-of-pocket medical expenditures and improving the level of labor supply are important intermediary channels for the poverty reduction and income increase effects of the urban and rural medical insurance policy.It is recommended to accelerate the coordinated development of China’s urban and rural basic medical insurance system in the new era.The government should increase policy preference for disadvantaged groups to prevent poverty due to illness,continuously improve the medical treatment cost mechanism for major epidemics,and accurately address the health risk shock.We should make social medical insurance become a long-term mechanism to solve poverty.