| As a kind of insurance mechanism,from the micro perspective,medical insurance is helpful to reduce the economic burden of the family,strengthen the risk management of family,spread health insurance and health knowledge,improve the medical service utilization,alleviate the psychological pressure of people,but also could encourage the problems such as the unhealthy behaviors,the waste of medical resources,excessive medical treatment.Universal basic medical insurance(Universal medical insurance)is a basic medical insurance system that covers all people in China.Is there a similar problem? This thesis takes the implementation of the medical insurance for urban employees(UEBMI)as a sample to analyze and discuss the economic and health effects that the basic medical insurance brings to families.The medical insurance for urban employees was launched at the beginning of1999 and basically completed by the end of 1999.Together with the medical insurance for urban and rural residents,it constitutes an important part of the national medical insurance in China.By playing the basic function of insurance economic compensation,it basically solves the problem of "difficult and expensive medical treatment" for urban workers,and generally improves the health level of urban workers.Reference to basic concepts of health economics,this thesis tries to build two fundamental medical insurance effect index(that is,the healthy index and economic index),to discuss the family health and economic effect of UEBMI,applying four phase tracking data of 2006-2015 China health and nutrition survey(CHNS),using the method of empirical analysis.This thesis is divided into eight main parts.The introduction makes clear the background,significance,literature review,research content and framework,research methods and technical route of this thesis,possible innovations.The first chapter is the medical insurance effect evaluation method and system construction.This chapter mainly defines the concept of medical insurance,medical insurance effect,moral hazard and adverse selection,constructs an effect evaluation system consisting of two dimensions and five items.The second chapter analyzes the realization mechanism of medical insurance effect.The first section discusses the realization mechanism of health effect,which is analyzed from two aspects of health awareness and income and choice phenomenon.The second section discusses the realization mechanism of economic effect,which is analyzed from three aspects of medical insurance treatment,release of normal medical needs and moral hazard.The third chapter discuss the model constructed in the empirical analysis,data source and data processing.In order to avoid selection bias and endogenous problems,this thesis uses four phase tracking data of China health and nutrition survey(CHNS)in the 2006-2015,establishes PSM-DID model to analyze the health effect and builds Heckman sample selection model to analyze the economic effect of medical insurance.The fourth chapter makes an empirical analysis of the health effect of UEBMI.The fifth chapter makes an empirical analysis of the economic effect of UEBMI.The sixth chapter puts forward the countermeasures and suggestions to improve the effect of UEBMI: introducing health management into UEBMI to improve the health level of the whole people;change the way medical insurance is paid and control unreasonable increases in medical expenses;deepen the coordinated reform of medical services,the pharmaceutical industry,and medical insurance.The conclusion summarizes the thesis from the research conclusion and research prospect,and summarizes the implications of the policy proposal.The main results and conclusions of this thesis are as follows: Firstly,the effect evaluation system of medical insurance should have at least two dimensions.This paper mainly evaluates the health effect and economic effect of medical insurance.The health effect further divided into health behavior,health service utilization,and health outcome,the economic effect is further divided into medical expenses and medical expenses of serious illness.The existence of medical insurance can compensate the medical expenses of patients,so that the patients who had previously looked down upon diseases or chose to give up treatment due to poverty can be treated,and the normal medical needs can be released,leading to the increase in the utilization of medical services,the improvement of health level and the increase of medical expenses.Moral hazard will lead to the insured choose unhealthy behavior,poor health,increased probability of getting sick,higher utilization rate of medical services,increased medical expenditure,and higher incidence of serious disease expenditure.Secondly,in terms of health indicators,after the purchase of UEBMI,(1)the samples in the treatment group tend to choose unhealthy lifestyle and increase the probability of smoking and drinking,that is,medical insurance will increase the occurrence of unhealthy behaviors,there is a certain ex-ante moral hazard;(2)the health outcomes of the samples in the treatment group are worse,the probability of illness or injury is significantly increased,and the health results of self-evaluation are improved,this is because moral hazard is obvious,and the probability of illness,the type of illness and the insured’s risk attitude can all determine the insured’s evaluation of their own health.Therefore,when the probability of illness increases,if the illness is mild,the health self-evaluation results may get better;(3)UEBMI has no significant effect on outpatient medical service utilization.Although the empirical result was a slight decrease in the probability or frequency of outpatient visits,the result was not significant.This is probably because the starting line and ceiling line are set in the outpatient reimbursement of UEBMI.In mild cases,the insured persons need to pay most of the medical expenses by themselves.Then in the context of rising drug prices,the actual expenses they pay may increase.And in slightly serious condition,the insured persons may choose to be hospitalized.Thus crowding out the number of outpatient visits.Thirdly,in terms of economic indicators,UEBMI leads to a 215.82% increase in total medical expenditure,among which the release of normal medical demand leads to a 0.61% increase in low-income families,moral hazard leads to a 114.47% increase in middle-income families.UEBMI resulted in a 99.57% increase in the self-pay medical expenditure,which increased the economic burden of the insured.However,the results are not significant.Among them,moral hazard leads to a 63.56% increase in the self-pay medical expenditure of middle-income families.A significant 17.9percent drop in self-payment ratio,which is the medical reimbursement rate,plays an even bigger role in low-income families,decreasing the self-payment ratio by 55 percent.UEBMI does not significantly reduce the incidence of serious illness expenditure,and it plays a very limited role in the "serious illness protection".That is to say,UEBMI has very limit effect in the protection function,and it does not reach our expectation.The functionality of UEBMI needs further improvement.The marginal contribution of this thesis is mainly reflected in:(1)the asymmetric information theory is introduced in this thesis to analysis the reason why people buy health insurance,this thesis use health behavior indicators in behavioral economics,medical service utilization and health output indicators in health economics,to build medical insurance effect evaluation system,which makes the research not only has a solid theoretical basis,the perspective of the research is more broader.(2)instead of using the traditional method,which can analyze the existence of moral hazard based on the positive correlation between risk level and insurance level,this thesis determines the release of normal medical demand and moral hazard effect by income classification,which can not only confirm the existence of moral hazard,but also quantitatively measure the size of moral hazard. |
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