| [Objective] Based on field survey and establishment survey, this study tried to analyze theselection of grades when they participated in the urban and rural cooperative medicalinsurance (URCMI) and urban and rural social pension insurance (URCPI) meanwhileanalyzed the influence factors of grades selection of the two insurances. Try to analyze themedical expenses of residents participating in URCMI with different grades. In themeantime this study adopted willingness to financing ratio and discrete choice experimentto estimate respectively the willingness to pay (WTP) and the sensitive influencing factorsof choices to different medical insurance plan. The ultimate purpose of this study was toexplore the methods which could make reasonable premium and reduce adverse selectionand promote vertical equity financing on the basis of taking comprehensive considerationof ability to pay and willingness to pay of residents.[Methods] This study used a combination of qualitative and quantitative research methods.The qualitative research methods:(1) literature research method, mainly for pre-datacollection and integration of documents, as well as attributes set and the levels set in thequestionnaire;(2) Delphi method and focus group discussion, parts of the content such asthe discrete choice experiment attributes and levels setting required expert consultation aswell as much discussion and revision. Quantitative research methods:(1) Descriptivestatistical analysis for a preliminary analysis of the data and holistic description;(2)Hypothesis testing, including the chi-square test, non-parametric test and so on, mainlyused for making statistical inferences of the different groups;(3) Multivariate statisticalanalysis: Binary logistic analysis was used to analyze the influencing factors for residentsto choose low-grade or high-grade of URCPI as well as discrete choice experiment wasused to analyze the willingness to pay of the residents for URCMI and the sensitive factorsfor different insurance plans selection.[Results](1)Based on the analysis results of sample area, more than90%respondentschose the first grade of URCMI as well as more than80%respondents chose the first gradeof URCPI;(2) The significant factor which affected the respond ents’ grade selection for URCMI was age meanwhile occupationand the respondents’ understanding of the premium politics werethe signicant factors affected the respondents’ grade selection for URCPI;(3) The outpatient expenses incurred by residents partic ipating in the first grade weresignificant higher than the second grade whereas the compensation was with no difference;(4) Under the100yuan and200yuan financing criteria, the median of residents’ willingnessto pay for URCMI was40yuan and60yuan, respectively. The median of willingnessfinancing ratio was0.67and0.43, respectively. In comparison with the existing policy, itcould be speculated that residents could accept the first grade of premium while about50%residents could accept the second grade of premium. Under the200yuan financing criteria,different areas had different willingness to pay.WTP was different between men and womenunder the100yuan financing criteria while different occupational groups had differentWTP;(5) Premium was the most sensitive attribute affected the selection of respondents fordifferent health insurance plans, followed by tertiary hospital compensation ratio.According to the results of DCE, it could be inferred that the current health insurance planwas less popular in all simulation plans.[Conclusions](1) The number of residents insured in the low grade and the high grade ofURCMI and URCPI differed greatly, number of persons insured in high-grade remained tobe further improved;(2) The propaganda dynamics for URCMI and URCPI politics should be increased;(3) Premium was the attribute that the respondents most valued in URCMI. Policy makersshould give full consideration to the residents’ willingness to pay in the formulation ofpremium of URCMI;(4) There was adverse selection when the residents chose the grades of URCMI, we couldconsider to identify the ability to pay of residents by the grades they participating in URCPIand make residents with high ability to pay to participate in the second grade of URCMI.[Innovations] In this study, a discrete choice model was introduced to medical insurancefield to analyze the sensitive factors affecting the selection of different insurance plans. Thisstudy combined two different insurances, URCMI and URCPI, to analyze the formulationof premium. Meanwhile this study proposed idea to identify the ability to pay by the grade they participating in URCPI and suggested intergrating the premium of the two insurances.[deficiencies](1) The results could not be extrapolated.because of different economicsituation and policy condition, the results in other districts may be different.(2) In theprocess of DCE, the respondents’ educational level, the ability to understand, the mislead ofinvestigator would lead to error.(3) Futher study needed to be conducted. The conclusionof this study required futher data support. |
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