Evaluation Of The "Instant Reimbursement Of Cross-provincial Medical Services" Policy In China

The equalization of public services provision has become the new trend of the public policy in China.The current research evaluates the instant reimbursement of cross-provincial medical services,a health insurance policy initiated in China since late 2016,as a case of promoting the equalization of public services provision.The instant reimbursement of cross-regional medical services aims at responding to the conflict between the fragmentation of medical insurance system and the normalization of population mobility in China.Through building an integrated platform for the reimbursement of cross-regional medical services,this policy aims to enable the insured to enjoy high-quality medical resources out of where their insurance is registered more conveniently,without paying for the total medical expense themselves and then going back where their insurance is registered in order to receive the reimbursement.The more important meaning of instant reimbursement of cross-provincial medical services lies on improving the capability of medical insurance governance through integrating national information of health insurance in an integrated platform.However,empirical research on evaluating this policy is relatively limited compared to its importance,and this paper attempts to fill the gap in research.Using the survey data collected from Anhui province,Henan province,Shandong province,and Sichuan province in August 2018,this research mainly analyzes the impact of instant reimbursement on the medical expenditure of cross-provincial inpatient services.Answering this question can respond to the public concerns on the additional burden and potential threat brought by instant reimbursement to the sustainability of medical insurance funding.According to the regression analysis conducted on cross-provincial patients,those using instant reimbursement induce significantly less total medical expenditure and out-of-pocket medical expenditure than that of those using later reimbursement.However,the cost containment effect of instant reimbursement found on cross-provincial sample does not exist on within-provincial sample.From the perspective of medical insurance management,itcould be supposed that within-provincial medical services could be under supervision by the local administration of medical insurance,especially effectively under the control of the global budget,no matter whether they use instant reimbursement or later reimbursement.This could prevent the unreasonable increase of medical expenditure due to the lack of supervision under the condition of later reimbursement.However,as for the cross-provincial patients who use later reimbursement,their medical expenditure could not be incorporated under the local supervision of medical insurance and global budget;as for the cross-provincial patients who use instant reimbursement,though the medical expenditure could not be incorporated into the control of global budget,the instant supervision brought by the online reimbursement can help promote the standardization of the cross-provincial healthcare behavior,thus preventing the waste of unnecessary medical resources to some extent.In addition,the current research applies the double-difference method in cross-sectional data by introducing two dimensions of comparison,i.e.instant reimbursement vs.later reimbursement,cross-provincial inpatient services vs.within-provincial inpatient services.Results show that the average medical expenditure of cross-provincial inpatient services is significantly higher than that of within-provincial inpatient services.But the cost containment effect brought by instant reimbursement narrows down the gap between cross-provincial costs and within-provincial costs.The above result could be interpreted as instant reimbursement of cross-provincial medical services promoting the equalization of public services provision,i.e.the insured people will not be confronted with additional financial burden brought by cross-provincial medical services relative to within-provincial medical services.The insured can enjoy the high-quality medical services wherever the services are located.Taken together,this study suggests that the cross-provincial medical expenditure could be incorporated into the global budget of the local administration on medical insurance,which could further improve the efficiency of medical insurance funding.Also,the instant reimbursement policy should be combined with other reform measures such as the construction of hierarchical medical system,which could better promote the equalization of public services related to health and healthcare in China.