| On the basis of the data released by The seventh National Census,the population aged60 and over has reached 264 million,and moderate aging may become an irreversible trend;The term " ageing of population" appears for the seventh time in the government work report in 2021;As an important form of ensuring social and people’s livelihood during the 14 th Five Year Plan period,taking the initiative and implementing accurate policies to deal with population aging will become the due meaning of the reform and upgrading of pension services and medical services.China’s basic medical insurance for urban workers is one of the inclusive and minimum guarantee institutional arrangements.The initial goal of setting up and the emphasis of reform have always been to improve the level of hospitalization security and reduce the economic risk of "poverty due to serious illness".How to preferably devote to the construction of "healthy China" and satisfy the demands of middle-aged and elderly groups for a healthy life is an urgent problem to be solved in the reform of employee medical insurance system,which is often positioned as "protecting serious diseases".The middleaged and elderly groups have low resistance and frequent diseases,so the frequency of treatment is high,and the recovery period of each disease is long.In the process of seeking medical advice,it is inevitable to have far more outpatient treatment than young people.Therefore,from the perspective of general outpatient overall planning,studying whether the outpatient security policy reform can give consideration to the health security of middleaged and elderly workers and the cost control of medical insurance fund is a breakthrough to verify whether the outpatient security policy reform of employee medical insurance is effective,and also provides a decision-making basis for the repositioning of urban employee medical insurance.Based on the investigation conducted by CHARLS in 2011,2013,2015 and 2018,the paper abided by the research train of thought: finding problems--sorting out literature--analyzing current situation--policy recommendations,used two-part model,Bivariate Probit model and OLS regression model to analyzes the policy effect of carrying out the reform of general outpatient safeguard policy from point of view of the utilization of medical services of middle-aged and elderly insured workers.The results show that under China’s current medical system,there is a tendency and current situation of inducing patients and hospitals to "replace outpatients with inpatients".The reform of general outpatient security policy not only improves the utilization rate of outpatient services of middle-aged and elderly insured workers,but also significantly reduces the probability of hospitalization,and the effect of the policy will be further improved with the improvement of the guarantee level of general outpatient service;The hospitalization expenses of middle-aged and elderly insured workers in the pilot area of outpatient security policy reform will be significantly reduced with the improvement of outpatient security level,and the medical expense burden of middle-aged and elderly insured workers will be significantly reduced with the operation of general outpatient security policy and the improvement of security degree.Finally,according to the results of empirical analysis,this paper brings forth some opinions: Firstly,speed up the reform of outpatient security system and establish an outpatient security system from disease type security to expenses guarantee as soon as possible;Secondly,distinguish different insured groups and different economic levels in different regions,adjust measures to local conditions and vary greatly with each individual and reasonably improve the security level of general outpatient service;Thirdly,actively prevent moral hazard and improve the construction of information services in the field of medical and health care. |
PDF Full Text Request