The Influence Of Medical Insurance On Medical Expenditure Of Middle-Aged And Elderly People

The current population aging phenomenon is becoming more and more serious,the proportion of the elderly population is increasing,and the coverage of medical insurance is gradually expanding at the same time.At the same time,the consumer demand for medical services of the middle-aged and elderly significantly exceeds the above population.Therefore,strengthening medical insurance The research on the medical service needs of middle-aged and elderly people is particularly important.This is conducive to achieving the two basic policy goals of fair use of medical care and controlling medical expenses,helping decision-makers to make better plans and promoting the improvement of the medical care system.The main goal of this article is to study the impact of various medical insurances on the total medical expenditures,medical out-of-pocket expenditures,and medical out-of-pocket expenditures for the elderly aged 45 and above,using micro data from the China Health and Retirement Longitudinal Study(CHARLS)database in 2015,Use the Andersen health service use model to select explanatory variables,and then use the Heckman model,the two-part model,and the adaptive Lasso Bayesian quantile regression model to systematically control the endogenity of the elderly medical expenditure and sample selection bias On the basis of empirical testing,the impact of China’s medical insurance on the needs of middle-aged and elderly medical services at each location.The main research conclusions are:(1)From the Heckman model and the two-part model,it can be seen that most medical insurance has promoted the medical utilization rate to a certain extent,and has improved the overall health of residents for a long time,thereby bringing less medical care.The total expenditure increases the probability of timely medical treatment for middle-aged and elderly people;(2)Some medical insurance reduces medical out-of-pocket expenditure to a certain extent,reduces the proportion of medical out-of-pocket expenditure,and reduces the medical burden of middle-aged and elderly patients;(3)The Bayesian quantile regression model of adaptive Lasso shows that,compared with middle-aged and elderly people without medical insurance,middle-aged and elderly people with new rural cooperative medical insurance have significantly reduced medical care at the high quantiles of 0.5 and 0.75.The total expenditures have significantly reduced medical out-of-pocket expenditures at 0.25,0.50,and 0.75 points;(4)Compared with middle-aged and elderly people without medical insurance,middle-aged and elderly people with urban employee medical insurance have significantly increased their total medical expenditures at the low points of 0.10,0.25,and 0.50;(5)Limitations of daily living ability(ADL)And self-assessed health status and other demand factors significantly affect the total medical expenditure and medical out-of-pocket expenditure at each quantile;(6)From the above models,it can be seen that although medical insurance has significantly improved the medical services of the elderly Utilizing and reducing the medical burden,but there are still significant urban-rural differences in the utilization of medical services for middle-aged and elderly people.The policy recommendations of this article are:expand the coverage of the new rural cooperative medical insurance system,set up outpatient deductible lines in most areas outside the township level,and set up the same inpatient compensation plan in different levels of hospitals;correspondingly reduce the proportion of reimbursements for high-end medical needs and reduce "small The emergence of the phenomenon of"seeing a big illness";increase the implementation and promotion of medical insurance,strengthen the supervision of the prices of medicines and medical equipment,eliminate unreasonable inspection items,expand the scope of medical insurance compensation drugs and items;improve medical insurance related chronic diseases(such as diabetes,Hypertension,etc.)Outpatient and hospital reimbursement conditions;Gradually reduce the urban-rural differences in medical insurance coverage,lower the standard line of reimbursement for major illnesses of the new rural cooperative medical system,and achieve fair medical care.