The Impact Of The Integration Of Basic Medical Insurance For Urban And Rural Residents On The Health Of Middle-aged And Elderly People

Health is the foundation of residents towards happiness life.Under the background of the increasing aging trend and the health system reform in China,the integration of the medical insurance for urban residents and the new rural cooperative medical care system has been gradually started,with the purpose of promoting the urban-rural integration process and narrowing the gap between urban and rural areas.The integration of the medical insurance for urban residents and the new rural cooperative medical care system into the basic medical insurance for urban and rural residents(referred to in this article as the "basic medical insurance for urban and rural residents" or "integration")was first piloted in 2007 and promoted nationwide in 2016.This paper aims to analyze the implementation effect of the integration of basic medical insurance for urban and rural residents on the health of middle-aged and elderly people and the impact mechanism based on the utilization of medical services.The potential innovations are to enrich the results with data from a large number of different regions and to introduce new variables into the model: self-treatment variables.On the one hand,the study of this problem can alleviate the burden of the deteriorating health status of the aging population on the society,on the other hand,it is helpful to put forward countermeasures and suggestions for the future integration of basic medical insurance for urban and rural residents.This paper mainly uses the literature research method,the case analysis method and the econometric analysis method to carry out the multi-angle research.After studying relevant literatures at domestic and abroad,the research about the impact of basic medical insurance on health before the integration was sufficient.But the research after the integration was insufficient and there was no agreement.It was generally believed that the integration had achieved certain results.The analysis of Zhejiang province in the east,Henan province in the middle and Ningxia hui autonomous region in the west shows that the financing level and guarantee treatment level after integration are significantly improved.The average number of medical visits per capita is also increased.The effect in the eastern region is better than that in the central and western regions.The quantitative analysis method uses the dual difference model to evaluate the implementation effect and further uses the fixed effect model in the control area to verify.The robustness test of the self-rated health variables and the double-difference method based on PSM-DID was carried out,and the integration test of the mediating effect model was used to examine the influence of the utilization of medical services on the health of the middle-aged and the elderly.The results of the quantitative analysis include the following points:Firstly,the integration of basic medical insurance for urban and rural residents has a significant promoting effect on the improvement of the health level of middle-aged and elderly people,making them improve their daily self-care ability(ADL)by 7.35%,operational daily self-care ability(ADL)by 2.87%,and mental health by 2.98%.Secondly,in the control variables,it was found that rural-urban gap had a significant negative effect on mental health,family size,namely the number of family members,had no significant effect on health,and self-treatment had a significant negative effect on health.At the same time,there are different income,sick population and urban and rural differences.Thirdly,integration had no significant effect on the health of middle and old people with low income and major diseases.The promotion effect of ADL,IADL and mental health of middle and old people with high income was 10.35%,8.34% and 5.61%,respectively.In order to prevent the differences caused by regions,the results of fixed effects in the controlled regions were confirmed by taking the high-income middle-aged and elderly groups as samples.Fourthly,integration is good for chronic diseases in the elderly population and the improvement of the major disease in the elderly population health.To a major disease in the elderly population health promotion effect is greater than the chronic diseases in the elderly group: as for the elderly effect of ADL,chronic disease group(6.09%)is slightly less than the major disease group(6.67%),or in the effect of IADL,chronic disease group(2.32%)is less than the major disease group(3.24%),or a mental health,chronic disease group(2.37%)is still less than the major disease group(3.47%).Fifthly,the integration effect is different between urban and rural areas: three health indicators were used to measure the health promotion effect(ADL: 8.51%,IADL: 4.28%,and mental health: 3.42%)of the middle-aged and elderly population in rural areas was greater than that in the elderly population in urban areas(ADL: 5.04%,IADL: 1.17%,and mental health: 1.84%).In the test of intermediary effect,it was found that the increase in the use of outpatient medical services was greater than that of inpatient medical services,and the basic medical insurance for urban and rural residents improved their health level through the increase in the use of grassroots outpatient services by the elderly.At last,three conclusions are summarized based on the above analysis.Firstly,integration significantly improves the overall health level of middle-aged and old people.Secondly,integration is more beneficial to the health level of the elderly with high income and non-major diseases.But it has no significant impact on the health level of patients with major diseases.Thirdly,with the use of medical services,it improves the health level of the middle-aged and elderly.The contribution of outpatients is higher than that of inpatients.Based on these,the following suggestions are proposed: first,for patients with serious diseases,the serious disease insurance,medical assistance,charity medical treatment and other systems should be effectively connected to improve the level of protection for patients with serious diseases.Second,we should pay attention to the health security of low-and middle-income groups and reduce the risk of poverty caused by diseases.Third,improve the quality and level of primary medical care and health care,focusing on the introduction of excellent primary medical staff.