图书简介
Health care is human's basic need.It has direct bearings on people's health and living standards.The improvement of people's health is conducive to eliminating poverty,narrowing social inequality and promoting economic growth.Therefore,it's government and society's major policy objective to ensure people's acess to basic health care.In recent years,China's health expenditure is soaring and people's medical burden is increasing.As a result,the difficulty and high costs of getting medical treatment is increasingly serious and the poverty caused by disease is becoming prominent.How to solve these problems is one of the urgent issues in reforming China's health care system.To solve these problems,it is necessary to analyze the factors affecting people's demand for health care so that we can allocate medical resources scienfically and ensure the resonability and feasibility of reform policies.
Using the data of Urban Resident Basic Medical Insurance Survey(URBMI)organized by State Council in 2007,this dissertation aims to conduct an empirical study on the demand for health care among urban residents so as to provide scientific evidences for policy makers.The structure of dissertation is as follows:Chapter one introduces the background,aims,significance and layout of the study.Chapter two presents a historical view on the evolution of health care sytem in urban China and its existing problems.Chapter three reviews the theorectical and empirical study on the health care demand.We first introduce Grossman's model of demand for health and health care and Supplier-induced Model(SID)so that it provides theoretical foundation for econometric analysis,then summarize the empirial studies both at home and abroad and introduces latest development.Chapter four introduces the data source,variable selection and characteristics of the population.Chapter five is empirical study,which is also the main body of the dissertation.In the first part,we use Logit model to analyze whether residents reported illness in past two weeks.In the second part,we use Multinomial Logit Model(MNL)to analyze the health care-seeking behavior by the residents who reported illness.The third part analyzes the inpatient health care utilization by urban residents over the past year.We disscuss four models that are commonly used to deal with count data,which are Poisson Model,Negative Binomial model,Two-Part Model and Latent Class Model.We use AIC and BIC to compare the performance of these models and found two-part model performs best.In part four,we analyze both the outpatient and inpatient expenditures by urban residents,disscuss and compare the strong points and weak points of Sample Selection Model,Two-Part Model and Generalized Linear Model in dealing with health care expenditure data.In chapter six,conclusions and policy implications from the empirical study are summarized and some polices in reforming China's health care system are disscussed.
The empirical analysis is robust and reliable,which can give us meaningful directions to control health care expenditures and meet people's health care demand.With descriptive analysis and econometric modelling,it is found that the demand for health care is affected by insurance,age,income,sex,marital status,work status,region,distance and chronic disease.The major conclusions are as follows:
1.Health insurance can effectively reduce the disease burden of insured people.The more generous the health insurance plan,the more health care utilization and expenditure the insured use and the less self-paid money by the people.
2.The higher level the household's income,the lower probability the people reported disease.The higher income increases people's probability of going to see doctor after they got ill.The income elasticity of medical care is near zero,implying that health care is a normal good for urban residents.
3.There exist regional differences in people's demand for health care.The phenomenon of“did not see care after getting ill and minor disease is delayed into catatrophic disease”is more serious in middle and western areas.Inequality in health care expenditure also exists in different regions.
4.Chronic disease is major factor causing the higher demand for health care and heavy medical burdent for urban residents.
5.The rate of self-reported disease is higher among the poorest people.The poorest people are less likely to see doctor after they got ill.However,the self-paid inpatient cost of the poorest people is higher than non-poorest people,which cause the poorer to subsidize the non-poor and make the inequality in health care more serious.
6.The privatization of hospitals can effetively reduces the cost of medical care;alleviate the problem of“the difficulty and high costs of getting medical treatment”.The inpatient cost of private hospital is 34% lower than that of public hospital after we control the disease patterns.
7.The distance of nearest medical institutions can affect people's health care seeking behavior.The farther the medical institutions,the lower probability the people went to see doctor and the higher probability to seek self-medication.
After discussing and explaing the above results,we propose several suggestions for pushing forward China's health care reform.
1.Continue to push forward the basic health inusrance programme featured by susidizing the demand side;conduct payment reform,changing from retrospective payment into prospective payment;cancel Medical Savings Account(MSAs)and proportional payment.
2.Put the public finance into full play;establish government-financed medicaid system and take comprehensive medicaid as the major approach.
3.Attach great importance to chronic disease burden and include outpatient services into the payment plan.At the same time,channel more resources into t primary health care institutions and introduce gatekeeper and capitation so as to change disease treatment into health promotion and management.
4.Further open the medical care market,encourage the entry of private resources so as to promote the competion of medical institutionas and reduce medical prices.
The originalities of this dissertation are:
1.Econometric Methodology.Among the relevant studies in China,most of which didn't treat the problems such as endogeneity,sample selection bias etc.This study focuses on these problems and uses the latest econometric models to compare and find the best model.Therefore,it can help us to estimate the model more accurately.
2.Comprehensiveness.This dissertation studies the demand for health care among urban residents from four aspects:whether the residents reported illness in the past two weeks,the health care-seeking behavior by illnes-reported residents,inpatient health care utilization and health care expenditure,thus it can give us a more general understanding of the residents’demand for health care.
3.Some novel findings.Although this study is based the many other studies,it reveals some novel results.For example,in analyzing the inpatient health care utilization,we found the two-part model performs better than other models;in analyzing the health care expenditure,we found that there is no selection bias in health care expenditure data.These findings not only help us better analyze the factors affecting health care demand,but also help us deepen the understandings of econometric methodology.
However,there are some shortcomings in this dissertation.First,the study is limited to urban residents and cannot be generalized to the whole population;Second,the data used is a cross-sectional data,thus cannot fully eliminate the bias caused by the unobserved heterogeneity;Future studies can use the panel data.Third,owing to the data limitation,we cannot include the price and quality variable in econometric models;future studies can collect the price and quality information;Fourth,supplied-induced demand(SID)is a controversial topic in health economics.If the variables about suppliers such as physicians per capita,hospital beds per capita are included in this study,it is very meaningful to conduct an empirical study on whether SID exists in China,and if it exits,what is the extent.
Key words:health care-seeking behavior;inpatient health care utilization;health care expenditure;health care reform
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