The impact of the urban-rural residents' medical insurance integration on rural residents' out-of pocket medical costs: Based on the deductible, reimbursement rate, and ceiling line

Chen Liu Yue Kong Qun Su ^* HuaiZhen Xing Zhongbao Tian

• Nanjing Agricultural University, Nanjing, China

The reform of China's healthcare system is confronted with a crucial problem, which is the relatively high medical burden borne by rural residents in China. In this study, data from CHARLS 2013-2020 was utilized, and a two-stage Heckman model was employed to investigate the influence of modifications in the compensation program. Such modifications encompass aspects like the deductible, reimbursement rate, and ceiling line, and their impact on the out-of-pocket (OOP) medical expenses of rural residents within the context of China's Urban and Rural Residents Basic Medical Insurance (URRBMI) integration. The findings of this research indicate several important points. Firstly, reducing the deductible for outpatient visits, along with increasing the reimbursement rate and ceiling line for outpatient services, can remarkably stimulate the demand for outpatient visits among residents. The pivotal factors in reducing residents' OOP costs for outpatient visits are lowering the deductible and the ceiling line. Conversely, the inpatient costs of rural residents exhibit greater sensitivity to the setting of the reimbursement rate for inpatient visits. Secondly, to decrease the OOP medical costs of rural low-income groups, the key lies in enhancing the reimbursement rate and the ceiling. In comparison, the medical attendance behavior of rural middle-income and high-income groups is less influenced by the compensation level. Moreover, augmenting the level of URRBMI compensation can facilitate the release of the medical care demand of rural residents with poor health conditions. It also holds significant implications for reducing their OOP medical costs.