Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds：Evidence from China

Qian, Wenqiang; Cheng, Xiangyu; Lu, Guoying; Zhu, Lijun; Li, Fēi

doi:10.3390/su11082437

Cited by 11 publications

(6 citation statements)

References 30 publications

(52 reference statements)

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“…In addition, due to the vast territorial extent of China, various provinces (cities, districts) may have different levels of economic development and cultural customs [33,34], and there may be some differences in the level of fertility desire among various regions and in medical insurance fund income and expenditure. It is difficult to guarantee that the calculation results of this study can be fully applicable to the specific conditions of each region in China or whether these findings will be applicable in the coming decades.…”

Section: Discussionmentioning

confidence: 99%

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

2021

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Background With the rapid growth of the ageing population, the operating burden of China’s basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. Methods We used an actuarial science method and took the urban and rural residents’ basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. Results Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. Conclusions The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.

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Section: Discussionmentioning

confidence: 99%

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

2021

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“…Secondly, change the model and regress again. In order to avoid possible estimation bias in the model setting, we refer to the practice of Qian et al (2019) and regress based on the fixed effect model and random effect model, respectively. As shown in Table 8, no matter whether the fixed effect model or the random effect model is used, the core conclusions of this paper have not changed fundamentally.…”

Section: Robustness Testmentioning

confidence: 99%

Fiscal decentralisation and green total factor productivity in China: SBM-GML and IV model approaches

Zhan

Li²,

Liu³

et al. 2022

Front. Environ. Sci.

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This paper uses the SBM-GML model to measure and evaluate green total factor productivity based on the panel data of 30 provinces and cities in China from 2012 to 2018. It examines the impact of different dimensions of financial decentralisation on green total factor productivity. The research results show that: 1) green total factor productivity in China is improved year by year and better in central and western regions; 2) the decentralisation of fiscal revenue and expenditure significantly weakens the increase of green total factor productivity in provincial level; 3) fiscal decentralisation inhibits green total factor productivity in central and western regions with regional heterogeneity; 4) local government competition affects the relationship between fiscal decentralisation and green total factor productivity, weakens the negative effect of fiscal decentralisation on green total factor productivity. Finally, the study aims to promote green total factor productivity and sustainable development from the perspective of financial decentralisation. This paper expands the literature and evidence of financial decentralisation on green total factor productivity and offers suggestions for governments and policymakers working toward sustainable development.

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“…This is because China is still a developing country, and local governments' fiscal resources may not be sufficient to afford hierarchical medical expenditure ( 26 ). Furthermore, local governments prefer to increase investment in vanity projects (such as infrastructure construction) instead of medical service investment ( 27 ). A hierarchical medical system and medical reform policies that are enforced might not achieve long-term results.…”

Section: Theoretical Framework and Research Hypothesesmentioning

confidence: 99%

Hierarchical medical system and local medical performance: A quasi-natural experiment evaluation in Shanghai, China

Chen

Zhao

et al. 2022

Front. Public Health

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BackgroundIn order to maintain high standards of healthcare, it is necessary for medical departments to provide high-quality and affordable medical services to local residents. This has been widely accepted in developed countries, while the medical treatment systems in developing countries remain to be improved. This research is based on a pilot of a hierarchical medical system in Shanghai, China, to evaluate the effects on policy of medical reform in developing countries.Methods and resultsBy means of the difference-in-differences (DID) method, the causal relationship between medical care services' improvement and hierarchical medical systems' implementation could be identified. This project also explores the differential effects of policy intervention and confirms that the pilot showed a significant improvement in medical performance in central districts while the result remains uncertain in terms of suburban districts. Furthermore, the dynamic effect of a hierarchical medical system has also been identified with the event study method, while the policy pilot only had short-term effects on local medical resources' improvement. In order to ascertain the function mechanisms of hierarchical medical systems and explain why the policy pilot only had short-term effects, this project also conducts influencing mechanism analysis with the triple-differences method (also known as difference-in-difference-in-differences or DDD method). According to the empirical results, there is no direct evidence indicating the hierarchical medical system could bring obvious benefits from the perspectives of patients and medical institutions.ConclusionsFor better implementation of hierarchical medical systems in the future, long-term supervision mechanisms should be given more attention in the enforcement process of hierarchical medical systems. At the same time, more safeguarding measures should be implemented, such as supervising the payment systems of the medical institution and conducting performance evaluation.

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Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds：Evidence from China

Cited by 11 publications

References 30 publications

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

Fiscal decentralisation and green total factor productivity in China: SBM-GML and IV model approaches

Hierarchical medical system and local medical performance: A quasi-natural experiment evaluation in Shanghai, China

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