Effects of the Integration of Urban and Rural Residents Basic Medical Insurance on the Self-evaluation of Health Status and Life Satisfaction of the Chinese Elderly

Abstract

Background Empirical research and evidence on the relationship among the medical insurance system reform, health status and life satisfaction of the elderly are scant. Objective To analyze the effects of the integration of the urban and rural residents basic medical insurance (URRBMI) on the self-evaluation of health status and life satisfaction of the Chinese elderly. Methods Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2018, elderly people over 60 years old with complete information were included as the research subjects. The demographic information, health status and function, medical care and insurance were extracted from the CHARLS questionnaire. According to the integration of URRBMI or not, subjects were assigned into URRBMI integration group and non-integration group. Logistic regression model was used to analyze the effects of the integration of URRBMI on the self-evaluation of health status and life satisfaction of the elderly. In addition, a structural equation model was constructed to analyze the mediating effect with the URRBMI integration as an independent variable, self-evaluation of health status as a mediating variable, and life satisfaction as a dependent variable. Results A total of 4 364 subjects were analyzed in this study, including 694 (15.90%) in the URRBMI integration group and 3 670 (84.10%) in the non-integration group. The self-evaluation of health status in the URRBMI integration group was significantly better than that of the non-integration group (20.74% vs 17.41%, P=0.038). The self-evaluation of health status in the URRBMI integration group was significantly superior (OR=1.281, 95%CI=1.038-1.581, P=0.021). The life satisfaction of the URRBMI integration group was significantly higher than that of the non-integration group (94.80% vs 91.87%, P=0.009). The life satisfaction was better in the URRBMI integration group (OR=1.378, 95%CI=1.037-1.831, P=0.027). There was a partial mediating effect of the self-evaluation of health status on the impact of URRBMI integration on the life satisfaction, with the mediating effect value of 0.050 (P=0.043), and the proportion of mediating effect in the total effect accounted for 46.66%. Conclusion The URRBMI integration is beneficial to improve the self-evaluation of the health status and life satisfaction of the elderly, which has a positive practical significance. In the future, further efforts should be made on strengthening the publicity of the URRBMI, constantly improving the medical insurance treatment level for urban and rural residents, establishing a more reasonable financing mechanism, promoting the quality of medical services in rural areas, and finally improving the health level of the elderly population.

Keywords

• integration of the urban and rural residents basic medical insurance|elderly|self-evaluation of health status|life satisfaction|mediation effect analysis