Has China's Critical Illness Insurance Improved the Situation of the Vulnerable Groups: Case Studies of the Elderly and Low-income Groups

Based on sample data of health insurance from selected cities, with a focus on the elderly and low-income people, an empirical analysis was conducted to determine whether critical illness insurance has improved the protection status of vulnerable groups. It is found that, as an important mechanism for preventing residents from falling into and returning poverty due to illness, critical illness insurance has significantly contributed to the utilization of medical services and upgraded their reimbursement level, while the amount of out-of-pocket expenses(OOP) and their economic burden have not been effectively reduced, and there is an upward trend in the incidence of catastrophic expenditures. It may be the rapid increase of medical costs outside the scope of policy, the unreasonable setting of the threshold for critical illness insurance, together with the youth-oriented tendency of the incidence rate of critical illnesses that might contribute to the unexpected findings. To solve the problems, it is argued that the definition of "critical illness"should be redefined by considering both the disease types and the amount of medical care expenditure, to expand the scope of expenditures with the policy, to target on the disadvantaged groups accurately to set differentiated deductibles, and especially to control effectively the unreasonable increases in medical expenses.