Rapid economic and social development、Population aging continues to intensify、In the context of changes in disease patterns and widespread application of new bet365 apuestas technologies，bet365 apuestas expenditures in various countries increase rapidly，How to use limited bet365 apuestas resources to maximize health has become a hot and difficult issue related to the well-being of all mankind。From developed countries to China，An important policy to deal with rising bet365 apuestas expenditures，The bet365 apuestas insurance payment method changes from fee-for-service to capitation、Prepayment methods such as group payment based on disease diagnosis。

In prepaid mode，According to age、Gender and other demographic characteristics are important for predicting bet365 apuestas expenses in advance，This directly affects the determination of the prepayment amount。There are two important issues in the related modeling process。First, the concentration of bet365 apuestas expenditures。Measured by the proportion of high-income bet365 apuestas consumers and the proportion of bet365 apuestas expenditure，Although the proportion of high bet365 apuestas expenses is not high，But its cost accounts for a very high proportion of the total cost。For example，1% of the insured population spends 50% of the total bet365 apuestas expenditures。The second is the continuing problem of bet365 apuestas expenditure。bet365 apuestas expenditures once incurred are likely to last for a long time，In this case，Whether the bet365 apuestas expenditure of the whole society can meet the relevant bet365 apuestas needs in the long term，Whether there are sufficient systems and financial guarantees。How to implement disease management for this high-spending group and persistent characteristics，The formulation of special critical illness insurance policies is an important focus of public policy analysis。

　　Highly skewed distribution of bet365 apuestas expenditures in developed countries

Concentration of bet365 apuestas expenditure，Research on the concentration of bet365 apuestas expenditures in developed countries and regions found that bet365 apuestas expenditures are highly skewed in distribution，A small number of groups consume most of the bet365 apuestas resources。For example，The bet365 apuestas expenditure of the top 5% of the total expenditure in the United States from 1996 to 2012 accounted for about 50%。The proportion of the top 10% of total expenditure in France in 2008 and 2013 was 59% and 62% respectively。

Continuity of bet365 apuestas expenditure，After World War II, developed countries and regions in Europe and the United States gradually established bet365 apuestas insurance systems covering the entire population，The goal is to provide financial protection for residents’ bet365 apuestas needs。With the advancement of bet365 apuestas technology、Income growth、Population aging and disease spectrum shifts，bet365 apuestas expenses start to rise，The corresponding expenditure risk is also rising。Since the end of the 20th century，Developed countries and regions have shifted from strict supervision and fee control to using market mechanisms to establish incentive-compatible fee control models，Causing researchers to pay further attention to the persistence of bet365 apuestas expenditures。Since the 21st century，Research on the persistence of bet365 apuestas expenditures begins to focus on disease and health management。A study conducted an empirical analysis on people under the age of 65 in the United States，bet365 apuestas expenditures are highly persistent and concentrated，The top 10% spending group will still have 34 in 5 years.4% probability of continuing to stay in this sequence，And many disease symptoms still exist after 5 years。

　　China’s bet365 apuestas expenditures are both concentrated and persistent

Empirical research based on developed countries has confirmed the existence of concentration and persistence of bet365 apuestas expenditures。China is the largest developing country in the world，Resident income and bet365 apuestas security levels are not high yet，Is bet365 apuestas expenditure also concentrated and sustainable？The author’s research findings，Similar to developed countries，Nearly 50% of bet365 apuestas expenditures in China’s sample areas are generated by the top 10% of spending groups，Meaning that 1% of the insured population spends about half of the bet365 apuestas expenditure。However，High bet365 apuestas expenditure groups have the characteristics of developing countries。

First, the age distribution of the top 10% spending groups is in an inverted U shape，Concentrated on people around 60 years old，In stark contrast to the monotonous increase in average bet365 apuestas expenses for adults in developed countries with age。During the sample period, the proportion of people over 65 years old among the top 10% annual expenditure groups increased year by year，Shows that as income increases and bet365 apuestas security levels improve，The bet365 apuestas needs of the elderly are gradually released。

Second, the proportion of men in the top 10% spending group is higher than that of women，The disease type is characterized by chronicity，But damaged、Poisoning still accounts for a certain proportion，Shows that disease spectrum transformation is still in progress。When considering longer time spans，Concentration of bet365 apuestas spending has declined，But the combined calculation shows during the sample period，The bet365 apuestas expenditure of 1% of the insured groups still accounts for nearly 30% of the total expenditure，Indicates that bet365 apuestas expenditure has strong sustainability。Also，Out-of-pocket expenditure analysis shows that the proportion of out-of-pocket expenditures among the top 1% of insured groups has declined over time，However, the combined calculation ratio during the sample period is still as high as 46.2%，Indicates that it is very necessary and important to continue to promote critical illness insurance and increase protection。Transition matrix analysis shows，The probability that the group in the top 10% will continue to stay in this sequence after one year is 37.6%；Although the probability decreases over time，But there are still 26 after 6 years.1% chance of continued high spending。

Third, the proportion of people over 65 years old among high-spending groups is increasing year by year，The cross-year correlation of bet365 apuestas expenditures is also slowly increasing，Indicates that with the increase of residents’ income and the improvement of bet365 apuestas security level，China’s sample areas have a tendency to converge towards developed countries in terms of concentration and persistence of bet365 apuestas expenditures。

Based on two-part model，The author further analyzed the differences in persistence characteristics between the probability of hospitalization and the level of hospitalization bet365 apuestas expenditure，And the impact of different disease types on the persistence of bet365 apuestas expenditures。The estimated results show，The persistence characteristics of the probability of bet365 apuestas treatment and the level of bet365 apuestas expenditure are different。Once hospitalization expenses occur，The probability of remaining hospitalized after 1 year will significantly increase6.9%，Increase 5 after 2 years.2%。Although persistence decreases over time，But the probability of hospitalization still increased by 2 after 6 years.4%。Given the occurrence of bet365 apuestas expenditures，The persistence of bet365 apuestas expenditure levels is more reflected in the two adjacent periods。Every 10% increase in expenditure in the previous period，The current expenditure will increase by 0.35%；Expenditure increased by 10% for the first 2 periods and earlier，The increase in current expenditure is only 0.1% or less。After controlling for disease and institutional characteristics，Old people aged 65 and above do not show greater spending persistence。We speculate that the possible reason is that the elderly in rural areas of China receive less investment in health，Or it may be caused by the higher mortality rate in the elderly。After adding disease and bet365 apuestas institution variables，The persistence of women’s bet365 apuestas expenditure exceeds that of men to a certain extent。

　　Further improve major bet365 apuestas risk protection

The important reasons for the concentration of bet365 apuestas expenditures are the low probability of major diseases and the aging of the population，The important reason for persistence is the transformation of disease spectrum，i.e. chronic and non-communicable diseases dominate。Also，Increased income and advances in bet365 apuestas technology also played an important role。Modern diseases are characterized by chronicity，Some diseases are less likely to occur but more expensive，May be an important reason for the concentration of bet365 apuestas expenditures。bet365 apuestas expenditure concentration analysis shows that the disease types of the top 10% spending groups are characterized by seriousness and chronicity。

The treatment period for chronic diseases is longer，Easy to cause ongoing bet365 apuestas expenses，And the affected groups are mainly the elderly，Aging will further lead to an increase in bet365 apuestas expenses，The top 10% spending groups are mainly people around 60 years old。The insured’s income increases、Improved ability to pay、bet365 apuestas technology advances and treatments become more abundant，All will increase the impact of disease on the concentration and persistence of bet365 apuestas expenditures。Of course，There may be many other factors that contribute to the concentration and persistence of health care spending，Such as moral hazard、bet365 apuestas insurance system design、Quality of diagnosis and treatment, etc.，It is just that it cannot be recognized under the current data structure and technical conditions。

Not only that，The unique formation mechanism of concentration and persistence of bet365 apuestas expenditure indicates，It is very necessary to establish and improve the corresponding insurance system protection。Analysis on out-of-pocket expenditure characteristics shows，As the time span increases，The proportion of out-of-pocket expenditures of the top 1% of the population (based on insured persons) to all out-of-pocket expenditures in the year is gradually decreasing，But the decrease rate also shows a decreasing trend year by year。These statistical results show，Out-of-pocket expenditures are also highly concentrated，High-cost groups have a heavy expenditure burden。Comparative analysis of the trends in the average out-of-pocket expenditure ratio of the top 1% of the population and the remaining 99% of the population over time，The out-of-pocket expenditure ratio (reimbursement ratio) of the top 1% of the population is lower (higher) than the remaining 99% of the population，Indicates that although the total expenditure of the high-cost group is higher，But the compensation is also more。It’s worth noting，Despite the insurance system as a guarantee，The average out-of-pocket ratio of high-expenditure people is still as high as 46%，Indicates the development of special critical illness insurance policies for this group of people，Should become an important focus of public policy analysis。

　(Author’s affiliation: School of Economics, Central University of Finance and Economics)