上海城镇职工医保基金结余预测及优化分析

Forecast and optimization analysis of Shanghai urban employee medical insurance fund balance

基于2005-2018年上海职工医保基金相关数据,主要选取2011-2018年数据进行分析,对上海职工医保基金收支规模和基金结余趋势行GM(1,1)模型预测并与全数据比较,显示以2011年上海医保政策覆盖外来员工为临界点,上海城镇职工医保基金累计结余持续增长,并已处于理论"过多"状态。在上海现有政策条件下,未来12年间累计基金结余规模呈不断扩大趋势。从医保基金发展的基本原则和城镇职工医保制度的定位看,职工医保基金沉淀过多不能充分体现风险同济和权益共享,优化和适度控制基金结余规模成为必然。

Based on the 2005-2018 Shanghai Employee Medical Insurance Fund related data,the 2011-2018 data is mainly selected for analysis,and the Shanghai Employee Medical Insurance Fund revenue and expenditure scale and fund balance trend are forecasted by the GM(1,1)model and compared with the full data.Taking the Shanghai medical insurance policy to cover migrant workers in 2011 as the tipping point,the cumulative balance of Shanghai urban employee medical insurance funds has continued to grow,and has been in a theoretical"excessive"state.Under the current policy conditions in Shanghai,the scale of accumulated fund balances will continue to expand in the next 12 years.Judging from the basic principles of the development of medical insurance funds and the positioning of the urban employee medical insurance system,excessive precipitation of employee medical insurance funds cannot fully reflect the risk relief and equity sharing,and it is inevitable to optimize and moderately control the scale of fund balances.