老年居民健康波动、医疗支出风险与医疗保险风险分担

Older Residents' Health Shocks,Medical Expenditure Risks and Social Medical Insurance Risk-sharing

文章研究了城镇老年居民健康波动对总体、个人自负和统筹支付三个方面医疗支出的影响,并分析了医疗保险统筹基金的风险分担作用。研究发现:(1)健康波动会产生医疗支出风险,这一风险主要由影响健康的持续性因子波动所致;对于参加职工基本医疗保险的居民来说,统筹基金同样面临支付风险。(2)健康波动产生的大病支出风险绝大部分由职工基本医疗保险统筹基金承担,个人自负支出风险则相对较小。具体来说,65岁时发生的健康波动会使0.1%的居民在未来面临不低于50万元的额外医疗支出,其中55%将由统筹基金承担。随着我国人口老龄化,除了落实个人账户外,政府还应进一步充实社会统筹基金和大病基金,以分担大病支出风险,并缓解"看病贵"的问题。

This paper analyzes the effects of urban older residents health shocks on medical expenditures from the perspective of overall pay, individual pay and coordination pay, and the risk-sharing function of social medical insurance. The result shows that health shocks give rise to medical expenditure risks which are mainly caused by fluctuations in persistent factors affecting health; as for residents who participate in employee basic med- ical insurance, the pool fund also faces payment risks. The risk of serious illness expenditures is mostly shared by the pool fund of employee basic medical insurance, and the expenditure risk of individual pay is relatively small. Specifically speaking, health shocks in the age of 65 will lead to addi- tional medical expenditure of no less than 500,000 yuan that faces 0. 1% of the residents in the future, and the pool fund will share 55% of the addition- al medical expenditure. As the population in China is aging, the governments should enrich the social pool fund and the serious illness fund besides individual accounts in order to share the risk of serious illness expenditures and mitigate the problem of expensive medical treatment. Key words,