老龄化背景下我国医疗保险制度的系统动力学研究

Research on Optimization of Medical Insurance System in China Based on the SD Method in the Context of Population Aging

目的建立老龄化背景下我国医疗保险系统动力学模型,观察医疗保险收支和个人支付医疗费用发展趋势,以及干预行为对系统的影响,为实现在维持医保基金平衡的基础上,最大程度地降低患者医疗费用负担提供政策建议。方法通过文献分析法、系统分析法确定医保系统主体。依据系统动力学方法,构建系统模型并进行仿真模拟。结果城镇基本医保基金收入与支出呈逐年增长趋势,医保基金结余逐年减少,至2025年医保基金结余为-239. 6亿元,个人支付费用为3620. 0元。结论模型能较为客观的模拟系统结构与行为规律,可用于医保费用的预测与政策干预。提高社区门诊和住院比例、提高政府对城镇居民医保费用的筹资标准、人口赡养比、离退休人口缴纳医保费用可有效降低个人的支付费用负担,促进医保系统的可持续发展。

Objective To establish a dynamic model of medical insurance system in China under the background of population aging.To observe the development trend of medical insurance receipts and expenditure,personal payment of medical expenses and the impact of intervention on the system.In order to provide policy recommendations of reducing the medical costs of patients based on balance of medical insurance fund.Methods The subject of medical insurance system was determined by literature analysis and systematic analysis.We constructed the system model according to the system dynamics method,and used it to simulation.Results The income and expenditure of urban basic medical insurance fund increased,but the balance of medical insurance fund decreased year by year.The balance of medical insurance will be-23.96 billion yuan by 2025,and the medical expenses paid by individuals will be 3620.0 yuan.Conclusion The model can simulate the structure and regular pattern of the system and can be used for the prediction of medical insurance costs and intervention policy.Increasing the proportion of community outpatient and inpatient,raising the government funding criteria for urban health insurance,population support ratio and medical premiums of retired population can effectively reduce the individual medical costs and promote the sustainable development of the medical insurance system.