社会医疗保险财政补贴增长及可持续性研究——以医保制度整合为背景

Evaluation for Growth and Sustainability of Financial Subsidy for China's Social Health Insurance

随着医保制度城乡统筹的推进,以财政补贴为主要筹资来源的新农合和居民医保两大制度筹资水平的增长将对财政形成持续的压力。本文基于医保制度整合的背景,综合人口结构转变等方面的动态变化因素,运用保险精算方法对未来三十六年的人均筹资和财政补贴增长进行了测算,并对财政补贴可持续性进行了评估。研究发现,两项制度的未来人均筹资和财政补贴总额都将持续增长,尤其在制度整合完成之前增长更快。尽管如此,现有的财政补贴政策依然是长期可持续的。本文的研究结论为推进社会医疗保险改革、建立公平和可持续的财政补贴机制有着重要的启示意义,未来财政补贴标准应当体现城乡差异和进一步突出年龄差异,补贴总量需要实现从新农合向居民医保的重心转移。同时,为提高政策的可持续性,各级政府的财政补贴责任应当制度化,并进一步强化中央和省级财政的出资责任。本文在某种程度上弥补了现有相关研究以定性分析为主的不足,所采用的研究方法和视角也具有一定的创新价值。

With the coordination of urban and rural development,the correspondingly raise of finance level of the New Cooperative Medical Scheme(NCMS) and the Urban Residents' Health Insurance System(URHIS)which financial source depend mainly on financial subsidy will exert continued pressure on government budgets. The objective of this paper is to forecast the growth of financial subsidy and to evaluate sustainability of the policy for China's health insurance in the coming 36 years. This article uses actuarial models taking into account various factors,such as demographic structure transformation,health insurance system integration,etc. The author concludes that the future dollars needed for each person and the total financial subsidy needed for either the two system will experience continuous increase in the coming 36 years, especially before achievement of the system integration. And the present financial subsidy policy for social health insurance is sustainable in the long ran. The findings are of great significance for the reform of China's social health insurance and construction of equitable and sustainable mechanism of financial subsidy. The subsidy level should reflect the differences between urban and rural and should further take the interests of the old people and the oldest old. The total amount of subsidy should shift the focus of NCMS to URHIS. Meanwhile,to enhance sustainability of the policy,it's important to institutionalize the responsibility between governments at all levels and further strengthen the financial contribution of the central government and the provincial governments. The innovation of this paper lies in the research method and study angles. It also helps to relieve the main shortages of the previous research which adopt mainly on qualitative analysis to a certain degree.