我国统筹医疗保险体系的财政承受能力研究

China's Fiscal Burden of Overall Planning of Medical Insurance System

政府对医疗保险基金财政补贴的承受能力,是制约我国医疗保险体系统筹的重要因素之一。文章在对医疗保险基金收支进行预测的基础上,运用代际核算方法分析了我国统筹医疗保险对财政体系负担的影响。模拟结果表明,如果整合城乡居民医疗保险体系,无论是短期还是长期都不会给政府财政造成太大压力。如果"城职保"、"城居保"和"新农合"完全统筹,"城居保"和"新农合"参保人员的缴费将大幅增加,会减轻政府的财政负担。如果"城居保"和"新农合"参保人员的待遇达到"城职保"水平,则"城居保"和"新农合"参保人员的缴费需要提高到676.8元,政府的负担才不会发生变化。因此,文章认为先统筹"城居保"和"新农合"是比较现实的选择,因为随着"城居保"和"新农合"参保人员缴费能力的上升,如果将"城居保"和"新农合"参保人员的缴费提高8倍左右,并把"城居保"和"新农合"参保人员的待遇提高到"城职保"水平也不会增加政府的财政负担。

Government burden of fiscal subsidies of medical insurance funds is an important factor restricting the overall planning of medical insurance system in China. Based on the estimation of the income and expenses of medical insurance funds, this paper analy- zes the effect of overall planning of medical insurance in China on fiscal burden through generational accounting method. The simulation shows that no matter in the long or short run, there is not too much burden over government finance if the integration of urban-rural medical insurance systems happens. If medical insurance for urban workers, medical insur- ance for non-working urban residents and new rural cooperative medical care system are o- verall-planned, the contribution of participants in medical insurance for non-working urban residents and new rural cooperative medical care system will increase greatly, and the fiscal burden will decrease instead. If the participants in medical insurance for non-working urban residents and new rural cooperative medical care system enjoy the same treatment as those in medical insurance for urban workers, the contribution of medical insurance for non- working urban residents and new rural cooperative medical care system should be raised to 676.8 RMB, leading to no change of fiscal burden. Thus, it is realistic to overall plan new rural cooperative medical care system and medical insurance for non-working urban resi- dents. With the income growth of the participants in new rural cooperative medical care system and medical insurance for non-working urban residents, if their contribution increa- ses by about eight times, the fiscal burden remains unchanged, while the participants in new rural cooperative medical care system and medical insurance for non-working urban residents enjoy the same treatment as the participants in medical insurance for urban workers.