城乡居民大病保险对城乡居民基本医保基金的影响探析

Analysis of the influence of unified catastrophic disease insurance for urban and rural residents on the funds of urban and rural basic insurance

目的 评估城乡居民大病保险全面实施对城乡居民基本医保基金的影响,为完善我国城乡居民大病保险制度提供建议。方法 选取肺癌、胃癌、食道癌3种疾病,根据《中国卫生统计年鉴》、《中国劳动统计年鉴》以及“中国恶性肿瘤发病与死亡”系列文献资料,计算这3种疾病2009-2013年经初次补偿后的住院医药总费用以及城乡居民基本医保基金结余,并比较两者差异。结果 2009-2013年肺癌、胃癌、食道癌的住院医药总费用年均增长率呈上升趋势,而城乡居民基本医保基金结余年增长率呈下降趋势,基金运用压力增大。结论 应扩宽大病保险的筹资渠道,推动城乡居民基本医保并轨,同时建立大病保险精算制度。

Objective To evaluate the influence of unified catastrophic disease insurance for urban and rural residents on the funds of urban and rural basic insurance and put forward suggestions to improve the unified catastrophic disease insurance for urban and rural residents. Methods Lung cancer, stomach cancer and esophagus cancer were selected as study objects, based on the infmxnation came from China Health Statistical Yearbook, China Labour Statistical Year- book and ＂Reports of Cancer Incidence and Mortality in China＂, the inpatients medical expense of these three disease that had been reimbursed first was compared with the funds surplus of urban and rural basic insurance from 2009 to 2013. Results The lung cancer, stomach cancer and esophagus cancer＂ average annual growth rate of inpatients medical expense showed increasing trend, but the annual growth rate of funds surplus of urban and rural basic insurance was downtrend, so the catastrophic disease insurance faced some pressure. Conclusion The catastrophic disease insurance should have more than one income resource, and the urban and rural basic insurance should also be integrated; on the other hand, establishing a actuarial system is also a good choice for perfecting the unified catastrophic disease insurance for urban and rural residents.