新型农村合作医疗财政补贴增长的精算分析

Actuarial Evaluation for the Financial Subsidy Growth for China's New Cooperative Medical Scheme

新农合财政补贴能否立足长远和实现合理增长,直接影响到这一制度的可持续发展。文章运用保险精算方法,将通常被忽略的人口迁移、人口老龄化和医疗保险制度整合等关键因素纳入分析框架,对新农合未来36年的财政补贴增长问题进行了研究。主要结论:第一,新农合人均财政补贴和总补贴都将逐年增长,且增长速度与制度整合的战略规划密切相关。在2019年制度整合完成之前,人均财政补贴和总补贴年增长率应分别达到10.6%左右和9.2%左右,之后增速可逐步放缓。第二,人均财政补贴增长需要采取定额递增的方式。如果保持现有补贴比例不变,在2020年之前,每年调增50元左右;2021—2025年每年调增60-70元,2026—2030年每年调增80-110元。第三,因为新农合总人口将逐年下降,财政对新农合财政补贴是长期可承受的。但未来补贴比例仍有必要向下调整,适度的财政补贴比例应该在60%-70%之间。

whether the financial subsidy for the New Cooperative Medical Scheme（ NCMS） can realize rational growth in the long- term has the direct bearing on the sustainable development of the system. Adopting an actuarial model,and taking into account key factors which are usually ignored including population migrant,population ageing and integration of health insurance systems,the paper studies the financial subsidy growth for NCMS in the coming 36 years. The main conclusions are as follows： First,either financial subsidy per capita or the total subsidies every year will experience year- by- year growth and the growth rates are determined by the strategic program of the system integration. Before 2019,the growth rates for the subsidy per capita and for the gross subsidies will need an extraordinary growth of up to 10. 6%and 9. 2% a year respectively. After then,the growth rate will slow down gradually. Second,the amount of financial subsidy per capita needs to be adjusted at an increasing rate. If keeping the present policy unchanged,the subsidy needs to increase with an average amount of 50 Yuan RMB every year before 2020,and 60- 70 Yuan RMB every year between 2021 and 2025,and 80- 110 Yuan RMB every year between 2026 and 2030. Third,due to gradually decrease of the total population of NCMS,the total amount of subsidies NCMS needed every year will be affordable for the government. However,the proportion of the subsidy still needs to be adjusted down in the future to a rate of between60% and 70%,which is concluded by the author a moderate region for the subsidy policy.