大病保险对新农合基金可持续运行的影响研究——基于江苏省调研数据的精算评估

Research on the Impact of Critical Illness Insurance on the Sustainable Operation of the New Rural Collaborative Medical Schemes Fund:An Actuarial Valuation Based on Investigation Data in Jiangsu Province

基于江苏省6个新农合统筹地区的实地调研,构建了新农合基金和大病保险基金收支预测模型及累计结余模型,以考察大病保险引入前后新农合基金的运行情况。研究发现:第一,维持当前筹资标准和补偿比例,即使不引入大病保险政策,样本地区新农合基金也存在超支风险;第二,引入大病保险政策势必会增加新农合基金运行压力和基金赤字风险,影响新农合基金的可持续运行;第三,提高个人缴费额或县级财政补助金额能够缓解新农合基金的运行压力,但如果继续提高新农合补偿支出水平,则会进一步恶化新农合基金的财务状况。研究认为,应通过建立单独的大病保险筹资增长机制、完善大病费用控制机制及健全新农合风险基金制度等方式逐步实现大病保险与新农合制度的可持续运行。

Based on some investigating data about six counties in Jiangsu province, this study build an actuarial model to analysis the impact of critical illness insurance on the NRCMS fund. The study found the follows： Firstly, if it maintains the current financing standard and compensation proportion, the NRCMS will have the risk of exceeding the budget, even if it does not introduce the critical illness insurance. Secondly, if introduce the critical illness insurance is bound to increase the operation pressure and affect the sustainable operation of the NRCMS fund. Thirdly, if it continues to improve the rates for individual contributions and county financial subsidy can reduce the operation pressure of the fund, on the contrary, increase the compensation level will further deteriorate financial situation. The last but not the least, the study suggests that we can achieve sustainable operation of the critical illness insurance policy and NRCMS through establishing separately a critical illness insurance fund-raising mechanism, perfecting the cost control regime of critical illness and improving the risk fund system of NRCMS.