生育政策调整对提高新农合基金可持续运行能力的影响

Impacts of Fertility Policy Adjustments on the Sustainable Operation Ability of The New Rural Cooperative Medical Fund

人口老龄化问题是我国目前面临的重大问题之一,在我国农村地区尤为严峻。接连出台的"单独二孩"和"全面二孩"政策充分显示出党和政府应对这一问题的决心。那么,调整生育政策能否优化我国人口结构和提高新农合基金可持续运行能力?本文基于医疗保险精算平衡理论,通过构建动态精算模型模拟了政策调整前后我国新农合基金的运行情况,并得到以下结论:第一,如果我国不调整生育政策,新农合基金将分别在2018年和2024年出现当期赤字和累计赤字;第二,按照"单独二孩"的实际生育意愿测算,新农合基金在目标期内出现当期赤字和累计赤字的时点不会改变,但是赤字金额会有一定减少;第三,"全面二孩"政策下,新农合基金发生当期赤字和累计赤字的时点仍未改变,但随着生育意愿的提高,当期赤字和累计赤字的下降幅度会更加明显。并且,当生育意愿不低于50%时,新农合基金将在2072年前再次出现当期结余,随后累计赤字逐年减少。可见,从长期看调整生育政策能有效改善新农合基金的财务状况,但近期还需通过增加财政补贴、提高农民人均可支配收入等方式增强新农合基金的可持续运行能力。

In 2012 ,The New Rural Cooperative Medical System （NRCMS） basically achieved universal cover- age of Chinese mainland. With the increase of budgets subsidy at all levels and continuous extending of the NRC- MS, the amount of NRCM funds continues to be on rise. But with the rise of utilization rate, the fund deficit risk mounts up year by year,some regions already appeared negative annual accumulated balance. In 2010, the ratio of population aged 65 and above has reached 10. 46% , which is significantly higher than the average level of urban and rural areas （9. 29% ） and the measuring standard of the aging society from the UN （7%）. The needs of the aged for medical resources are significantly greater than other age groups. Therefore, the deepening of aging popula- tion degree in rural areas is bound to increase the running pressure of the NRCM fund. In order to solve the serious social problems which are caused by aging population, the Chinese government introduced the ＇2nd-child Policy＇ in 2013 and the ＇ fully two-children Policy＇ in 2015 successively. Then, could the degree of aging population be re- lieved by adjusting fertility policy in China？ Could the financial support ability of the NRCM fund be improved？ To compare the situation of the NRCM fund before and after fertility policy adjusting, a dynamic actuarial mod- el was built based on the medical insurance actuarial equivalent theory and the following conclusions were a- chieved： Firstly,if the fertility policy keeps unchanged,the current deficit of the NRCM fund would appear in 2018 and the cumulative deficit would appear in 2024;Secondly, with the adoption of ＇2nd-child Policy, according to the current fertility intention of couples, through counting, the occurrence of the point of current deficit and cumulative deficit will not change, but the amount of current deficit and cumulative deficit would continue to reduce; Thirdly, with the adoption of ＇ fully two-children Policy＇ the improving fertility intentions would not change the point of cur- rent deficit and cumulative deficit occurrence, which has some link with the time lag of fertility policy adjust- ment. But, the higher the fertility intention is, the less the amount of current deficit and cumulative deficit is; Fourthly,when there is no less than 50% couples that have the intention to have two children, the NRCM fund would appear a current balance again before 2072 and be positive to 2090. Last but not least, all results are valida- ted by sensitivity test to examine the stability and the reliability. Hence, in the long run, the fertility policy could reduce the government＇ s financial burden effectively. But in recent years, we need to ensure the safe operation of NRCM fund by following measures：Firstly, budgets subsidy at all levels should give more support, and increase the fund＇ s ability of saving and value-adding in order to cope with the medical consumption peak posed by aging population; Secondly, the government should continue to adjust the distribution pattern of national income and increase rural per capita net income to increase the capacity of medical consumption; Thirdly, relevant authorities should speed up payment reform and advance grading care and lead the patients to see doctor in basic medical institutions, in order to control the unreasonable growth of medical expense and improve the NRCM fund＇ s utilization rate. In addition, to ensure the fertility policy was implemented smoothly, the government at all levels sho.uld give full play to the leading role, and introduce relevant supporting measures combined with the provincial realities, such as income tax relief and financial subsidies for individuals, etc. But it is important to note that the government at all levels must do supervision work strictly, to prevent further gender imbal- ance at rural areas.