城乡居民医疗保险“多缴多得”的经济激励效果检验

The Inspection of Economic Incentive of “the More Premium, the More Reimbursement” for the Medical Insurance System for Urban and Rural Residents

目的:检验"多缴多得"政策对参保的经济激励效果。方法:基于参保人理性选择视角,建立个人缴费及赔付的精算现值模型,借助补偿收益率指标,测算不同缴费档次模式下的成本收益情况。结果:在医疗消费支出高的年龄参保、低档次缴费是理性选择,该政策起到了相反的经济激励效果,即多缴并未多得。结论:"多缴多得"的政策设计违背了基本医疗保险的公平性原则,不利于制度的良好稳定发展及社会公平,应当从完善长效筹资机制,实行强制参保入手,消除参保过程中的逆向选择。

Objective： To inspect the economic incentive of ＂the more premium, the more reimbursement＂ for the medical insur- ance system for urban and rural residents. Methods： Based on the perspective of rational choice of the insured, it built the actuarial present value models for individual pay cost and compensation. Using the index of compensation yield, it examined the economic en- courage participation in insurance by different payment grades. Results： The rational choices of the insured was low payment grade and insured at the high medical consume age, that is, ＂the more premium, the more reimbursement＂ police have no economic incen- tive effect. Conclusion： It was a breach of the principle of equity, which was not conducive to benign operation of the system and sta- ble development of the society. It should improve the long-term financing mechanism, implement compulsory insurance and eliminate the adverse selection.