“健康中国”背景下城乡居民基本医疗保险基金可持续性的精算评估——基于多种政策调整的实证分析

Actuarial Evaluation of the Sustainability of Urban and Rural Residents’ Basic Medical Insurance Funds

《“健康中国2030”规划纲要》要求实现基本医疗保险基金中长期精算平衡,然而现阶段,湖北省人口老龄化程度不断上升,社会医疗保险基金支付压力逐步上升,基金将不可持续。在此背景下,本研究以人口经济学、保险学、社会保障、精算学等相关理论为基础,建立精算模型,对“全面二孩”政策和调整缴费率对基金运行影响进行预测。预测发现:“全面二孩”政策和调整缴费率有利于缓解基金不可持续的未来状况,降低基金累计赤字,且生育意愿越高,缴费率越高,对基金累计赤字缓解效果越好。因此政府应积极鼓励生育,控制医疗费用的增长速度,进一步明确财政对社会医疗保险的责任。

The“Healthy China 2030”Planning Outline requires the realization of a medium- and long-term actuarial balance of the basic medical insurance fund.However,at this stage,the population aging of Hubei Province is rising,the payment pressure of social medical insurance funds is gradually increasing,and the fund will not be sustainable.In this context,based on population economics,insurance,social security,actuarial science and other related theories,this study establishes an actuarial model to predict the impact of the“two-child”policy and the adjustment of the contribution rate on the operation of the fund.The“Comprehensive Two-Child”policy and the adjustment of the contribution rate are conducive to alleviating the unsustainable future situation of the fund and reducing the accumulated deficit of the fund.Moreover,the higher the fertility willingness,the higher the contribution rate,and the better the mitigation effect on the fund s accumulated deficit.Therefore,the government should actively encourage births,control the growth rate of medical expenses,and further clarify the financial responsibility for social medical insurance.