基于内蒙古自治区城乡居民基本医疗保险一体化的综合模拟测算

Comprehensive Simulation Calculation Based on the Integration of Basic Medical Insurance for Urban and Rural Residents in Inner Mongolia Autonomous Region

目的:综合考虑内蒙古自治区城乡居民基本医疗保险的现状,在确保城乡居民基本医疗保险缴费比率不大幅提升的基础上,考虑起付线与封顶线等因素,综合测算政府、社会和个人三大筹资主体的筹资比例与额度,分析合理的自治区城乡居民基本医疗保险一体化对接模式。方法:本研究创新性地将精算模型与ProModel系统仿真相结合,对起付线、封顶线等因素加以考虑,并对自治区城乡居民基本医疗保险一体化进行综合模拟测算。资料来源于2007-2018年内蒙古自治区卫计委数据、中国统计年鉴与前期的研究成果。结果:(1)居民个人筹资额度不断增加,且从2014年至2018年,增长幅度在60%以上,但可行性依然较强。(2)政府与社会筹资额度不断增加,年增长幅度在20%以上,筹资能力面临挑战。结论:积极关注城乡居民自付费用,构建以基本医疗保险为主导,商业医疗保险为辅助的多维保险体系。

Objective Taking into account the current situation of basic medical insurance for urban and rural residents in Inner Mongolia Autonomous region,and on the basis of ensuring that the payment ratio of basic medical insurance for urban and rural residents is not greatly increased,and taking into account factors such as payment line and capping line,This paper comprehensively calculates the financing proportion and amount of the three major financing subjects of the government,society and individuals,and analyzes the reasonable integrated docking mode of basic medical insurance for urban and rural residents in the autonomous region. Methods This study innovatively combined the actuary model with ProModel system simulation,considered the initial payment line,capping line and other factors,and comprehensively simulated and calculated the integration of basic medical insurance for urban and rural residents in the autonomous region. The data were derived from the data of Inner Mongolia Autonomous region Health and Family Planning Commission from 2007 to 2018,China Statistical Yearbook and previous research results. Results:(1) The amount of individual financing for residents has been increasing,and from 2014 to 2018,the rate of increase has been more than 60%,but the feasibility is still strong.(2) the amount of government and social financing has been increasing,with an annual growth rate of more than 20%,and the ability to raise funds is facing challenges. Conclusion: we should actively pay attention to the out-of-pocket expenses of urban and rural residents and construct a multi-dimensional insurance system dominated by basic medical insurance and supplemented by commercial medical insurance.