人口老龄化背景下医保基金可持续发展的风险分析

Risk Analysis Of Sustainable Development Of Medical Insurance Fund Under The Background Of Population Aging

在现行医保制度下,通过构建动态收支平衡预测模型,根据人口规模和结构、人口健康和就医情况、工资收入与参保缴费等数据,模拟2020年-2035年我国医保基金的收支平衡状况。结果发现:现行制度下医保基金运行不具有可持续性,预计当年结存在2026年左右首次出现缺口,累计结存在2034年左右出现缺口。其中,职工医保基金和居民医保基金的累计结存预计分别在2039年左右和2023年左右出现缺口。建议牢牢把握“十四五”这个关键时期,加快健全稳健可持续的筹资运行机制,改革医保支付机制,加强基金运行管理和风险预警防范,坚决守住不发生系统性风险底线。

Under the current medical insurance system,the author builds a dynamic revenue and expenditure balance forecast model,using population size and structure,population health and medical care,salary levels and insurance contributions to simulate the income and expenditure of medical insurance funds from 2020 to 2035 in China.The results found that,under the current system,the medical insurance fund is not sustainable.The income and expenditure gap of the basic medical insurance fund will appear in 2026.The gap in the cumulative account of the medical insurance fund will appear in 2034.The cumulative account gap of the employee medical insurance fund will appear in 2039,and the cumulative account gap in the medical insurance fund for urban and rural residents will appear in 2023.It is recommended to fi rmly grasp the key window period of the‘14th Five-Year Plan’.We should speed up the improvement of the medical insurance fund fi nancing mechanism,reform the medical insurance fund payment mechanism,eff ectively strengthen fund operation management and risk early warning and prevention,and resolutely maintain the bottom line of avoiding systemic risks.