“个人账户”改革背景下的医保基金运行态势预测及绩效改善路径

Forecast of the Operation Situation and Performance Improvement Path of Medical Insurance Fund under the “Individual Account” Reform

目的:对"个人账户"改革背景下的对医保基金运行态势进行预测,并探索基金运行绩效的改善路径。方法:根据2019年医疗保障事业发展统计公报和相关文献建立方程并在Vensim中建立医保基金运行系统模型。结果:按照目前的政策条件,个人账户基金呈现先降低后缓慢上升的态势、统筹账户基金存量、总基金流出速率在未来10年内都呈现指数增长态势。转化时间、统筹基金支付比例的调整,不同程度地影响医保基金的支出情况。结论:加快个账转化为统筹基金的速度、合理确定统筹基金的支付比例、加快推进以价值为基础的支付模式将有益于医保基金的合理运行。

Objective: To predict the operation situation of medical insurance fund under the "individual account" reform, and explore the improvement path of fund operation performance. Methods: According to the statistical bulletin on the development of medical insurance in 2019 and related literature, the equation is established and the operation system model of medical insurance fund is established in Vensim. Results: According to the current policy conditions, the individual account fund, the overall account fund stock and the total fund outflow rate will show an exponential growth trend in the next decade. The transformation time and the adjustment of payment proportion of overall fund affect the expenditure of medical insurance fund. Conclusion: The rational operation of medical insurance fund is beneficial to speed up the transformation of individual account into overall planning fund and determine the payment proportion of overall planning fund reasonably.