居民医保强制参保背景下贫困人群的参保困境及财政代缴负担测算

Study on the insurance plight and the calculation of financial burden for the poverty under the background of mandatory participation in medical insurance

居民医保强制参保背景下,贫困人群面临着较重的参保缴费负担,而现行医疗救助政策对贫困人群的参保补贴范围较窄,补贴水平也不充分。本研究综合多源微观数据库,对政府代贫困人群缴费财政负担进行测算。结果表明,以2018年为例,假定政府对个人缴费补贴比例为80%~100%,窄口径下将未参保贫困人群纳入补贴将会新增财政负担40.73~84.42亿元(占财政总支出0.018%~0.038%),宽口径下政府代所有贫困人群缴费的总负担为414.26~787.52亿元(占财政总支出0.188%~0.357%),与OECD国家平均水平相比,我国卫生支出少,对贫困人群的参保补贴仍有大幅提升的空间。本文提出:第一,完善社会保险相关法律,明确参保补贴范围与标准;第二,逐步拓宽参保补贴范围,渐进式提高补贴标准。

Under the background of compulsory participation in health insurance,China's poverty are facing the financial burden of insurance fees.Nowadays,the Chinese government provides subsidy for this group of people but its coverage is not enough,and the financial support for each individual is not sufficient.Based on the data collected from multiple sources,this study quantified the financial burden of the government on behalf of the poverty.With an assumption that the government's subsidy ratio for individual payment is 80%~100%(taking 2018 as an example),the results of this study showed that incorporating the uninsured poverty into the subsidy will increase the financial burden by 4.073~8.442 billion Yuan,accounting for 0.018%~0.038%of the total financial expenditure.Therefore,the government's total financial burden will be 41.426~78.752 billion Yuan,accounting for 0.188%~0.357%of the total financial expenditure;which is generally small.It is thus suggested that the relevant legal system of basic medical insurance should be improved and the scope and standard of subsidy should be reassessed and fine-tuned.In addition,the scope of subsidy should be broadened and its standard should be gradually improved.