突发疫情与城镇职工基本医疗保险基金支付风险预警——基于COVID-19干预下的情景分析

Emergency Epidemic and Early Warning of Payment Risks of Urban Workers’ Basic Health Insurance Fund: Scenario Analysis Based on the COVID-19 Intervention

在人口老龄化、疾病负担不断加重以及新冠肺炎疫情突发的背景下,通过建立健全基金收支预测和风险预警机制,确保医保基金可持续,其意义重大。文章采用精算方法并考虑突发疫情对关键参数的影响,对比分析了不同情景下未来城镇职工基本医疗保险基金的收支情况。研究发现:长期来看,疫情对医保基金的可持续影响较小。我国疫情防控措施到位,一定程度上遏制了过度医疗的势头。当疫苗覆盖率为70%,且工资增长率和失业率都为乐观情景时,同时实行延迟退休政策相比较原退休政策而言,至少可以带来累计基金出现赤字推迟8年,最高可推迟12年的结果。最后,文章还通过建立风险预警机制以实现对基金风险的早期识别,为基金支付预警机制提供了实证依据。

Against the background of an aging population, increasing disease burden, and the outbreak of COVID-19, it is of great significance to guarantee the sustainability of health insurance funds by establishing an effective fund income and expenditure prediction and risk early warning mechanism. Using actuarial methods and considering the impact of unexpected events on key parameters, the paper compares and analyzes the future income and expenditure of the urban workers’ basic health insurance fund under different scenarios. The study finds that, in the long run, the epidemic had a low sustainable impact on the health insurance fund;the implementation of China’s epidemic prevention and control measures has curbed the trend toward over-medication;and when vaccine coverage is 70% and both wage growth and unemployment rates are optimistic scenarios, the simultaneous implementation of a delayed retirement policy can bring about a delay in the accumulated fund deficit of at least eight years and up to 12 years compared to the original retirement policy. The study establishes a risk warning mechanism to achieve early identification of fund risks. It provides an empirical basis for the predictive effect of the fund payment early warning mechanism.