上海市职工基本医疗保险基金可持续性评估及降费空间研究

A study on the sustainability assessment of Shanghai basic medical insurance fund for urban employees and room for reduction in contribution

本文以上海市为例,构建精算模型,分析人口年龄结构及非人口结构因素带来的人均医疗费用增长率变动对上海市职工基本医疗保险基金可持续性及医保缴费率降低空间的影响,研究发现:(1)2020—2035年上海市职工基本医疗保险基金能实现可持续运行的目标,2035年累计结余为4021.50~8177.51亿元;(2)2020—2035年上海市职工医保缴费率存在降低空间,达2.72~4.83个百分点,可以由11.5%降至6.67%~8.78%;(3)当非人口结构因素带来的人均医疗费用增长速度越低,基金可持续运行效果越好,医保缴费率的降低空间越大。综上所述,上海市职工医保基金在未来15年可持续运行,且缴费率存在下调空间,可进一步降低企业缴费负担,这为完善职工基本医疗保险待遇奠定了基础。

This paper constructs an actuarial model to analyze the impact of changes in the growth rate of per capita medical costs due to non-demographic factors and in the population age structure on the sustainability of the Shanghai basic medical insurance fund for urban employees and the room for reduction of the medical insurance contribution rate,taking Shanghai as an example.Major findings include(1)Shanghai basic medical insurance fund for urban employees is expected to operate sustainably between 2020—2035,with a cumulative balance of 402.150~817.751 billion yuan in 2035;(2)A 2.72~4.83 percent decrease in the rate of Shanghai basic medical insurance for urban employees is possible between 2020 and 2035,lowering the rate from 11.5%to 6.67%~8.78%;(3)The sustainability is better when the growth rate of per capita medical cost brought by non-demographic factors is lower,and the room for reducing the medical insurance contribution rate is bigger.In summary,a sustainable development of Shanghai basic medical insurance fund for urban employees can be expected in the coming 15 years,and there is room for a downward adjustment of the contribution rate,which in turn further reduces financial burden of enterprises,laying a foundation for improving the basic medical insurance treatment for urban employees.