长期护理保险对城乡居民医疗保险财政负担的影响——基于地区视角和替代效应

The Impact of Long-Term Care Insurance on the Financial Burden of Medical Insurance for Urban and Rural Residents:From the Regional Perspective and Based on Substitution Effect

随着人口老龄化问题的加深和医疗费用的提高,城乡居民医疗保险支付能力减弱,财政压力逐年加重。为减轻个人缴费负担,部分长期护理保险试点地区在制度实施初期采取依托医疗保险基金划转的筹资方式,若按这种筹资方式持续下去,未来会对医保基金的财政负担产生何种影响?基于包含替代效应的医疗保险精算模型模拟了2021—2050年各地区长护险基金和医保基金的运行。结果表明,在两项制度独立运行时,医保财政负担将显著增加;如果长护险完全依赖于医保基金,则当期赤字和累计赤字均提前6年。若长护险对医疗费用存在替代效应,当居家护理补助的替代因子为2.043,全国范围内推广长护险将不会对医保基金的可持续性造成任何影响。因此,在制度运行初期采取依托医保基金划转的筹资方式,并不会带来过重的财政负担,并且有助于扩大参保率,为长护险制度逐步独立运行提供保障。

With the deepening of population aging and the increase in medical expenses,the ability of urban and rural residents to pay for medical insurance has weakened,and the financial pressure has been increasing year by year.In order to reduce the personal payment burden,some pilot areas of long-term care insurance adopted a financing method of relying on medical insurance fund transfer during the initial implementation of the system.If this financing method continues,what impact will it have on the financial burden of the medical insurance fund in the future?Based on an actuarial model of medical insurance that includes substitution effects,this paper simulates the operation of long-term care insurance funds and the medical insurance funds in various regions from 2021 to2050.The results indicate that when the two systems operate independently,the financial burden of medical insurance will significantly increase.If the long-term care insurance relies entirely on medical insurance funds,both the current and cumulative deficits will be advanced by 6 years.If the long-term care insurance has a substitution effect on medical expenses,when the substitution factor for home care subsidies is 2.043,promoting the long-term care insurance nationwide will not have any impact on the sustainability of the medical insurance fund.Therefore,adopting a financing method that relies on the transfer of medical insurance funds during the initial operation of the system will not bring excessive financial burden,but it will help to expand the coverage rate and provide guarantee for the gradual independent operation of the long-term care insurance system.