北京市三大基本医疗保险制度实施城乡统筹的可行性研究

Analysis on the Feasibility of Coordinating the Three Basic Medical Insurance Systems for Urban and Rural Areas in Beijing

目的:通过测算北京市实行三大基本医保城乡统筹后各筹资主体的可负担性,判断自由选择的医保城乡统筹模式是否可行。方法:以对北京市三年实证调查的数据为基础,结合ILO筹资模型的成本估计子模型和四部模型,测算各筹资主体的筹资额度,判断其可负担性。结果:如果实行基本医保城乡统筹,在调查年度内(2010、2012和2013年)居民个人缴费率分别为1.54%、2.45%和1.93%,远低于居民最大缴费能力;政府的筹资总额与政府实际医疗卫生筹资总额相比,需分别增加13.05亿元、21.67亿元和58.49亿元,占当年政府财政支出的比例均不到1%。结论:测算得个人与政府筹资额度具有可负担性,北京市实行三大基本医保自由选择的城乡统筹模式是可能的途径。

Objective:To assess the financing feasibility of the urban and rural coordination mode for the three basic medical in-surance in Beijing, define whether the free chose urban and rural coordination mode for medical insurance was accessible.Methods:Based on the three-year data of empirical investigation in Beijing, the cost estimate submodel and the four part model of ILO financ-ing model were combined to estimate the financing amount of the different raisers and measure the affordability.Results:The resi-dents' estimated payment rate in 2010, 2012 and 2013 would be 1.54%, 2.45% and 1.93%, further lower than the maximum afford-ability, if the basic medical urban and rural coordination mode was implemented. Compared with the government's actual health fi-nancing, the government estimated financing needed to increase by 1.305 billion yuan, 2.167 billion yuan and 5.849 billion yuan.Conclusion:Estimating individual and government financing amount had affordability. It was possible to implement the urban and ru-ral coordination mode for the three basic medical insurance in Beijing.