河北省健康扶贫补充保险基金规模测算研究

The size estimate of supplementary insurance fund under health care program for poverty alleviation in Hebei Province

目的随着健康扶贫工程逐步推进,建立健康扶贫补充保险,构建可持续的扶贫机制对于提高贫困人口的医疗保障水平具有重要意义。文章旨在测算2019-2024年河北省健康扶贫补充保险基金规模,并分析参数改变对基金的影响,为未来河北省补充保险的建立及可持续运行提供数据支持。方法构建补充保险基金预测模型,结合河北省基本医疗保险、大病保险以及健康扶贫救助的相关数据对基金规模、财政负担以及参数变化的影响进行测算。结果 2019-2024年基金规模和人均保费不断增长,到2024年基金规模69.27亿元,人均保费230.9元;河北省运行补充保险预期所需的财政投入与现有的财政投入的年平均差额约为5.5亿元,其中张家口市、保定市、承德市年平均差额较大,分别为1.07亿元、1.02亿元和0.84亿元;非贫困参保人占比、基本医保和大病保险实际补偿比、保障目标、出险率以及年费用增长率均会影响基金规模和人均保费,异地就医比例和费用的变化对基金规模和人均保费的影响不明显。结论河北省健康扶贫补充保险的基金规模和人均保费呈不断增长的趋势,并且补充保险预期所需的财政投入与政府健康扶贫财政支出预算之间存在较大差距。建议将非贫困人口纳入到参保人群中,并控制医疗费用过快增长,提高补充保险的统筹层次,整合健康扶贫资金,建立动态调整机制,提高补充保险的持续运营能力。

Objective With the gradual advancement of health care program for poverty alleviation,it is significant to establish a supplementary insurance and develop a sustainable poverty alleviation mechanism for improving the medical security level for the poverty stricken population.This paper aims to measure the scale of supplementary insurance fund of the health care program from 2019 to 2024 in Hebei Province,to analyze the impact of parameter changes,and to provide data support for the establishment and sustainable operation of the insurance.Methods A forecasting model was established and the impact of fund size,financial burden and parameter changes on supplementary insurance fund was measured based on the data including basic medical insurance,critical illness insurance and medical assistance for poverty alleviation in Hebei Province.Results The fund size and premiums per capita will keep increasing from 2019 to 2024.By 2024,the fund size will have been 6.927 billion yuan and the premium per capita will be 230.9 yuan.The annual average gap between the expected financial investment for the operation of supplementary insurance and the existing investment is about 550 million yuan,and the annual average gaps in Zhangjiakou City,Baoding City and Chengde City arerelatively large,which are at 107 million yuan,102 million yuan and84 million yuan,respectively.The proportion of non-poor insured population,the actual compensation ratio of basic medical insurance and critical illness insurance,the insurance target,the claim rate andtheannual growth rateof medical expense will affect the fund size and premiums per capita,however,the impact of the changes in the proportion and cost of nonlocal medical treatment is not obvious.Conclusions The fund size and premiums per capita tend to be increasing,and there was a big gap between the expected financial investment for the operation of supplementary insurance and the existing financial budget.It is recommended to include the non-poor population in the insured,control the excessive growth of medical expenses,improve the overall pooling level of supplementary insurance,integrate the funds for health care and poverty alleviation,and establish a dynamic adjustment mechanism to improve the sustainable operational capability of supplementary insurance.