基于解释结构模型法的我国城镇职工基本医疗保险基金可持续影响因素分析

Analysis of the Sustainable Influencing Factors of China’s Urban Employee Basic Medical Insurance Fund Based on the Interpretative Structural Model Method

城镇职工基本医疗保险制度作为我国社会保障制度的重要组成部分,不仅是减轻参保人就医经济负担的重要制度安排,也是保障人民群众医疗需求的安全网。城镇职工基本医疗保险基金安全可持续是保障医疗保险制度良好运行的关键环节之一,城镇职工基本医疗保险基金收支平衡、略有结余,其收支规模与经济发展水平相适应,能够促使基金保障能力实现长期稳健、可持续。文章通过文献研究法和德尔菲法,确定了城镇职工基本医疗保险基金缺口、城镇职工基本医疗保险基金收入水平、城镇职工基本医疗保险基金支出水平、经济发展水平、社会平均工资水平、城镇职工基本医疗保险费阶段性减征政策实施情况、参保在职退休比等11个影响因素,以专家咨询结果为根据,运用ISM方法探究影响因素间的相互关系。文章通过ISM模型研究发现医疗费用支出水平以及参保在职退休比水平是城镇职工基本医疗保险基金出现支付压力的根本影响因素,因此,控制医疗费用支出水平、扩展参保空间是实现城镇职工基本医疗保险基金可持续发展的关键举措。

The medical insurance system is an indispensable and important part of the social security system. It provides a social safety net for the people. It not only has the function of “shock absorber” for economic operation, but also provides strong support for the harmonious and stable development of society. Through literature research and Delphi method, this paper determines 11 influencing factors, such as the gap of employee medical insurance pooling fund, the income level of employee medical insurance pooling fund, the expenditure level of employee medical insurance pooling fund, the level of economic development, the level of social average wage, the implementation of phased reduction policy of employee medical insurance premium, and the ratio of insured on-the-job retirement. Based on the results of expert consultation, ISM method is used to explore the relationship between influencing factors. Through the ISM model, it is found that the level of medical expenses and the level of inservice retirement ratio are the fundamen-tal factors affecting the payment pressure of the employee medical insurance fund. Therefore, controlling the level of medical expenses and expanding the insurance space are the key measures to realize the sustainable development of the employee medical insurance fund.