| 引用本文：余芷晴, 焦晓怡, 曾益.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[J].中国卫生政策研究,2022,15(9):64-72 |
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| 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 |
| 投稿时间：2022-06-28 修订日期：2022-09-06 PDF全文浏览 HTML全文浏览 |
| 余芷晴, 焦晓怡, 曾益 |
| 中南财经政法大学公共管理学院 湖北武汉 430073 |
| 摘要: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4 021.50~8 177.51亿元；(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。 |
| 关键词:职工医保 基金可持续 降费空间 人口老龄化 |
| 基金项目:国家社科基金后期资助项目(19FRKB002)；湖北省社科基金(2015033)；中央高校基本科研业务费项目(2722020JCT028) |
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| A study on the sustainability assessment of Shanghai basic medical insurance fund for urban employees and room for reduction in contribution |
| YU Zhi-qing, JIAO Xiao-yi, ZENG Yi |
| School of Public Administration, Zhongnan University of Economics and Law, Wuhan Hubei 430073, China |
| Abstract: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. |
| Key words:Medical Insurance for Urban Employees Sustainability of Fund Room for Reduction in Contribution Population aging |
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