| 引用本文：宋锦涛,邢若斌,郑锦轩,等.北京市城乡居民基本医保筹资现状及公平性分析[J].中国卫生政策研究,2025,18(11):31-38 |
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| 北京市城乡居民基本医保筹资现状及公平性分析 |
| 投稿时间：2025-10-09 修订日期：2025-11-03 PDF全文浏览 HTML全文浏览 |
| 宋锦涛1，邢若斌1，郑锦轩1，马延涛1，阳宛谕2，曾雁冰1,3 |
| 1.首都医科大学公共卫生学院 北京 100069;2.海南医科大学公共卫生学院 海南海口 571199;3.首都医科大学环境与衰老北京市重点实验室 北京 100069 |
| 摘要:目的 系统评估北京市城乡居民基本医保筹资现状，分析定额筹资政策下不同群体的公平性差异，通过模拟测算不同费率制筹资方案的公平性变化，为推进医保筹资制度改革提供依据。方法 基于2018—2023年北京市16个区居民人均可支配收入及参保人数，分别测算基尼系数、集中指数、Kakwani指数及筹资前后变化，评估不同参保群体间的筹资负担。运用几何均数法预测2024—2035年北京市各区的人均可支配收入及参保人数，模拟不同费率制筹资方案。结果 2018—2023年筹资后净收入的基尼系数始终高于筹资前原始收入的基尼系数，集中指数为正且呈上升趋势，Kakwani指数均为负数；老年人及劳动者群体在财政补助支持下筹资后基尼系数略有下降，学生儿童群体则始终高于原始值。差异化费率制模拟方案下，2024—2035年筹资后基尼系数低于原始值，Kakwani指数为正数。结论 城乡居民基本医保现行定额筹资机制存在累退性、公平性不足的问题，各类参保群体之间存在公平性差异，有必要制定差异化的费率制筹资标准，特别是基于不同区域及群体收入水平实行动态调整的筹资机制，从而改善城乡居民基本医保筹资的公平性。 |
| 关键词:城乡居民医保 筹资现状 公平性 政策优化 |
| 基金项目:国家自然科学基金面上项目（72474143）；教育部人文社科一般项目（23YJAZH010）；北京市高层次公共卫生技术人才项目（学科骨干-03-15） |
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| Analysis on the current status and equity of Beijing's urban and rural residents' basic medical insurance funding |
| SONG Jin-tao1, XING Ruo-bin1, ZHENG Jin-xuan1, MA Yan-tao1, YANG Wan-yu2, ZENG Yan-bing1,3 |
| 1.School of Public Health， Capital Medical University， Beijing 100069， China;2.School of Public Health， Hainan Medical University， Haikou Hainan 571199， China;3.Beijing Key Laboratory of Environment and Aging， Capital Medical University， Beijing 100069， China |
| Abstract:Objective To systematically evaluate the current financing status of Beijing's urban and rural residents' basic medical insurance， analyze equity disparities among different groups under the existing flat-rate financing policy. By simulating the equity changes of various financing schemes with different contribution rates， this study aims to provide foundations for advancing medical insurance financing system reform.Methods Based on the per capita disposable income and number of insured residents in Beijing's 16 districts from 2018 to 2023， we separately calculated the Gini coefficient， concentration index， and Kakwani index， along with their changes before and after financing adjustments， to assess the funding burden among different insured groups. Using the geometric mean method， we projected per capita disposable income and insured populations for each district in Beijing from 2024 to 2035， simulating various financing schemes under different premium rate systems.Results From 2018 to 2023， the Gini coefficient of net income after financing consistently exceeded that of original income before financing. The concentration index remained positive and showed an upward trend， while the Kakwani index was negative for all periods. The Gini coefficient after financing slightly decreased for the elderly and working populations with fiscal subsidy support， whereas it remained higher than that for students and children. Under the simulated differentiated rate system， the post-funding Gini coefficient for 2024—2035 was lower than the original value， and the Kakwani index was positive.Conclusions The current fixed-amount financing mechanism for urban and rural residents' basic medical insurance exhibits regressive characteristics and insufficient fairness， with disparities in equity among different insured groups. It is necessary to establish differentiated financing standards based on differential rates， particularly implementing a financing mechanism with dynamic adjustments according to regional and group income levels， to enhance the fairness of financing for urban and rural residents' basic medical insurance. |
| Key words:Urban and Rural Residents' Basic Medical Insurance Funding status Equity Policy optimization |
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