城镇职工医疗保险个人账户改革方案设计与评估  

Design and Evaluation of Urban Employee Medical Insurance Personal Account Reform Plan

作　　者：田勇 殷俊[1] 薛惠元[1] TIAN Yong;YIN Jun;XUE Hui-yuan(Social Security Research Center,Wuhan University,Wuhan,Hubei,430072,China)

机构地区：[1]武汉大学社会保障研究中心,湖北武汉430072

出　　处：《经济管理》2018年第9期173-188,共16页Business and Management Journal ( BMJ )

基　　金：教育部人文社会科学重点研究基地重大项目"社会保障精算研究(11JJD840017);中央高校基本科研业务费专项资金资助项目"生育;退休和费率政策调整背景下城镇职工基本养老保险财务可持续性研究"(2017QN069)

摘　　要：近年来,城镇职工基本医疗保险个人账户弊端日益显现,改革医疗保险个人账户的呼声日益高涨。本文设计了五种不同的职工医疗保险个人账户改革方案,并从医疗保险基金收支平衡的角度,建立医疗保险精算模型,对不同的改革方案进行评估。研究发现:医疗保险个人账户改革需要采取"过渡方案+最终方案"模式,首先将总缴费额划入个人账户的比例由当前的47.5%降低到32.5%,由统筹基金支付住院费用,个人账户支付门诊费用的报销;然后完全取消个人账户,单位缴费和个人缴费都纳入统筹基金,将门诊费用报销纳入统筹基金。这个组合方案能够最大程度地提高个人账户利用率,维护职工医保统筹基金的安全,但需要延迟退休政策的配合。此外,个人自付门诊费用、提高医保缴费率、退休职工缴纳医疗保险也能够有效改善统筹基金的收支状况,增强个人账户改革的效果,但是政策推行难度较大。The basic medical insurance for urban workers in China adopts the model of integrating the pooling funds and individual accounts,but at present there are many disadvantages in personal accounts.On the one hand,the employee medical insurance pooling fund has the risk of not receiving any payment.On the other hand,personal accounts have a large amount of surplus funds and cannot be effectively utilized.Under this background,it is more necessary to reform the personal accounts to maintain the safety of the pooling funds.In this paper,five different personal insurance reform plans are designed.From the point of view of balance of medical insurance funds,medical insurance actuarial models are established to evaluate different reform plans.This article finds that under the existing scheme,on the one hand,the pooling fund faces the risk of revenue and expenditure.On the other hand,there is a large amount of fund balance in the personal account.In order to improve the efficiency of the use of personal account and maintain the security of the pooling fund,it is necessary to reform the personal accounts.This article attempts to solve this problem by reducing the proportion of total funding allocated to individual accounts and canceling individual accounts.Under Option 1,When the total amount of funds allocated to individual accounts is reduced to 40%,it was found that although the scale of personal account accumulation has declined,it still shows a slow growth trend.There is still a huge deficit in the pooling fund,and the purpose of the reform has not been realized.Therefore,Option 1 is not desirable.Option 2 continued to reduce the proportion of total fund-raising into personal accounts to 32.5%.Under this option,the accumulated balance of individual accounts was significantly reduced.At the same time,the balance of payments for pooling funds has been greatly improved.This option achieves a balance between the pooling account and the individual account,basically achieving the purpose of reform.On this basis,this article

关 键 词：职工医疗保险个人账户 改革方案设计 统筹基金 精算评估 

分 类 号：F840.612[经济管理—保险]