广西城乡居民基本医疗保险一体化背景下筹资标准测算及可负担性分析  

Financing standard calculation and affordability analysis in the context of basic medical insurance integration for urban and rural residents in Guangxi

作　　者：张伟艺 赵劲民 冯启明 罗红叶 赵歆妍 ZHANG Wei-yi;ZHAO Jin-min;FENG Qi-ming;LUO Hong-ye;ZHAO Xin-yan(School of Information and Management,Guangxi Medical University,Nanning 530021,China;Guangxi Society of Medical Insurance Research,Nanning 530022,China)

机构地区：[1]广西医科大学信息与管理学院,南宁市530021 [2]广西医疗保险研究协会,南宁市530022

出　　处：《广西医学》2021年第6期720-724,共5页Guangxi Medical Journal

基　　金：广西医科大学特色新型智库课题(GXMUZK05)。

摘　　要：目的探讨广西城乡居民基本医疗保险一体化背景下筹资标准的测算方法并分析居民的可负担性。方法以广西城乡居民基本医疗保险为例,运用社会健康保险筹资模型(ILO模型)的成本估计子模型,计算2017~2019年在当前基金运行的情况下广西城乡居民基本医保总成本,以及广西城乡居民人均理论筹资额、不同参保人群的个人筹资标准,分析可负担性。结果 2017~2019年广西城乡居民医保人均筹资标准分别为755元/人、880元/人及1 168元/人,对应的理论缴费率分别为3.79%、4.09%及5.01%,其中个人应负担的缴费率分别为0.94%、1.09%及1.49%,筹资负担分别为3.12%、3.80%、5.02%。结论在广西城乡居民医疗保险基金的现行筹资标准下,居民在医疗保险筹资缴费方面具有可负担性,但不同人群之间的个人筹资占比存在不合理性,今后需完善医保基金的筹资负担比例。Objective To explore the calculation method for financing standard,and to analyze the residents′affordability in the context of basic medical insurance integration for urban and rural residents in Guangxi.Methods Taking the basic medical insurance service for urban and rural residents in Guangxi as an example,the relevant data of medical insurance service for Guangxi urban and rural residents were calculated by using the cost estimation sub-model in the International Labor Office′s social health insurance financing model,including the total costs of basic medical insurance service for Guangxi urban and rural residents with the implementation of existing funding system between 2017 and 2019,as well as the per capita theoretical contributions for Guangxi urban and rural residents and the individual contribution standards for different insured populations.And the affordability was analyzed.Results In 2017,2018 and 2019,the per capita contribution standards of medical insurance fund for Guangxi urban and rural residents were 755 yuan,880 yuan and 1168 yuan,respectively,the corresponding theoretical contribution payment rates were 3.79%,4.09%and 5.01%,respectively,wherein the individual contribution payments accounted for 0.94%,1.09%and 1.49%,respectively,the individual contributions accounted for 3.12%,3.80%and 5.02%,respectively.Conclusion In the setting of existing financing standard for medical insurance service for Guangxi urban and rural residents,the contribution payment for medical insurance service is affordable for the residents,but the proportion of individual contributions is unreasonable among different populations,and the contribution proportion of medical insurance fund needs to be improved in future.

关 键 词：城乡居民医疗基本保险 筹资标准 可负担性 

分 类 号：R195[医药卫生—卫生统计学]