统账结构调整政策对城镇职工医疗保险基金可持续运行的影响  

The Effect of Account Structure Adjustment Policy on the Sustainable Operation of Urban Workers'Medical Insurance Fund

作　　者：王京捷 郭有德[1] WANG Jingjie;GUO Youde

机构地区：[1]复旦大学社会发展与公共政策学院,上海200433

出　　处：《社会保障研究》2021年第4期57-67,共11页Social Security Studies

基　　金：复旦大学2019年“卓越博士生科研促进计划”(2019053);上海市医保协会立项课题(YBXH-KT201907)的阶段性成果。

摘　　要：国家医保局发布的《关于建立健全职工基本医疗保险门诊共济保障机制的指导意见(征求意见稿)》提出统账结构调整方案,将原来由单位缴纳的划入个人账户的基本医疗保险费计入统筹账户。本文运用精算模型对统账结构调整政策实施前后城镇职工基本医疗保险基金的收支状况进行分析和预测。研究发现:政策调整前,我国城镇职工基本医疗保险统筹基金将在2036年出现缺口;政策实施后,基金缺口发生可推后至2050年;政策调整对个人账户结余影响较大,人均个人账户累计结余会在5年内归零。假设取消个人账户,实现门诊统筹制度改革,在其他条件不变的情况下,医疗保险统筹累计结余赤字会在2038年发生。建议建立精算预警机制,尽快实现门诊统筹制度,确保城镇职工基本医疗保险基金长效、平稳、可持续的运行。"Guidelines on Establishing and Improving the Mutual Assistance Mechanism of the Basic Medical Insurance for Employees(draft)"issued by the National Medical Insurance Administration proposed a plan to adjust the accounts structure,in which the basic medical insurance premiums originally paid by the unit and assigned to the individual account should be included in the pooling account.This paper uses actuarial method to analyze and forecast the income and expenditure of the basic medical insurance fund before and after the implementation of the policy.The results show as follow:before the policy adjustment,there will be a gap in the pooling fund of basic medical insurance for urban employees in China in 2036;after the policy is implemented,the funding gap can be pushed to 2050;the policy adjustment has a great impact on the individual account balance,and the per capita accumulated individual account balance will return to zero within 5 years.Assuming that the individual account is cancelled and the reform of outpatient pooling system is realized,the cumulative balance deficit of medical insurance pooling will occur in 2038 under the condition that other conditions remain unchanged.Therefore,it is suggested to establish an actuarial early warning mechanism and realize the outpatient coordination system to ensure the long-lasting,stable and sustainable operation of urban workers'basic medical insurance fund.

关 键 词：统账结构 城镇职工基本医疗保险 基金平衡 统筹账户 个人账户 

分 类 号：F83[经济管理—金融学]