城镇职工基本医疗保险制度改革受益归宿分析  

Benefiting Destination of Urban Employees’Basic Medical Insurance System Reform

作　　者：金双华[1] 张晖晔 霍雅倩 JIN Shuanghua;ZHANG Huiye;HUO Yaqian(School of Finance and Taxation,Northeastern University of Finance and Economics,Dalian 116012,China)

机构地区：[1]东北财经大学财政税务学院,辽宁大连116025

出　　处：《山东财经大学学报》2024年第5期13-28,共16页Journal of Shandong University of Finance and Economics

基　　金：辽宁省社会科学规划基金重点建设学科项目“共同富裕视角下辽宁省财政性社会保障收支政策对收入分配调节效应研究”(L23ZD021)。

摘　　要：我国于2021年4月发布了关于城镇职工基本医疗保险制度改革的指导意见。为了探究此次改革的具体受益情况,在赋予城镇职工基本医疗保险的个人账户资金私人属性的基础上,采用模拟分析的方法,对不同收入阶层、参保群体在改革前后的自费负担和自费负担变化幅度进行测算。研究表明:城镇职工基本医疗保险制度改革增加了患病参保群体的受益程度,减轻了自费负担;在不同报销金额、起付线和报销比例的条件下,收入越低的参保群体,其受益增加程度越大;同一假设条件下的在职职工与退休人员,后者在改革中的受益略高于前者。基于结论提出完善城镇职工基本医疗保险缴费、报销环节设计、进一步扩大个账使用范围以及简化家庭共济流程等相关建议。China issued the guiding opinions on the reform of basic medical insurance system for urban employees in April 2021.In order to explore the specific benefit situation of this reform,this study,based on granting the personal account funds of urban employees’basic medical insurance with private attribute,calculates the self-payment burden and its change amplitude of different income groups and insured groups before and after the reform by adopting simulation analysis method.The research indicates that the reform of urban employees’basic medical insurance system has increased the benefit degree of the insured illness population and has reduced self-payment burden;under different reimbursement amounts,deductible payment lines and reimbursement ratios,the lower the income of the insured groups,the greater the increase in their benefits;and under the same assuming conditions,the retirees benefit slightly more from the reform than the in-service employees.Based on these conclusions,such relevant suggestions are proposed as perfecting the design of payment and reimbursement processes for urban employees’basic medical insurance,further expanding the scope of personal account use and simplifying the process of family assistance.

关 键 词：城镇职工基本医疗保险制度改革 受益归宿 自费负担 政策模拟 

分 类 号：F842.0[经济管理—保险]