可持续性视角下我国医保基金发展规模预测研究  

The prediction of the development scale of China’s medical insurance fund from the perspective of sustainability

作　　者：丁海峰 陈希安 DING Haifeng;CHEN Xi’an(School of Public Administration and Law,Hunan Agricultural University,Changsha 410128,China)

机构地区：[1]湖南农业大学公共管理与法学学院,湖南长沙410128

出　　处：《南京医科大学学报(社会科学版)》2025年第2期121-130,共10页Journal of Nanjing Medical University(Social Sciences)

基　　金：国家社会科学基金重点项目“全景关怀:大国社会保障高质量发展研究”(22FGLA004);湖南农业大学研究生科研创新项目“数字技术对农村老人健康老龄化的影响机制研究”(2024XKC082)。

摘　　要：基于可持续性视角分析我国基本医保及其构成险种的基金收支现状,选取2009—2022年我国基本医保基金收支数据作为预测指标,通过构建灰色GM(1,1)预测模型,对我国基本医保基金收支规模和结余情况进行预测。2023—2030年,我国基本医保基金规模不断扩大,但基金当期结余增速下降,“十五五”时期医保基金规模扩张放缓,存在潜在结构性风险。具体来看,城镇职工医保存在年龄结构失衡风险,城乡居民医保存在泛福利化和医疗寻优导致的政府财政压力风险。未来应坚持医疗保险制度的民生兜底职能,进一步优化医疗保险基金运转机制,以提升服务水平,促进医疗保障系统可持续发展。Based on the perspective of sustainability,this paper analyzes the current revenue and expenditure of China’s basic medical insurance and its constituent insurance types.Using the revenue and expenditure data of China’s basic medical insurance fund from 2009 to 2022 as the prediction indicator,this study constructs a grey GM(1,1)prediction model to predict the scale and balance of China’s basic medical insurance fund revenue and expenditure.From 2023 to 2030,the scale of China’s basic medical insurance fund will continue to expand,but the growth rate of the fund’s current balance will decline.During the“15th Five-Year Plan”period,the expansion of the medical insurance fund will decelerate,with potential structural risks.Specifically,there is a risk of age structure imbalance in urban employee medical insurance,while urban and rural resident medical insurance encounters government fiscal pressure risks caused by disproportionate welfare tendency and medical service optimization-seeking behavior.Moving forward,we should uphold the safety-net function of the medical insurance system in protecting people’s livelihood,further optimize the operation mechanism of the medical insurance fund,and enhance service quality to ensure the sustainable development of the system.

关 键 词：基本医疗保险 医保基金 可持续性视角 GM(1 1) 

分 类 号：F842.6[经济管理—保险]