摘要
目的:分析居民医保筹资机制,通过模拟干预提出居民医保筹资的优化方案,提升居民医保筹资结构均衡性,实现居民医保基金收支平衡。方法:基于“以支定收”的筹资模式构建居民医保筹资的系统动力学模型,集成灰色预测模型与表函数方程,设定筹资责任分担与保障水平多维情景,对2024~2050年模型中的关键指标展开长时序动态预测及多情景模拟。结果:我国居民医保实行个人筹资和财政补助相结合的筹资方式,2016~2024年个人筹资标准波动上升、财政补助标准稳步增长,二者在总筹资中的比重分别由26.32%、73.68%演化为37.38%、62.62%。除筹资标准外,居民筹资负担系数和财政补助比也是“以支定收”模式下居民医保筹资机制中的关键变量。SD仿真结果显示,研究期内个人筹资标准与财政补助标准均呈现增长趋势,符合居民医保现实发展趋势;不同情景下居民筹资负担系数在时序上总体呈现出先增长后趋于平缓、略有下降的趋势,个人筹资比重提高和高保障水平均使居民筹资负担系数有所增长,总体处于可接受范围;个人筹资比重不断提高的情景下财政补助比梯度降至1.22。结论:“高保障水平+个人筹资比重提高5%”协同联动能够较好兼顾参保积极性与筹资结构均衡性,是居民医保筹资机制的优化方案。
Objective To analyze the financing mechanism of residents medical insurance,and propose an optimization plan for residents medical insurance financing through simulation intervention,so as to improve the balance of residents medical insurance financing structure and achieve a balance between income and expenditure of residents medical insurance.Methods Based on the financing model setting the income based on expenditure,a system dynamics model of residents medical insurance financing was constructed,the grey prediction model and table function equation were integrated,the multi-dimensional scenarios of financing responsibility sharing and treatment guarantee were set,and the long-term dynamic prediction and multi-scenario simulation of the key indicators in the model from 2024 to 2050 were carried out.Results From 2016 to 2024,the individual financing standards fluctuatingly increased,and the financial subsidies kept steady growth,and the proportions of which in total financing evolved from 26.32%to 37.38%,and 73.68%to 62.62%,respectively.In addition to the financing criteria,the financing burden coefficient and the financial subsidy ratio are also the key variables in the financing mechanism of residents medical insurance which setting the income based on expenditure.The SD simulation results showed that the individual financing standard and financial subsidy standard had an increasing trend during the study period,which was in line with the realistic development trend of residents medical insurance.Under the different scenarios,the coefficient of residents financing burden generally showed a trend of first increasing and then flattening and slightly decreasing,and the increase in the proportion of individual financing and the high level of security increased the coefficient of residents'financing burden,which was generally within the acceptable range.Under the scenario of increasing the proportion of individual financing,the gradient of financial subsidy ratio decreased to 1.22.Conclusion The synergistic linkage of"high security level+5%increase in the proportion of individual financing"can better coordinate the enthusiasm of insurance participation and the balance of financing structure,which is the optimization scheme of the financing mechanism of residents medical insurance.
作者
张煜龙
李红艳
Zhang Yulong(School of Management,Shanghai University of Engineering Science,Shanghai,P.R.China)
出处
《中国卫生事业管理》
北大核心
2025年第9期1005-1011,1068,共8页
Chinese Health Service Management
基金
国家社会科学基金一般项目“多层次医疗保障的政策效应与协同发展的整体性治理研究”(24BSH096)。
关键词
城乡居民基本医疗保险
个人筹资标准
财政补助标准
以支定收
系统动力学
basic medical insurance for urban and rural residents
individual financing standard
financial subsidy standard
setting the income based on expenditure
system dynamics
