通讯作者: 曾益, zengyi532@126.com

DOI：10.12201/bmr.202210.00017

Study on the Sustainability Assessment of Shanghai Basic Medical Insurance Fund for Urban Employees and the Space for Fee Reduction

• 摘要：随着老龄化进程的加快和新冠疫情进入常态防控阶段，职工医疗保险基金支出可能显著增加，未来职工基本医疗保险基金可持续性将会如何发展？为了减轻新冠疫情对企业的冲击，职工基本医疗保险缴费率是否存在降低空间？本文以上海市为例，构建精算模型，分析人口年龄结构及非人口结构因素带来的人均医疗费用增长率变动对上海市职工基本医疗保险基金可持续性及医保缴费率降低空间的影响，研究发现：（1）2020-2035年上海市职工基本医疗保险基金能实现可持续运行的目标，2035年累计结余为4021.50-8177.51亿元；（2）2020-2035年上海市职工医保缴费率存在降低空间，达2.72-4.83个百分点，可以由11.5%降至6.67%-8.78%；（3）当非人口结构因素带来的人均医疗费用增长速度越低，基金可持续运行效果越好，医保缴费率的降低空间越大。综上所述，上海市职工医保基金在未来15年可持续运行，且缴费率存在下调空间，可进一步降低企业缴费负担，这为完善职工基本医疗保险待遇奠定了基础。

  关键词： 职工医保; 基金可持续; 降费空间; 人口老龄化

   

  Abstract: As the ageing process accelerates and the COVID-19 epidemic enters a regular prevention and control phase, the expenditure of the basic medical insurance fund for urban employees may increase significantly, how will the sustainability of the basic medical insurance fund for urban employees develop in the future? In order to mitigate the impact of the COVID-19 epidemic on enterprises, is there any space to reduce the contribution rate of urban employees basic medical insurance? Taking Shanghai as an example, this paper constructs an actuarial model to analyze the impact of changes in the growth rate of per capita medical costs due to non-demographic factors and in the population age structure on the sustainability of the Shanghai basic medical insurance fund for urban employees and the space for reduction of the medical insurance contribution rate, and finds that: (1) Shanghai basic medical insurance fund for urban employees can achieve the goal of sustainable operation in 2020-2035, with a cumulative balance of 402.150-817.751 billion yuan in 2035; (2) there is space to reduce the contribution rate of Shanghai basic medical insurance for urban employees from 2020 to 2035, amounting to 2.72-4.83 percentage points, which can be reduced from 11.5% to 6.67%-8.78%; (3) when the growth rate of per capita medical cost brought by non-demographic factors is lower, the more effective the sustainable operation of the fund is, the greater the space for reducing the medical insurance contribution rate. In summary, Shanghai basic medical insurance fund for urban employees can operate sustainably in the next 15 years, and there is space for downward adjustment of the contribution rate, which can further reduce the burden of enterprise contributions, which lays the foundation for improving the basic medical insurance treatment for urban employees.

  Key words: Medical Insurance for Urban Employees; Fund sustainability; Fee Reduction Space; Population Aging

  提交时间：2022-10-24

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2022-06-28	bmr.202210.00017V1	下载

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