Reform of individual financing mechanism of residents medical insurance from quota system to fixed ratio system

Corresponding author: Zhang Chu, ruczc96@126.com

DOI: 10.12201/bmr.202105.00013

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  Abstract: The capital source of medical insurance for urban and rural residents, covering one billion people, is composed of government per capita subsidy and individual fixed payment. There is a consensus that the financing mechanism of capitation quota payment is faced with such problems as unfair financing burden, unstable premium growth, inadequate financing level, unbalanced financing responsibility, etc. In order to respond to the growing demand of residents for medical insurance in the new era. In 2020, opinions on deepening the reform of medical security system proposed to improve the basic medical insurance financing sharing and dynamic adjustment mechanism. This paper demonstrates that the transformation from the fixed rate financing system to the fixed ratio financing system can not only realize the equity of burden at the financing process, improve the total financing level, build the automatic adjustment mechanism of financing, solve the problem of insufficient basic medical insurance for urban residents, but also narrow the gap with the employees medical insurance; At the same time, due to the relative increase of individual payment of middle and high-income people, it can also solve the problem of unbalanced burden between the government and individuals. This paper calculates the scenarios of low-income peoples burden reduction, system income increase and individual and government responsibility balance under different rates; At the same time, it is suggested that when the relative burden of low-income peoples payment is reduced, the fiscal subsidy should be refined to the regional differential subsidy, so as to ensure that the relative level of the total amount of financing in low-income areas does not decline.

  Key words: The financing mechanism of residents medical insurance; Quota financing; Fixed ratio financing; Balance of financing responsibility; Automatic adjustment mechanism of financing

  Submit time: 30 August 2021

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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