通讯作者: 张 楚, ruczc96@126.com

DOI：10.12201/bmr.202105.00013

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

• 摘要：覆盖十亿人口的城乡居民基本医疗保险的资金来源由政府按人头补贴和个人定额缴费组成。有共识的意见是按人头定额缴费的筹资机制面临着筹资负担不公平、保费增长不稳定、筹资水平不充分、筹资责任不均衡等等问题,为了回应新时代背景下居民日益增长的医保需求,2020年中发5号文《关于深化医疗保障体制改革的意见 》提出完善基本医保筹资分担与动态调整机制。本文论证了定额筹资制度向定比筹资制度转变,不但可以在筹资端实现负担公平,提升总筹资水平、内置筹资自动调整机制,破解城镇居民基本医疗保险保障不充分的问题,还可缩小与职工医保的差距；同时由于中高收入者个人缴费相对增加,还可以改善政府与个人负担不均衡的问题。本文计算了不同费率条件下,低收入人群减负、制度增收及个人与政府责任均衡的情景；同时建议在减轻低收入者缴费的相对负担时,财政补贴细化地区级差补贴,以保证低收入地区筹资总额相对水平不下降。

  关键词： 居民医保筹资机制; 定额筹资; 定比筹资; 筹资责任均衡; 筹资自动调整机制

   

  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

  提交时间：2021-08-30

  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	2021-05-06	bmr.202105.00013V1	下载

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