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

Corresponding author: Zeng Yi, zengyi532@126.com

DOI: 10.12201/bmr.202210.00017

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  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

  Submit time: 24 October 2022

  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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