Research on the Sustainability of the Nanjing City’s Employee Medical Insurance Pool Fund under the Background of the Outpatient Mutual Aid Reform

Corresponding author: ZHAO YU, zhaoyu543210@126.com

DOI: 10.12201/bmr.202403.00006

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  Abstract: Taking the aging population of Nanjing as an example, through the method of constructing actuarial models, this paper predicts and analyzes the impact of the reform of outpatient mutual aid security mechanism on the income and expenditure of the overall planning funds of workers medical insurance in Nanjing during 2021-2035, and simulates the impact of policies such as delaying retirement, expanding financing and reforming payment methods on improving the sustainability of medical insurance funds. Based on this, it proposes policy suggestions. The study finds that under the current outpatient mutual aid security plan, by 2032, the overall planning funds of workers medical insurance in Nanjing will face the risk of running out; compared with the current policy, implementing the same retirement age for men and women will delay the time point of accumulated deficits by one year; implementing the policy of expanding financing, after both employed and retired workers pay contributions to the overall planning funds, the overall planning funds will eliminate the risk of deficits in the medium term; implementing the policy of reforming payment methods can also make the overall planning funds sustainable in the medium term. Therefore, it is concluded that the reform of outpatient mutual aid security implemented in the context of aging population may lead to payment pressure on the overall planning funds. In the long run, a combination of various supporting policies is needed to achieve sustainable development of the overall planning funds.

  Key words: medical insurance reform; the outpatient mutual aid security; actuarial science; ageing population

  Submit time: 7 March 2024

  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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