摘要
在"高补贴、频调整"的定额筹资政策运行十余年之后,基本医疗保险迫切需要建立起更加科学、合理的财政补贴调整机制。文章以新农合为例,运用保险精算方法构建调整模型,从理论和实证两个方面对这一问题进行了研究,得到不同医疗费用增长率条件下的适度保障水平区间和最低财政补贴比例。在此基础上,以个人筹资占人均纯收入的2%作为个人责任的上限,针对具体的财政补贴调整方案进行定量测算,得出一系列有政策参考价值的调整结果。研究结论及相关研究思路和方法,对于实务部门完善基本医疗保险筹资机制及建立财政补贴动态调整机制有着重要的启示意义。主要创新在于:从调整频率、调整时机和调整幅度三个维度构建基本医疗保险财政补贴调整机制,提出基于灾难性支出发生率标准的"适度保障水平区间"并以此测算不同调整方案下的财政补贴水平。主要不足之处:文章仅考虑全国平均水平及新农合单项制度,有待未来的研究改进。
The objective of this paper is to study the dynamic adjustment mechanism of the financial subsidy for China's basic health insurance since more than 10 years of implement of the quota financing mechanism of 'high rate of subsidy, frequent adjustments' of the system. Taking the New Cooperative Medical Scheme(NCMS) as an example,and introducing an actuarial model,the paper makes theoretical and empirical analysis on this issue. Based on theoretical study on 'space of suitable security level',the paper makes a quantitative study on the minimum financial support ratio for NCMS. And a quantitative analysis is also made on two specific adjustment plans, supposing individual liability would be adjusted up gradually up to the limit of 2% of income. The paper has provided a series of outcomes including the 'space of suitable security level' and the minimum financial support ratio for NCMS under different growth rates of health care expenditures. It also presents data about how financial subsidy changes when apply different adjustment plan in which individual liability is gradually increase in the coming years. All these results are meaningful not only for the policy makers but also for the practical departments. The key limitation of the study is that it based on the average level of the whole country and focuses solely on the NCMS system due to data collection difficulty, which means futher research need to be done in the future if related data is available. The theoretical framework the paper constructed combined with the quantitative research method will shed light on the improvement of the financial mechanism of the basic health insurance and the con-struction of an adjustment mechanism of the financial subsidy for the system. The study first proposes a dynamic financial subsidy mechanism for NCMS from three aspects of adjustment frequency, adjustment time and adjustment range. It's also the first time to come up with 'space of suitable security level' from the aspect of Catastrophic Payment Head-count and taking it a
出处
《公共管理学报》
CSSCI
北大核心
2017年第1期128-141,共14页
Journal of Public Management
基金
广东省自然科学基金项目(2016A030313712)
教育部人文社会科学青年基金项目(15YJC630064)
