The Study On Influencing Factors Of Basic Medical Insurance Fund Balance For Urban Workers In Shaanxi Province

As an important part of the social security system,urban workers’ basic medical insurance plays a huge role in providing medical insurance and dispersing the disease risks for employees.In recent years,with the changes in population structure and the prevalence of chronic and major diseases in China,medical expenses and employee medical insurance fund expenditures have increased year by year.At the same time,the insured’s increasing demand for high quality medical services also brings expenditure pressure to the medical insurance fund,and the basic medical insurance fund for urban employees is facing the risk of running out in some provinces under the high pressure of expenditure.What factors affect the balance of employee medical insurance fund and which measures can promote the balance of fund need to be studied theoretically and empirically.Taking Shaanxi Province as an example,this paper established the theoretical framework of the factors affecting the balance of urban workers’ basic medical insurance funds in Shaanxi Province by sorting out relevant literatures and theories of medical insurance fund at home and abroad.Using the macroeconomic data of Shaanxi Province in 2013-2017 and the income and expenditure data of the basic medical insurance fund of urban employees in Shaanxi Province,this paper analyzed the population structure,economic development,medical security level,and the balance of income and expenditure of the employee medical insurance fund.Besides,the grey prediction model GM(1,1)was adopted to predict the future fund gap of the pooling account and personal account,and obtained the balance assessment result of the Shaanxi Medical Insurance Fund.Based on the macro-positive test(correlation and principal component analysis)and micro-questionnaire survey,this paper identified the key factors affecting the balance of workers’ medical insurance funds in Shaanxi Province.The main conclusions are as follows:(1)The trend of population aging in Shaanxi Province is accelerating,Chronic diseases and major diseases have become the main direction of people’s medical expenditure.Besides,medical expenses have been increasing year by year,hospitalization accounts for about 80% of all medical expenses,and the hospitalization medical expenses for retired elderly accounts for about 68% of the total cost of hospitalization expenses;(2)The growth rate of expenditure of shaanxi employees’ medical insurance for pooling account is higher than the growth rate of fund income.The pooling account may be in deficit in 2021 with a deficit gap of 457.742 million yuan,and the personal account funds work well and the fund deficit is unlikely.(3)The macro-positive results show that the number of participants,the average monthly salary,the aging population and etc have a significant positive correlation with the income of the pooling fund.The total medical expenses,the aging population,the number of people enjoying the benefits and etc are significantly positively correlated with the expenditure of the pooling fund.The three driving factors affecting the balance of employee medical insurance funds are income and cost factors,policy control factors and additional value-added factors.The results of micro questionnaire survey indicate that six factors,including fund income factors,fund expenditure factors,medical insurance policy and etc will affect the balance of employees’ medical insurance fund,and people pay more attention to the reimbursement ratio,scope and procedure of medical insurance.Based on the research conclusions,this paper proposes long-term dynamic adjustment measures to promote the balance of urban workers’ basic medical insurance funds in Shaanxi Province from the aspects of deepening the reform of medical insurance system for employees,improving the efficiency of employee medical insurance funds,and strengthening the supervision and management of medical insurance funds for employees.The research in this paper has certain reference value for promoting the balance of medical insurance funds and formulating medical insurance policies in Shaanxi Province.