Research On The Impact Of Medical Insurance Policy Adjustment On The Sustainability Of Urban Employee Basic Medical Insurance Fund

On April 22,2021,the National Healthcare Security Administration issued the Guidelines on establishing and Improving the outpatient mutual aid Guarantee mechanism of basic medical insurance for employees in order to further improve the nationwide medical insurance system featuring mutual aid and shared responsibilities.The guidelines aim to improve the personal account system and the outpatient insurance mechanism.At the same time,the universal three-child policy and progressive retirement delay policies have been implemented or will be implemented soon.In theory,"universal three-child policy" can promote the increase of total fertility rate and alleviate the degree of aging,thus making the income of medical insurance fund increase relatively and the expenditure decrease relatively,thus improving the sustainability of medical insurance fund.However,delaying retirement can ensure the sustainability of the fund by extending the number of years for employees to pay contributions.Therefore,the impact of this adjustment of medical insurance policy on the sustainability of basic medical insurance fund for urban employees and the operation of medical insurance fund for urban employees under different parameters caused by the implementation of "universal three-child policy" and progressive delayed retirement should become the focus of research.This study is based on the perspective of the establishment of outpatient mutual aid system.In the research process,this paper first expounds the research background and significance of the selected topic,and reviews relevant literatures on the sustainability of medical insurance fund at home and abroad.Then it defines the core concepts involved in the research,such as medical insurance fund for urban employees,delayed retirement and universal three-child policy,and introduces the basic theories used,such as life-cycle consumption theory,social insurance actuarial theory and demographic transition theory.Next,through the establishment of the medical insurance fund balance model for the future urban employee medical insurance fund sustainability trend forecast.After the adjustment of the medical insurance policy,the proportion of the overall account and individual account of the urban employees’ medical insurance fund will be changed first.In addition,the establishment of outpatient mutual aid security and the reform of personal accounts will change the use of outpatient and inpatient services by insured patients,so that the parameters of the actuarial model,such as outpatient service,inpatient service utilization and annual medical expenses,will change.Therefore,this paper will consider the variation of parameters in the model and measure the operation of the urban employees’ medical insurance fund after the reform of the unified accounting structure.According to the results,before the reform of medical insurance policy,China’s employee medical insurance pooling fund will start to have a cumulative revenue and expenditure gap in 2036,and the employee medical insurance system cannot maintain normal operation in that year.Relevant policies must be implemented as soon as possible to relieve the payment pressure of employee medical insurance fund.After the health care policy reform,and there is a cumulative balance as a whole fund year until 2039,that health policy adjustment to the worker the sustainability of medical insurance fund but limited role,establish outpatient service security system can only withstand 2039 years before balance deficit risk problem,system ageing could still exist after 2039.However,after the implementation of the universal three-child policy,the time when the income and expenditure gap of the employee medical insurance fund does not change,but the scale of the deficit is smaller than before,and the sustainability crisis has not been solved.In "comprehensive three children" and health care policy reform,on the basis of introducing delay retirement policy can alleviate the pressure of the town worker medical insurance of on-the-job worker pay,again delay fund has been the point,the income gap in improving fund finances,but in the long run,town worker medical insurance fund is still appear close not to,The implementation of delayed retirement can not achieve the mid-and long-term actuarial balance of urban medical insurance fund。To increase the mutual aid of the medical insurance system and realize the long-term sustainable operation of the pooling fund,this paper puts forward the following policy suggestions: First,on the basis of the reform of the medical insurance policy and the adjustment of the family planning policy,we will implement the gradual delay of retirement as soon as possible.Second,we will improve the reform of medical insurance policy and supporting policies for the universal three-child policy.Third,further improve the outpatient mutual aid system,optimize personal accounts.I hope the suggestions in this paper can provide real and effective help for improving the employee medical insurance system.