Research On Influencing Factors And Prediction Of Fund Balance Of Employee Medical Insurance Pooling In Q City Under The New Policy

With the deepening of the aging of the population,the imbalance of medical insurance fund is becoming more serious.On April 22,2021,The General Office of the State Council issued the Guidelines on Establishing and Improving the Outpatient Mutual Aid Security Mechanism of Basic Medical Insurance for Employees(hereinafter referred to as the Opinions),which included all the unit fees originally allocated to individual accounts into the pooling fund at the income end,and included the medical expenses of general outpatient services into the scope of outpatient insurance at the expenditure end.The implementation of the new policy of outpatient service security causes people to think a lot.For example,under the background of the new policy,how will all the influencing factors of fund balance function? What impact will the adjustment of this policy bring to the balance of income and expenditure of medical insurance pooling fund for urban workers in Q City in the future? In this context,this paper analyzes the influencing factors of the pooling fund balance of employee medical insurance in Q City under the new policy,and makes a simulation forecast of the future pooling fund income and expenditure,and puts forward relevant countermeasures and suggestions to promote the pooling fund balance of employee medical insurance based on the analysis and prediction results.Firstly,this paper expounds the concepts related to employee medical insurance and the law of large numbers theory,health management theory,demographic structure transformation theory and market failure theory,and briefly introduces the basic situation of employee medical insurance in Q City,such as the structure of insured personnel,pooling fund raising,treatment payment and fund operation.Then,the influencing factors of the fund balance of employee medical insurance pooling in Q city under the new policy were analyzed from the aspects of income,expenditure and other factors,and on this basis,the fund situation of employee medical insurance pooling in Q City was simulated and predicted.Finally,the following conclusions are drawn :(1)the coverage of insurance in Q city keeps expanding,but the aging problem of insurance is prominent;Per capita financing and payment base increase year by year,but enterprises are facing great pressure of payment;The high number of people receiving medical benefits and the high hospitalization rate directly led to the rapid growth of medical insurance expenditure.(2)The number of insured persons,the average salary of employees,the number of insured persons,the rate of payment and the proportion of unit payment into the pooling fund,the demand for outpatient medical services,the ability of grass-roots health services,residents’ health and health care awareness and other factors have a positive impact on the income of pooling fund for medical insurance in Q City;The aging degree of population has a negative impact on pooling fund income.Average salary of employees,aging degree of population,difficulty of supervision and other factors may increase the overall fund expenditure of Q City;The number of insured people,the demand for outpatient and inpatient medical services,the capacity of community-level health services,residents’ awareness of health and health care,and the setting of payment standards are conducive to reducing the expenditure of the pooling fund.(3)consider only outpatient medical service demand and hospitalization health service demand two factors,the future Q city worker medical insurance fund balance of payments imbalances is severe,other influencing factors are introduced to plan as a whole fund balance of payments imbalances to get some relief,but as the population aging degree is relatively serious,and it takes time to the improvement of the system,In the future,the overall fund situation of employee medical insurance in Q City will still be unbalanced.According to the research results,this paper puts forward countermeasures and suggestions from the aspects of perfecting the financing mechanism of medical insurance,actively coping with the aging of population,improving the payment mechanism of medical insurance,promoting the connection between outpatient overall planning and grass-roots health services,and establishing and improving the supervision system of medical insurance fund.