Influecing Factors And Countermeasure Research Of Urban Employees' Basic Medical Insurance Fund Balance

BackgroundSince 1970s, many countries in the world have suffered the same problem --excessive increase of social insurance expenditure though they varied in social insurance pattern and developed in different way. The absolute number of increasing expenditure as well as the ratio of social insurance expense to GDP has presented a surprisingly increasing momentum. In some countries, such as Japan, France and Spain, it has occurred the situation that funds expense has overweighed revenue. Our conntry also face the same problem, the increasing speed of medical expenditure is more fast that of GDP and salary income per capital. It brings great risk on our medical insurance which funds is collected based on salary.Funds of medical insurance is the basis of implementing medical insurance. Whether the funds can keep balance or not is imperative to the sustainable development of medical insurance. Therefore, keeping funds' balance has always been the focus of medical insurance institutions, health care providers and other relative institutions. Two aspects, revenue and expenditure, will influence the balance of funds. In second quarter of 2005, the expenditure have exceeded the revenue in 169 cities, whick accounts to 7.3% of the total cities where have implemented medical insurance. The entire overspending amount was up to 170million RMB. There is a tendency that the numbers of these cities and the overspending amount will be on the rise in the future, which presents severe challenge to the sustainable development of basic medical insurance system.This research has been sponsored by the China Social Insurance Association Medical Insurance Branch and is a part of the project of Macro influencing factors on the revenue and expenditure of basic medical insurance. The research contents include to research the direct or indirect effecting factors concerning the revenue and expenditure of medical insurance funds, analyze their impact on keeping funds' balance and how to control them.ObjectivesBy analyzing implementation of medical insurance in C and H cities, and researching the increasing rule of revenue and expenditure, and the influencing factors of keeping funds' balance, to bring out the suitable advises of increasing revenue and conrtroling expenditure, and provide evidence for proposing rational policy. MethodsIn this research, quantity and quality study methods such as health statistic analysis, health economic analysis, focus group interview and health policy analysis have been employed. They are used as follows.(1)Economic analysis. We have used economic method to compare the increasing health expense to the economic growth, and have analyzed the financing and expenditure of medical insurance and the harmonious development of population and economy from macroeconomic perspective.(2)We have used health statistic approach and health economic approach to study the influencing factors and their effect, and have estimated the implementation of funds.(3)We have organized focus group interview to investigate relative stuff, acquiring their opinions concerning medical insurance, so that provided evidence for proposing rational policy.(4)We have used policy analysis approach to evaluate the problems confronted with medical insurance in a comprehensive way and have presented corresponding solution.Main results1. We have found out that total health expenditure (THE) can be increased harmoniously with GDP and salary in long phase. Now the increase of THE has overspeeded the GDP and salary. The fast increase of medical expense has made the disease burden more heavily.2. We have also found out that the increase rate of total salary income was lower than that of THE. While the increase rate of medical expenditure was a little bit higher than that of the THE. Therefore, in terms of medical insurance whose financing is dependent on the total salary income, funds are confronted with the risk of expenditure exceeding financing.3. By investigating the two cities and other cities all over the country, the implementation of funds demonstrated such characteristics as follows. The coverage was not extensive enough and the expanding potential under existing system is not strong. Both the total funds and the unified medical fund (UMF) of the medical insurance have experienced the higher expenditure increasing rate than those of financing, and funds have shown a tendency of overbalance. In city C and H, the elasticity coefficients (expenditure increasing rate to financing increasing rate ) of UMF per capita were 1.89 and 2.32 respectively.4. We have concluded that the salary income, the premium rate and the proportion of employees are the direct influencing factors on funds financing. The salary income has positive relation with UMF per capita. In city, H The UMF per capita has positive relation with the proportion of employees while in city C there is no linear relation between each other. The premium rate also has positive relation with medical insurance funds per capita, and the UMF has no linear relation with personal account. 5. The influencing factors concerning the funds expenditure are as follows: age structure of participants, hospitalization rate, hospitalization expense per time, stay days in hospital and the level of hospital. We have found out that the main expense of hospitalization was by the age group of 50 to 70. And the majority expense occurred in tertiary hospitals, accounting more than 80%.6. By using attribution analysis on the medical expense per capita in hospitals of all levels, we have found out that the contribution rate of hospitalization rate in secondary and tertiary hospitals in two cities ranked first, and the hospitalization expense per time ranked second. The attribution analysis on primary hospitals was different in two cities. While the attribution analysis on employees' and retirees' medical expense per capita was the same, with hospitalization rate ranking first and medical expense per time ranking second.7. The existing tendency of financing and expenditure in the two cities will lead to overbalance of funds. By estimating the employee to retiree ratio we have concluded that if the increasing rate of funds' expenditure per capita was 3% higher than salary income, funds' financing would exceed expenditure in 10 to 15 years. And if 6% higher, funds' overbalance would occur in 5 years.8. We also suggested that medical insurance institutes and health care provider should coordinate with each other and the health care in community should be played in full. It will be significant for reducing participants' economic burden, meeting aged people's medical needs and relieving the pressure of fund's balance in the aging population society.Suggestions1.Further expending coverage of insurance.Currently, the participants of basic medical insurance in our country are over 130million. However, it had only covered 55% of the entire employees in urban areas. Under existing medical insurance policy, the process of expanding coverage will be slowed down. We should make break through in policy to expand coverage. It will not only increase funds' revenue but also help to improve participants' age structure, share medical risks and keep funds' balance. In this course, participants' reserved choices deserve attention. 2.0pening more channels to increase revenue of funds.As far as financing is concerned, we recommend solutions as follows. Firstly, delaying the time of retirement .Secondly, raising the proportion of financing .At last, the retirees should also pay premium in some extent.3.Strenthening supervision on hospitals and doctors and exploring rational payment methods to control medical expenditure.Hospitals and doctors, as the health care providers, play a crucial role in controlling medical expenditure. Uncertainty of medical consumption and unsymmetry of medical information make health care provider become the dominating part of medical consumption. We should foster rational payment method to regulate provider's behavior.4.Futher exploring approach to reserve and raise the funds' value. We should broadenthe implementation way of funds to strengthen funds' ability to protect risks.5.Setting up risk funds.All funds have risks and the funds of medical insurance are without exception. When meeting with some uncontrollable factors, such as epidemic, the peak of aging population, risk funds will help balance the funds of medical insurance. It will be significant to the funds' sustainable balance. 6.Building pre-alarm system.The implementation of funds is a dynamic process. If we can forecast the time when the funds' revenue will exceed the expenditure and take corresponding action, we may avoid the occurrence of funds' overbalance. Building pre-alarm system is not only useful when there's risk in funds, but also provides regular data for medical insurance institute to improve policy. 7.Improving relative law.We should legislate to make clear regulation on financing, allocation and utilization of health expenditure and define the responsibility, rights and interests of all parties which will guarantee the steady implementation of medical insurance system in the long term.