Research On Imbalance Between Income And Expenditure Of Basic Medical Insurance Funds For Urban Employees And Countermeasures

Whether the basic medical insurance for urban employees(hereinafter referred to as "employee medical insurance")can maintain the balance of income and expenditure is an important condition for the sustainable development of the medical insurance system for urban employees.At this stage,the employee medical insurance fund still has a slight balance of income and expenditure,but under the combined effect of the aging population trend and the increasing medical expenses,etc.,the medical insurance fund for Chinese employees is facing the situation of its spending exceeds incoming,and it has an increasing trend,which will result in an imbalance.In the current situation of “receiving expenditures” as total amount control,although the balance of fund income and expenditure can be maintained,it is clear that the suppression of real medical insurance demand is contrary to the policy requirements of relieving people's “difficulty in seeing a doctor and expensive medical treatment”.The existing method of controlling the total amount of medical insurance expenditure is not sustainable,so as to meet the requirements of real medical insurance,influence the steady operation of the medical insurance system.Therefore,to study the reasons and propose measures to deal with the imbalance between the income and expenditure of the employee medical insurance fund have significant realistic meanings for the reformation and improvement of social system.On the basis of combing the domestic and foreign scholars' literature on the balance of medical insurance,in order to relax the total amount of medical insurance expenditure and measure the demand for real medical insurance expenditure,this paper constructs a theoretical analysis framework with the medical insurance balance management theory as the core and the influencing factors of the balance of the income and expenditure.This paper further starts from the actual balance of income and expenditure of China's urban employee medical insurance fund,empirically tests the factors affecting the balance of income and expenditure of the fund,and uses factor decomposition method to determine the factors affecting the income of medical insurance funds mainly include three types: The average wage of employees has the greatest impact on the income of the employee medical insurance fund,and plays a leading role.The number of employees in the insured is second,and it is also an important component;the actual contribution rate of the employee medical insurance is the least.Through the regression analysis of the factors affecting the expenditure of employee medical insurance funds by constructing the econometric model,it is found that the most important factors affecting medical expenses are the income level of employees,the degree of aging of the population,the level of medical technology development and the factors of induced demand.Based on the theoretical basis and parameter setting factors of the employee medical insurance fund,this paper uses the actuarial analysis method to predict the balance of the employee medical insurance fund.The forecast analysis shows that the urban employee medical insurance coordinating fund will have a revenue and expenditure gap in 2020,and the gap is yearly expanding,the financial support to make up for the gap in the medical insurance fund will reach the limit in 2040,and the overall risk of income and expenditure will be imbalanced.At the same time,although the income and expenditure trends of employee medical insurance funds in different regions of the eastern,central and western regions are different,the imbalance of income and expenditure of the funds of the eastern,central and western is widespread.It is difficult to achieve success through the national coordinating method to ease the imbalance between income and expenditure.To further promote the reform of the medical insurance system is needed in order to promote the sustainable development of medical insurance.On the basis of referring to the typical national medical insurance fund revenue and expenditure system and the corresponding measures taken to deal with the imbalance of income and expenditure,this paper explores the adjustment path to solve the imbalance of income and expenditure of the employee medical insurance funds.Combining with the research conclusions on the factors affecting income and expenditure and the development tendency of the balance of income and expenditure,in the respect of increasing the income of medical insurance,this paper proposes to expand the funding channels and adjust the proportion of contributions: the delayed retirement age can significantly improve population structure of employee participated,which has obvious effects on expanding the scope of payment and reducing medical insurance expenditure.It can delay the imbalance time of the employee medical insurance fund by 6 years.Implementation effect of a single measure such as adopting the standard of medical insurance contribution and adjusting the allocation ratio of personal account is similar to the delayed retirement age,both of which could delay the imbalance time by 4 years.Using the above three payment reform measures,the imbalance of employee medical insurance coordinating fund can be postponed for 15 years(i.e.2035),and the imbalance time can be alleviated,but the trend of imbalance expansion cannot be completely reversed.Therefore,it is still not enough to realize the sustainable development of the medical insurance fund by implementing the comprehensive payment reform from the perspective of increasing the income of the fund,linkage implementation of the medical insurance fund expenditure control mechanism to achieve fund balance is needed.From the perspective of controlling the expenditure of medical insurance funds for employees,in accordance with the principle of the growth control mechanism of medical insurance funds,this paper proposes three reform measures as deepen hierarchical medical system,promoting medical and pharmaceutical separation and strengthen prevention and health care,and uses metrological inspection to measure the impact of each method on the expenditure growth of employee medical insurance coordinating funds.The test results show that,assuming that the factors affecting the income of the fund remain unchanged,under the conditions of medium and low program setting,the linkage adjustment of deepen hierarchical medical system,promoting medical and pharmaceutical separation and strengthen prevention and health care cannot achieve the balance of medical insurance fund;and under the high program setting conditions,the linkage adjustment of deepen hierarchical medical system,promoting medical and pharmaceutical separation and strengthen prevention and health care can achieve the balance of the fund.Under the high scenario simulation scenario,the balance of income and expenditure of the employee medical insurance coordinating fund shows a “U”-type development trend,which can be realized from negative to positive and gradually increasing.However,it takes a long time to achieve a growth trend after the balance of payments,in the year around 2032.As the standard for measuring risk reduction of the total gap between income and expenditure after implementing adjustment mechanism,this paper constructs a resolution degree model of each adjustment mechanism,which verifies the adjustment measures to promote the balance of funds.In the process of comprehensive implementation of the reform and adjustment of the income and expenditure linkage medical insurance system,the imbalance risk of the fund is gradually reduced,and finally the balance of income and expenditure of the coordinating fund is realized,thus fundamentally solving the threat of imbalance and realizing the sustainable development of the employee medical insurance fund.The chapters in this article can be divided into:The first chapter is introduction.It mainly includes the purpose and significance of the research,the research progress at home and abroad,the research methods,the research content and the innovation and inadequacies of the paper.The second chapter is the theoretical analysis of the balance of medical insurance funds.Based on the relevant theories of medical insurance supply and demand,large number of rules,insurance actuarial,health management,etc.,this chapter analyzes the balance management framework and the factors affecting the income and expenditure of medical insurance funds.The third chapter is the historical and realistic analysis of the income and expenditure system of the employee medical insurance fund of China.Based on the theoretical analysis framework and the balance of income and expenditure of the employee medical insurance fund,this chapter analyzes the evolution process and current situation of the basic medical insurance income and expenditure system of urban employees in China,and proposes the imbalance problem of income and expenditure faced by employee medical insurance fund.The fourth chapter analyzes the factors affecting the income and expenditure of China's employee medical insurance funds.On the basis of theoretical research,the factor decomposition model is constructed,this chapter empirically measures the factors affecting the balance of income and expenditure of medical insurance funds,quantitatively judges the impact of various factors on the income and expenditure of medical insurance funds,and provides scientific index selection and parameter setting standards for predicting the tendency of fund balance.The fifth chapter is an empirical analysis of the imbalance between the income and expenditure of China's employee medical insurance funds.Based on the "China's sixth census" data to predict population structure,the employee medical insurance fund balance model is constructed to predict and analyze the income and expenditure of the national and eastern,middle and western employee medical insurance funds,and the financial support ability to the gap between income and expenditure of medical insurance coordinating funds is calculated.The sixth chapter is the international experience revelation of the design of the medical insurance fund revenue and expenditure system.This chapter summarizes the imbalance situation of income and expenditure of medical insurance funds and the countermeasures of the international typical national medical insurance fund system,providing experience for setting up a reasonable balance and payment improvement mechanism of medical insurance fund.The seventh chapter is the adjustment path of imbalance of China's urban employee medical insurance fund.Separately check the effect of the payment control mechanism,the expenditure control mechanism and the linkage of payment and expenditure to the balance of income and expenditure of the fund,cumulative risk resolution of the unbalanced income and expenditure of the medical insurance fund is calculated by superimposing one by one.The eighth chapter is research conclusions and policy recommendations.This chapter summarizes the imbalance performance of the employee medical insurance fund,the reasons for its formation and the main adjustment path to resolve the imbalance between income and expenditure.It proposes countermeasures such as linkage implementation of comprehensive payment reform and comprehensive expenditure reform.