Research On The History Debt Of Basic Medical Insurance For Urban Workers

The transition of social insurance system inevitably results in the revealing of history debt. "Decisions in Establishing Urban Basic Medical Insurance System", which was issued by the State Council in December 1998, indicated the transition from "Labor Medical Insurance System" to "Basic Medical Insurance System for Urban Workers (BMI hereafter)", and therefore generated the history debt of BMI. The research on history debt of BMI will contribute to the reflection of the system transition in the recent decade and have great reference value for improving the current system.The study is conducted based on the history—"transition of the system" and the reality—"low level of the medical security and absence of the government responsibility". This paper deals with the problem on history debt of BMI by using the theories of Institutional Economics, Transition Economics, Social Policy Sciences and Actuarial Sciences as analysis tools. Firstly, after reviewing the history of system transition, this study defines the concept of history debt of BMI. It includes the Category I and Category II's treatment from the whole fund and the individual fund based on the "equivalent period of payment" after their retirement. The phenomenon, that government shifts some responsibility to the enterprise and the individual when dissolving the debt, is revealed by this research. Secondly, this paper analyzes the major factors which affect the scale of history debt of BMI, including the population, increasing medical cost and the policies. The study establishes the actuarial model to estimate the Category I and Category II's history debt of BMI respectively according to the ratio of "equivalent period of payment" under the old system and payment years under the reformed system, and predicts the growth rate of the whole fund payment and individual account debit base. On that base, the paper estimates the history debt of BMI of Hangzhou City (about 71.595 billion yuan in 2010). Lastly, solutions to dissolve the debt and improve the system are given, including estimating the history debt scientifically, strengthening government responsibility, reforming the model of "social pooling and individual account combination" and establishing the medical insurance actuarial system.