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文章研究了城镇老年居民健康波动对总体、个人自负和统筹支付三个方面医疗支出的影响,并分析了医疗保险统筹基金的风险分担作用。研究发现:(1)健康波动会产生医疗支出风险,这一风险主要由影响健康的持续性因子波动所致;对于参加职工基本医疗保险的居民来说,统筹基金同样面临支付风险。(2)健康波动产生的大病支出风险绝大部分由职工基本医疗保险统筹基金承担,个人自负支出风险则相对较小。具体来说,65岁时发生的健康波动会使0.1%的居民在未来面临不低于50万元的额外医疗支出,其中55%将由统筹基金承担。随着我国人口老龄化,除了落实个人账户外,政府还应进一步充实社会统筹基金和大病基金,以分担大病支出风险,并缓解“看病贵”的问题。
The article studies the influence of health fluctuation of elderly inhabitants in cities and towns on medical expenditures in three aspects: overall, personal conceit and overall payment, and analyzes the risk sharing role of medical insurance pool funds. The findings are as follows: (1) Health fluctuation will generate the medical expenditure risk, which is mainly caused by the volatility of the sustainability factors that affect the health. For the residents participating in the basic medical insurance for workers, the pool fund also faces the risk of payment. (2) The risk of serious illness caused by health fluctuation is mostly borne by the employees’ basic medical insurance co-ordination fund, and the risk of personal self-reported expenditure is relatively small. Specifically, the health fluctuations that occur at age 65 will cause 0.1% of residents to face additional medical expenses of not less than $ 500,000 in the future, of which 55% will be covered by the pool fund. With the aging of our population, in addition to the implementation of personal accounts, the government should further enrich the social pool funds and major illness funds so as to share the risk of serious illness and expenditures and alleviate the problem of “expensive medical treatment.”