Design and Financial Release Estimation for the Individual Accounts Reform Plan of Basic Medical Insurance for Employees in the Context of Outpatient+Co-payment Reform
- VernacularTitle:门诊共济背景下职工基本医疗保险个人账户改革方案设计与释放资金测算
- Author:
Zhihong LU
1
;
Min WU
;
Xiaomin MU
;
Zhiyan HAN
Author Information
1. 山东中医药大学 山东 济南 250035
- Publication Type:Journal Article
- Keywords:
Basic Medical Insurance for Employees;
outpatient co-payment;
individual account;
fund release
- From:
Chinese Health Economics
2025;44(2):46-49
- CountryChina
- Language:Chinese
-
Abstract:
Based on the national policy direction of improving the individual account crediting method for employees'basic medical insurance,it designed three individual account reform scenarios,considering the individual account reform and fund sustainability considerations.Based on the 2022 data of the basic medical insurance for employees in Shandong Province,simulations were conducted to predict the overall scale of individual account reform funds released and individual subtractions under each scenario after the full implementation of the individual account reform in 2024,as well as to conduct an early warning analysis of public opinion risks for key populations.The results indicated that Plan I had the largest total amount of released funds from individual accounts(16.55 billion yuan),but the highest per capita monthly reduction in credits(52.97 yuan),thereby increasing the risk of generating social public sentiment.Plan III minimized the resistance to the implementation of the individual account reform but has the smallest total amount of released funds from individual accounts(13.484 billion yuan).Plan II achieved areas such as the provincial government and oil fields have the highest public sentiment risk due to the highest reduction ratio for retirees(>90%);11 coordinated areas have a percentage of retiree subtraction of more than 80%.It provided empirical evidence for policymakers on different plans for the reform of individual accounts in the employee basic medical insurance and their impacts,and suggested that high-risk areas should be given special attention,adopting refined and differentiated policy measures to effectively alleviate social public sentiment pressure and ensure the smooth progress of the reform.
