Construction and validation of a financing model for the urban and rural residents′ basic medical insurance based on regional experience
10.3760/cma.j.cn111325-20250116-00048
- VernacularTitle:样本地区城乡居民医保基金筹资模型的构建与验证
- Author:
Zhengxian YING
1
;
Ming LUO
;
Qiaoyu SHAO
;
Ye MA
;
Xiaohua YING
Author Information
1. 温州医科大学附属东阳医院，金华 322100
- Publication Type:Journal Article
- Keywords:
Insurance, health;
Financing level;
Health care costs;
Sustainable development;
Funding model
- From:
Chinese Journal of Hospital Administration
2025;41(7):506-511
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To develop a financing model for the urban and rural residents′ basic medical insurance (URBMI) based on medical service costs, providing a scientific foundation for achieving a balance between fund revenue and expenditure.Methods:Drawing on operational experience from regional hospitals, 10 key factors influencing URBMI fund expenditures were distilled: the number of hospital beds per thousand population, annual hospitalization rates per hundred population, average length of stay, bed occupancy rate, county-level hospitalization rate, regional age-specific medical expenditure index, proportion of hospital personnel costs in medical revenue, number of hospital staff per bed, average annual personnel costs per employee, and the average reimbursement rate for insured individuals. Based on these 10 key factors, a URBMI financing model for a sample region was developed, and the reasonable per-capita medical expenditure and the sustainability threshold of per-capita financing were preliminarily estimated.Results:Model calculations revealed that the predicted reasonable per-capita medical expenditure of the sample county was 4 140.9 yuan. Assuming an average reimbursement rate of 50% for URBMI enrollees, the per-capita financing requirement was at least 2 070.5 yuan. Sensitivity analysis showed that the sustainability threshold of per-capita financing was more sensitive to changes in average length of stay and the proportion of hospital personnel costs in medical revenue.Conclusions:This study constructed a URBMI financing model based on 10 key factors affecting fund expenditures. By adjusting regional characteristic variables, the model can reflect how regional economic conditions and health-care needs influence URBMI financing requirements.
