Research on the sustainability of the Nanjing City's employee medical insurance pool fund under the background of the outpatient pooling reform
10.3969/j.issn.1674-2982.2024.02.002
- VernacularTitle:"门诊共济"改革背景下南京市职工医保统筹基金的可持续性研究
- Author:
Ai-Qin LI
1
;
Yu ZHAO
Author Information
1. 江苏师范大学公共管理与社会学院 江苏徐州 221116
- Keywords:
Medical insurance reform;
Outpatient pooling;
Insurance actuarial
- From:
Chinese Journal of Health Policy
2024;17(2):9-16
- CountryChina
- Language:Chinese
-
Abstract:
Taking the aging population of Nanjing as an example,through the method of constructing actuarial models,this paper predicts and analyzes the impact of the reform of outpatient mutual aid security mechanism on the income and expenditure of the overall planning funds of workers'medical insurance in Nanjing during 2021-2035,and simulates the impact of policies such as delaying retirement,expanding financing and reforming payment methods on improving the sustainability of medical insurance funds.Based on this,it proposes policy suggestions.The study finds that under the current outpatient mutual aid security plan,by 2032,the overall planning funds of workers'medical insurance in Nanjing will face the risk of running out;compared with the current policy,implementing the same retirement age for men and women will delay the time point of accumulated deficits by one year;implementing the policy of expanding financing,after both employed and retired workers pay contributions to the overall planning funds,the overall planning funds will eliminate the risk of deficits in the medium term;implementing the policy of reforming payment methods can also make the overall planning funds sustainable in the medium term.Therefore,it is concluded that the reform of outpatient mutual aid security implemented in the context of aging population may lead to payment pressure on the overall planning funds.In the long run,a combination of various supporting policies is needed to achieve sustainable development of the overall planning funds.
