老龄化背景下城镇职工基本医疗保险基金财务运行状况的精算预测——对“全面二孩”政策效应的评估

本文通过构建动态精算模型，以在社会医疗保险中占据重要地位的城镇职工基本医疗保险为例，模拟分析实施“全面二孩”政策对医保基金的影响。研究发现：第一，如果继续实施原生育政策，基金将在2036年出现累计赤字，2070年累计赤字额高达261.60万亿元；第二，引入“全面二孩”政策，各生育意愿下的累计赤字时点并未发生变化，但2038年以后的累计赤字额有所减少。第三，在“全面二孩”政策已实施基础上，再进一步引入延迟退休和调整划入统筹基金比例政策，且同时实施，可使基金不再出现累计赤字，2070年累计结余36.84万亿~82.44万亿元。由此可见，“全面二孩”政策可在一定程度上改善城镇职工基本医疗保险基金的财务运行状况，但其作用并不能在短期内得到发挥；若该政策与延迟退休和调整划入统筹基金比例等政策配合实施，效果会更好。

An actuarial forecast of the financial operation of basic medical insurance fund for urban employees under the background of population aging: Based on the evaluation of the effects of universal two-child policy

Taking the basic medical insurance fund of urban employees as case study, this paper quantitatively analyzes the impacts of the implementation of the universal two-child policy on the financial operation of the fund by constructing a dynamic actuarial model. The study results are as follows:First, if the original birth policywas continued, the accumulated deficit of the pooled fund wouldappear in 2036, and the accumulated deficit in 2070 would beas high as261.60 trillionyuan. Second, with the introduction of the universal two-child policy, the accumulated deficits for each fertility intention willnot change, but the cumulative deficit will decrease after 2038.Thirdly, on the basis of the implementation of the universal two-child policy,if the retirement age is delayed and the proportion of the unit''s expenses into the pooled fund is adjusted, there will be no gap in the fund, and the accumulated balance in 2070 will be 36.84~82.44 trillion yuan. Thus, the universal two-child policy can improve the financial status of pooled fund to some extent, but it can''t play a significant role in the short term.If delaying the retirementage andadjustingthe proportion of the unit''s expenses into the pooled fund are made,the effects of improving the basic medical fund will be better.