论居民医保个人筹资机制从定额制到定比制的改革

城乡居民基本医疗保险的资金来源由政府按人头补贴和个人定额缴费组成。目前,按人头定额缴费的筹资机制面临着筹资负担不公平、保费增长不稳定、筹资水平不充分、筹资责任不均衡等问题。本文论证了定额筹资制度向定比筹资制度转变,不但可以在筹资端实现负担公平,提升总筹资水平、内置筹资自动调整机制,破解城镇居民基本医疗保险保障不充分的问题,还可缩小与职工医保的差距;同时由于中高收入者个人缴费相对增加,还可以改善政府与个人负担不均衡的问题。本文计算了不同费率条件下,低收入人群减负、制度增收及个人与政府责任均衡的情景;建议在减轻低收入者缴费的相对负担时,财政补贴细化地区级差补贴,以保证低收入地区筹资总额相对水平不下降。

Reform of individual financing mechanism of residents' medical insurance from quota system to fixed ratio system

The funding of medical insurance for urban and rural residents consists of government subsidy for each person and personal fixed contribution. The current individual fixed-amount contribution leads to unfair funding burden, unstable premium growth, insufficient contribution, unbalanced funding responsibilities, etc. This paper discusses the transformation from the quota system to fixed ratio system. On one hand, it can achieve a fair contribution, enhance the overall funding, establish a self-adjustment funding mechanism, solve the insufficiency of basic medical insurance for urban residents, and narrow the gap between medical insurances for urban residents and employees. On the other hand, the relative increase in individual contributions of middle and high-income groups will also address the unbalanced burden between the government and individuals. In this paper, we calculate the reduced contribution of low-income groups, the increased premium revenue under such schemes and the balance between individual and government responsibilities at different contribution rates. Therefore, we suggest relatively reducing the contribution of low-income groups and refining regional government subsidies, so as to ensure that the total funding of low-income areas will not decline.