基于内蒙古自治区城乡居民基本医疗保险一体化的医疗保险基金的测算

目的:测算内蒙古自治区医疗保险基金中的医药补偿费、管理费用以及风险储备金,继而测算2011—2015年不同补偿方案下的医疗保险基金总体筹资额度与人均医保基金筹资额度,研究内蒙古自治区城乡居民基本医疗保险一体化进程中的筹资可行性。方法:运用残差合格模型、关联度合格模型、均方差比合格模型以及小误差概率合格模型等多种方法,对2011—2015年内蒙古自治区不同补偿方案下的医疗保险基金进行测算。结果:2011—2015年的五项补偿方案下的人均医保基金在521.43~2 012.27元之间;五种补偿方案分别应需筹集资金在128.85~497.23亿元之间。无论哪类补偿方案下,内蒙古自治区城乡居民基本医疗保险基金的筹资额度均在逐年增长,平均年增长幅度为20%,人均医保基金筹资额度平均年增长幅度为10%。结论:各筹资主体筹资额度逐年增加,且迅速增长,筹资压力相对较大,这对于目前内蒙古自治区城乡居民基本医疗保险一体化的有序推进,是一个难题。同时,本研究为推进内蒙古自治区基本医疗保险一体化提供了一套科学、有效地医疗保险基金筹资测算方案。

Calculation of medical insurance fund: Based on the integration of basic medical insurance for urban and rural residents in the Inner Mongolia Autonomous Region/Xue Qing-yuan, Yu Cai-xia, Fan Yan-cun//

Objective: To calculate the medical compensation fee, management fee and risk reserve in the medical insurance fund of Inner Mongolia Autonomous Region, and then calculate the total financing amount of the medical insurance fund under the different compensation scheme in 2011-2015 and the amount of fund-raising fund of the per capita health insurance fund, and study the urban and rural areas of Inner Mongolia Autonomous Region Financing Feasibility in the Process of Resident Basic Medical Insurance. Methods: The medical insurance fund under different compensation schemes in Inner Mongolia Autonomous Region was calculated by using the residual qualified model, the correlation degree qualified model, the variance ratio qualified model and the small error probability qualified model. Results: The average health insurance fund under the five compensation schemes in 2011-2015 was between 521.43 and 22.2 yuan. The five compensation schemes were to be raised between $ 128.85 and $ 49.73 billion respectively. No matter what kind of compensation program, the Inner Mongolia Autonomous Region urban and rural residents basic medical insurance fund financing amount are increasing year by year, the average annual growth rate of 20%, per capita health insurance fund financing the average annual growth rate of 10%. Conclusion: The amount of fund raising is increasing year by year, and it is rapid and the financing pressure is relatively large. This is a difficult problem for the orderly advancement of the integration of basic medical insurance for urban and rural residents in Inner Mongolia Autonomous Region. At the same time, this study provides a scientific and effective financing plan of insurance fund for promoting the integration of basic medical insurance in Inner Mongolia Autonomous Region