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2012年8月24日,我国出台城乡居民大病保险制度,但并未对筹资水平予以明确规定。本文采用精算模型和两部分模型,以新农合为例,测算了历年大病保险所需的总筹资额,结果显示:当大病保险的起付线为农民人均纯收入除以新农合的自付比例时,目前新农合的累计结余不足以支付1年的大病医疗保险费用;当大病保险的起付线为新农合的封顶线时,新农合的累计结余只能用于支付2~3年的大病医疗保险费用;即使每年从新农合的筹资额中划出一定比例作为大病医疗保险资金,也会影响农民基本医疗费用的支付,更别说用于支付大病医疗费用。如果考虑由政府、农民等多方共同筹资,当人均筹资水平为农民人均纯收入的1%~4.5%时,就可以保证资金来源的稳定性。
On August 24, 2012, China introduced the system of serious illness insurance for urban and rural residents, but it did not stipulate clearly the level of funding. In this paper, using actuarial model and two-part model, taking NCMS as an example, the total amount of funding required for major illness insurance over the years is calculated. The results show that when the line of the serious illness insurance starts from the per capita net income of farmers divided by the NRCMS At the time of payment, the current NRCMS accumulated balance is not enough to pay for one year of serious illness medical insurance expenses; when the MSW insurance coverage line is the NCMS captive line, the NRCMS cumulative balance can only be used to pay 2 ~ 3 years of serious illness medical insurance costs; even if each year from the NCMS fund-raising amount of a certain percentage of funds as a serious illness medical insurance will also affect the payment of basic medical expenses of farmers, not to mention to pay for serious illness and medical expenses. If the government and peasants are considered as co-financing, when the per capita funding level is 1% -4.5% of the per capita net income of peasants, the stability of the sources of funds can be guaranteed.