《保险研究》20201104-《扩大长期护理保险试点对我国城镇职工医保基金可持续性的影响》（荆涛、邢慧霞、万里虹、齐铱）

［摘   要］我国目前试点城市长期护理保险制度中的筹资及支付机制主要采用依托基本医疗保险的做法,其稳定性、持续性、准确性及可行性将直接影响城镇职工医保基金的可持续性。本文基于医疗保险精算平衡理论,通过构建动态精算模型,模拟了扩大长期护理保险试点对我国城镇职工医疗保险基金运行的影响。研究发现:在长期护理保险试点推广前,有3个试点省市将在2025年前后医保基金累计结余出现赤字,但可持续性不会受到严重影响；17个长期护理保险试点在所属的15个省、市全面推广的情况下,预计到2025年,将至少有6个省市医保基金累计结余出现赤字,赤字总额可能高达4898.4亿元,全国基金累计结余将比试点推广前减少28944.5亿元,将直接影响职工医保基金的可持续性运行；加大自付比例会降低职工医保基金的赤字风险,合理自付比例约为30%。基于结论,提出逐步实现长期护理保险制度独立设险、独立筹资以及设计完善的支付补贴体系等政策建议。

［关键词］长期护理保险；医保基金；筹资；支付；可持续性

［基金项目］教育部人文社会科学研究规划基金项目“人口移出老龄化背景下我国农村失能老年人‘居家扶助型’养老模式研究”(16YJA840004)；中国人民大学科学研究基金重大规划项目“健康老龄化视域下的中国老年照护体系研究”(17XNLG08)。

［作者简介］荆涛,对外经济贸易大学保险学院教授,博士生导师；邢慧霞,对外经济贸易大学保险学院博士；万里虹,经济学博士,高级经济师,现供职于中国人寿保险股份有限公司战略规划部；齐铱,美国南加州大学社会学教授,博士生导师。

The Influence of Expanding the Pilot Program of Long-term Care Insurance on the Sustainability of Medical Insurance Fund for Urban Employees in China

JING Tao,XING Hui-xia,WAN Li-hong,QI Yi

Abstract：The financing and payment models of long-term care insurance program in pilot cities in China mainly follow the practices of the basic social medical insurance program.Its stability,sustainability,accuracy and feasibility will directly affect the sustainable development of the urban employee medical insurance fund.Based on the actuarial equilibrium theory of medical insurance,this paper simulated the impact of expanding the pilot program of long-term care insurance on the operation of the social medical insurance fund for urban employees in China by building a dynamic actuarial model.The results show that:firstly,before the pilot of long-term care insurance is promoted,there will be a deficit in the accumulated balance of medical insurance fund in three pilot provinces around 2025,but the fund sustainability will not be seriously affected;secondly,when the 17 long-term care insurance pilot programs are fully launched in 15 provinces and cities,it is estimated that by 2025,at least 6 provinces and cities will have a deficit in the accumulated balance of the social medical insurance fund,and the total deficit may run as high as 489.84 billion yuan,and the accumulated balance of the national fund will be reduced by 2894.45 billion yuan compared with that before the pilot expansion,which will directly affect the sustainable operation of the employee medical insurance fund;thirdly,increasing the proportion of out-of-pocket payment will reduce the fund′s deficit risk,and the reasonable self-payment ratio is about 30%.Based on the above conclusions,this paper put forward some policy suggestions,such as establishing an independent insurance,independent financing and a viable payment and subsidy system for long-term care insurance.

Key words：long term care insurance;social medical insurance fund;financing;payment;sustainability