《保险研究》20250806-《从“定额”到“定比”：居民医保筹资机制优化研究——基于筹资可负担性与公平性的验证》（谢明明、贾铮、朱铭来）

［摘   要］优化居民医保筹资机制是缓解制度内公平性矛盾、提升基金可持续性的关键举措。本文基于“以支定收”原则，运用ILO模型的成本估计模型测算8个省级统筹地区居民医保筹资规模，根据个人与财政不同负担比例方案下的均衡费率，结合各收入组的平均收入得出各收入组在不同方案下的个人缴费标准，并评估定比筹资模式下居民医保筹资的可负担性与公平性。研究发现：定比筹资模式可以显著降低低收入组的缴费负担，增强较高收入人群的缴费责任；定比筹资模式有效缓解了不同地区之间由经济发展、医疗水平等因素导致的负担不公；定比筹资模式下，政府的财政补助可以控制在可负担范围内；定比筹资模式提高了医保筹资的纵向公平性，且具有调节收入分配的正向功能。因此，建议建立基于收入水平的居民医保缴费基数确定机制、“以支定收”导向的居民医保筹资机制和财政与个人责任分担比例设定为动态可调的弹性机制。

［关键词］城乡居民基本医疗保险；筹资机制；可负担性；再分配效应

［基金项目］国家社会科学基金青年项目“相对贫困视角下医疗保障化解支出型贫困的机理与政策优化研究”（20CSH029）。

［作者简介］谢明明，郑州大学商学院副教授、硕士生导师，研究方向：卫生经济与医疗保障；贾铮，郑州大学商学院硕士研究生，研究方向：卫生经济与医疗保障；朱铭来（通讯作者），南开大学卫生经济与医疗保障研究中心主任，南开大学金融学院教授、博士生导师，研究方向：卫生经济与医疗保障。

From “Fixed Quota” to “Fixed Ratio”：Optimizing the Financing Mechanism of China’s Basic Medical Insurance for Residents—Empirical Validation of Financing Affordability and Fairness

XIE Ming-ming，Jia Zheng，ZHU Ming-lai

Abstract：Optimizing the financing mechanism of the basic medical insurance for residents is a key measure to alleviate internal equity disparities and enhance the sustainability of the fund. Based on the “expenditure-determined revenue” principle，this study applied the ILO’s cost estimation model to calculate the financing scale of the Basic Medical Insurance for Urban and Rural Residents in eight provincially pooled regions. Using the equilibrium contribution rates under different personal and government contribution schemes，and combining them with the average income of each income group，the individual contribution standards across different schemes were derived. The study further evaluated the affordability and fairness of the resident medical insurance financing under a fixed-ratio （income-linked） contribution model. The findings indicate that：the fixed-ratio contribution model significantly reduces the contribution burden for low-income groups while enhancing the contribution responsibility of higher-income groups;the model effectively mitigates inequities in distribution across regions with varying levels of economic development and healthcare provision;under the fixed-ratio model，government fiscal subsidies can be maintained within an affordable range;the model improves the vertical equity of medical insurance financing and exerts a positive effect on income redistribution. Based on these conclusions，the study proposes policy recommendations including setting scientifically reasonable contribution bases，establishing flexible adjustment mechanisms for contribution standards，and expanding financing channels.

Key words：Basic Medical Insurance for Urban and Rural Residents;financing mechanism;affordability;redistribution effect