Department of Public Administration, School of Management, Jiangsu University, Zhenjiang, China.
BMC Public Health. 2021 Jul 22;21(1):1444. doi: 10.1186/s12889-021-11367-7.
With the rapid growth of the ageing population, the operating burden of China's basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability.
We used an actuarial science method and took the urban and rural residents' basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds.
Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed.
The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.
随着人口老龄化的快速增长，中国基本医疗保险基金的运行负担越来越重。为应对人口快速老龄化和一系列问题，中国多次调整生育政策。2016 年 1 月 1 日，全面二孩政策实施。本研究分析了生育政策调整和生育意愿提高对参保人群和医疗保险基金可持续性的影响。
我们采用精算学方法，以覆盖大部分城乡居民的城乡居民基本医疗保险（URRBMI）为例，构建人口增长动态预测模型和医疗保险基金动态精算模型。
与原政策相比，在当前生育意愿（40%）下实施普遍二孩政策后，URRBMI 参保人群的人口结构老龄化程度将在 2026 年后显著下降，2050 年 65 岁及以上人口将仅占参保总人数的 19.01%。URRBMI 基金的当期亏空和累计亏空将分别推迟一年至 2022 年和 2028 年。如果生育意愿持续上升，人口结构老龄化程度将降低，亏空将进一步推迟。
普遍二孩政策有利于降低人口老龄化程度，推迟 URRBMI 基金亏空发生，提高 URRBMI 基金可持续性。如果生育意愿增加，效果将更强。但是，由于普遍二孩政策的调整存在一定的时滞，需要一定的时间来证明这一影响。因此，在积极推进普遍二孩政策的同时，还应采取其他措施，如提高育龄夫妇的生育意愿，改革医疗保险支付方式。
