Wu Jing, Yang Hualei, Pan Xiaoqing
School of Public Administration, Yanshan University, Qinhuangdao, China.
School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China.
Health Econ Rev. 2024 Sep 18;14(1):77. doi: 10.1186/s13561-024-00554-y.
The integration of the health insurance fund pool may threaten the sustainability of the fund by increasing its expenditures through the exacerbation of the moral hazard of participations. The purpose of this paper is to assess and predict the impact of the single pool reform of China's Urban Employee Basic Medical Insurance (UEBMI) on the expenditure and sustainability of the health insurance fund.
In this paper, we consider the pilot implementation of the single pool reform in some provinces of China as a quasi-natural experiment, and develop a staggered DID model to assess the impact of the single pool reform on medical reimbursement expenditure. Based on the results, an actuarial model is developed to predict the impact on the accumulated balance of China's health insurance fund if the single pool reform is continued.
We found that the medical reimbursement expenditure would increase by 66.4% per insured person after the unified provincial-level pool reform. There is individual heterogeneity in the effects of the unified single pool reform on medical reimbursement expenditure, and the reimbursement expenditure of retired elderly has the largest increase. If the unified single pool reform is gradually promoted, the current and accumulated balance of the UEBMI pooling fund would have gaps in 2031 and 2042, respectively.
We verified that a larger fund pool will bring unreasonable growth of fund expenditures, which will threaten the sustainable development of health insurance. To minimize the impact of the unified single pool reform on the sustainability of the health insurance fund, we suggest strengthening the monitoring of moral hazard behavior, promoting the delayed retirement system, and encouraging childbearing.
医疗保险基金统筹可能会通过加剧参保者的道德风险增加支出，从而威胁基金的可持续性。本文旨在评估和预测中国城镇职工基本医疗保险（UEBMI）的统账结合改革对医疗保险基金支出和可持续性的影响。
本文将中国部分省份统账结合改革的试点实施视为一项准自然实验，构建交错双重差分模型评估统账结合改革对医疗报销支出的影响。基于结果，建立精算模型预测若继续推进统账结合改革对中国医疗保险基金累计结余的影响。
我们发现省级统筹改革后，人均医疗报销支出将增长66.4%。统账结合改革对医疗报销支出的影响存在个体异质性，退休老年人的报销支出增长幅度最大。若逐步推进统账结合改革，UEBMI统筹基金的当期结余和累计结余将分别在2031年和2042年出现缺口。
我们证实了更大的基金统筹会带来基金支出的不合理增长，这将威胁医疗保险的可持续发展。为尽量减少统账结合改革对医疗保险基金可持续性的影响，我们建议加强对道德风险行为的监测，推进延迟退休制度，并鼓励生育。
