我国城乡统筹居民大病保险:模式设计与模拟测算

发布时间：2019-01-22 11:40

【摘要】：本文依据社会基本医疗保险按次报销和大病保险按年度累计补偿的不同特征,设计了"再保险"、"共同保险"、"再保险之上共同保险"、"共同保险之上再保险"四种模式,以期完善我国城乡居民大病保险。进一步地,本文以"个人自付比例占医疗费用总支出的20%左右"、"避免家庭灾难性医疗支出"为制度设计目标,测算不同模式下大病保险的起付线、封顶线与补偿比例。最后,本文采用2012年中国家庭追踪调查(CFPS)数据模拟测算后发现,前述四种模式均能有效降低城乡居民家庭灾难性医疗支出的发生概率和严重程度。其中,"再保险之上共同保险"模式可将家庭灾难性医疗支出的发生概率降至0.55%,满足大病保险的设计预期。
[Abstract]:According to the different characteristics of the annual accumulative compensation between the social basic medical insurance and the major illness insurance, this paper designs "reinsurance", "co-insurance", "co-insurance on reinsurance", and "co-insurance on reinsurance". The four modes of co-insurance and reinsurance are expected to perfect the insurance of serious illness of urban and rural residents in China. Furthermore, taking "the proportion of personal self-payment to 20% of the total medical expenditure" and "avoiding the catastrophic medical expenditure of the family" as the system design goal, this paper calculates the starting line, capping line and compensation ratio of the serious illness insurance under different modes. Finally, by using the (CFPS) data of China Household tracking Survey in 2012, we find that the above four models can effectively reduce the probability and severity of catastrophic medical expenditure of urban and rural households. Among them, the "co-insurance on reinsurance" model can reduce the incidence probability of catastrophic medical expenditure to 0.55 to meet the design expectation of serious illness insurance.
【作者单位】：东南大学经济管理学院;
【基金】：国家自然科学基金资助项目(71473036) 教育部人文社会科学研究青年资助项目(14YJC630202) 江苏省社科应用研究精品工程重点资助项目(14SWA-015)
【分类号】：F842.684

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