陕西省职工医保统筹基金中期风险研究

发布时间：2019-04-17 05:50

【摘要】：本文从陕西省职工基本医疗保险基金发展运行背景出发,总结出影响职工医保基金收入支出的因素。进而以2009年-2015年统筹基金运行现状数据为基础构建统筹基金收支模型,使用SPSS19.0进行模型参数预测,测算出到2020年统筹基金的收支、结余情况。以测算得出的2016年-2020年统筹基金收支情况为主,联合2009年-2015年统筹基金的收支现状得出在经济增速放缓、老龄化程度加剧、医疗费用不断增长的三重压力之下,统筹基金即将发生收不抵支的风险。主要风险为:统筹基金当期结余不足而累积结余过高,基金既面临当期支付不足的风险又有保值增值的压力;统筹基金的收入增速明显低于支出增速,未来面临收不抵支的风险;统筹基金与个人账户比例结构不合理的问题。针对这些问题文章最后从基金的收入方面提出深挖扩大参保面、拓宽筹资渠道、尝试建立省级调剂金等建议;从统筹基金的支出方面提出完善分级诊疗、基层首诊制度,推行混合医疗保险支付模式,加强监管、防止过度医疗等建议;从基金管理方面提出建立科学的预算管理。
[Abstract]:Based on the background of the development and operation of the basic medical insurance fund in Shaanxi Province, this paper summarizes the factors that affect the income and expenditure of the medical insurance fund of the staff and workers. Then, based on the data from 2009 to 2015, the income and expenditure model of the co-ordinated fund is constructed, and SPSS19.0 is used to forecast the parameters of the model to calculate the income and expenditure and balance of the overall fund by 2020. Based on the estimated income and expenditure of the 2016-2020 co-ordinated fund, combined with the current situation of the 2009-2015 co-ordinated fund, it is concluded that under the triple pressure of slowing economic growth, increasing aging, and increasing medical expenses, The co-ordinated fund is about to have the risk that the income will not exceed the expenditure. The main risks are as follows: the current balance of the co-ordination fund is insufficient and the accumulated balance is too high, and the fund is faced with the risk of insufficient current payment and the pressure of maintaining and increasing the value; The income growth rate of the co-ordinated fund is significantly lower than that of the expenditure growth rate and faces the risk of not exceeding expenditure in the future; the unreasonable structure of the overall fund and individual accounts. In view of these problems, the paper finally puts forward some suggestions from the income aspect of the fund, such as expanding the insurance coverage, widening the financing channels and trying to establish the provincial-level dosing fund and so on. From the aspect of co-ordinating the expenditure of the fund, some suggestions are put forward, such as perfecting the level diagnosis and treatment, the primary consultation system, carrying out the mixed medical insurance payment mode, strengthening the supervision and preventing the excessive medical treatment, and putting forward the establishment of scientific budget management from the aspect of the fund management.
【学位授予单位】：西北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

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