城乡居民基本医疗保险筹资动态调整机制的构建
Study on Dynamic Fund Adjusting Mechanism of URHIS Financing System

随着城乡一体化进程的加速，城乡居民医保筹资调整的短期性和随意性问题日益突出。在“政府财政补贴为主、个人缴费为辅”的筹资方式下，城乡居民医保的筹资调整包括对筹资水平和筹资结构的调整，需要考虑多种复杂因素的动态影响。通过从指导原则、组成要素、调整依据、机制构建等多个方面对筹资动态调整机制进行了要素分类，认为筹资调整需要坚持稳定性、可持续性和精算平衡三大原则，调整机制应当包括调整对象、调整依据、调整频率、调整时机和调整幅度、调整权限和决策程序等组成要素。其中，如何使筹资调整“有据可依”，是解决现行筹资标准确定的主观性和随意性问题的关键。为此，综合考虑制度内部的“拉动因素”和外部社会经济环境的“推动因素”，从日常预警和定期评估两方面对调整依据进行了重点研究，并在此基础上提出了以精算机制为核心的筹资动态调整机制理论框架。
Along with the speeding up of urban-rural integration in China, the financing adjustment issues of URHIS are becoming increasingly acute. Under the present fund-raising mode of “government subsidies first, individual payment second”, financing adjustment for URHIS includes adjustment of either funding level or funding structure, and needs to consider the dynamic effect of a variety of complex factors. This paper conducts a theory study on the fund-adjusting mechanism of URHIS by analyzing the guiding principles, constituent components, adjustment basis and the construction of the mechanism. The author concludes that the adjustment needs follow principles of stability, sustainability and actuarial equivalent. The construction of adjustment mechanism should consider elements including the adjustment subject, adjustment basis, adjustment frequency and scope, adjustment permission and decision-making process, of which the adjustment basis is the key part of the mechanism to solve the problem of subjective and random determination for the financing standard. And for this the paper studies the adjustment basis specifically taking into account of routine supervision and regular evaluation with all the “pull factors” inside the system and “driving factors” in the external social and economic environment considered together. Finally, the paper proposes a theoretical framework for the dynamic financial adjustment mechanism centered around actuarial method.