推进医疗保险实现省级统筹是提高基金抗风险能力,解决医疗保障领域发展不平衡、不充分问题的重要举措。本研究基于2020年和2021年贵州省基本医疗保险基金运行数据,利用健康保险筹资模型、粗估法中的平衡系数等方法,分析贵州省职工医保统收统支模式下省级统筹的筹资标准及适配性待遇方案。研究表明,7.0%的企业筹资比率符合贵州省的筹资实务,可实现参保人受益水平和企业缴费负担之间的平衡。在7.0%的筹资水平下,35个待遇方案中共有15个政策合格方案,其中包含3个最佳平衡方案和12个基本平衡方案。本研究可提高职工医保省级统筹事业的科学性和稳健性,为医保管理部门解决省级统筹的筹资和待遇测算问题提供逻辑理路、实证资料和政策参考。

Provincial pooling of medical insurance is an important measure to improve the fund's anti-risk ability and solve the unbalanced and inadequate development of medical insurance. Based on the operation data of the basic medical insurance fund in Guizhou Province in 2020 and 2021, this study analyzes the compatibility between the financing standards of provincial pooling and the treatment plan under the form of unified collection and expenditure of employee medical insurance in Guizhou Province by the health insurance financing model and the balance coefficient in the rough estimation method. The results show that the financing ratio of 7.0% is in line with the financing practice of Guizhou Province, which can achieve the balance between the benefit level of the insured and the burden of the enterprises. At the 7.0% financing level, there are 15 qualified schemes among the 35 treatment schemes, among which there are 3 optimally balanced schemes and 12 basically balanced schemes. This study can improve the scientificity and robustness of the provincial pooling of medical insurance for employees, and provide a logical way, empirical data and policy reference for the medical insurance management departments to carry out the financing and treatment of the provincial pooling.