社会医疗保险基金的抗风险韧性与可持续能力关乎制度运行。2020年初暴发的新冠肺炎疫情,客观上为讨论我国社会医疗保险应对重大突发公共卫生事件的能力和相应的制度建设提供了契机。论文构建城镇职工医疗保险和城乡居民医疗保险基金精算模型,考察患者救治费用对武汉市医保基金可持续性的影响,并选择人均可支配收入处于不同区间的其他5个省会城市,模拟分析同等规模的突发公共卫生事件对其医保基金的冲击。结果显示,疫情对医保基金可持续性的冲击主要集中在短期,职工医保基金的可持续性不会受到显著影响,居民医保基金的风险承受能力则相对不足。若不考虑常规医保基金支出可能出现的递延特征、医疗救助体系作用及2018年之前的基金累计结存,2020年武汉市和模拟分析中的3个城市的居民医保基金或因同等规模公共卫生事件出现当期赤字。基于研究结论,要提升我国医保制度风险承受能力和可持续能力,应推进省级统筹,建立中央调剂金制度和应急储备金制度,并完善公共卫生治理多元分担机制。

The sustainability and risk resilience of the insurance fund are crucial to the functioning of the social health insurance system. The outbreak of COVID-19 in early 2020 has stimulated discussion on the capacity of China's social health insurance to deal with major public health emergencies and on the construction of relevant systems. This paper constructs an actuarial model of health insurance fund for urban workers and for urban and rural residents, explores the impact of the COVID-19 patient treatment costs on the sustainability of Wuhan's health insurance fund, and selects five other provincial capital cities with different ranges of per capita disposable incomes to simulate and analyze the impact of COVID-19 on their health insurance funds. The results show that the impact of the epidemic on the sustainability of the health insurance fund is mainly concentrated in the short term, specifically, sustainability of the social health insurance fund for urban workers will not be significantly affected, but the resilience of the health insurance scheme for urban and rural residents is weak. Without taking into account the possible deferred health expenditures, the urban and rural residents' scheme in Wuhan and the other three cities in the simulation analysis will have current deficits in 2020 due to COVID-19 although not big enough to affect the fund's long-term balance. In addition, the government's financial burden of medical expenses is heavy, with the overall share of costs ranging from 33.19% to 37.07%. In order to improve the resilience and sustainability of China's health insurance system, it is suggested to promote the provincial-level pooling of health insurance, establish central adjustment fund and emergency reserve fund for health insurance, and improve collaborative governance in public health.