调剂金模式省级统筹风险小、易于操作且兼顾地区共济与风险管理,因此是基本医疗保险省级统筹起步阶段的常用模式。本研究基于2021年贵州省城乡居民基本医疗保险运行情况的实证数据,围绕不同调剂比例下的集中与拨付机制以及方案成效对比展开,以阐释调剂机制,明晰调剂逻辑,展示调剂效果。关于调剂金的提取,研究将调剂金分为基础调剂金和附加调剂金,基础调剂金按照5%、8%和10%的比例提取进行计算演示。关于调剂金的拨付,实行赤字调剂与考核调剂相结合的机制,在两种机制的实施过程中分别引入抚养比和地区人口老龄化率,旨在消除人口老龄化导致的地区基金负担不均的影响。通过比较三种调剂比例下的成本与效益,最终得出按5%比例提取调剂金的方案为最优方案,在此基础上总结贵州省调剂金制度的特点,并明确实施调剂金统筹的注意事项。本研究可为即将实施调剂金省级统筹制度的省市提供参照借鉴,提升改革的科学性和稳健性。

The provincial pooling of basic medical insurance under the adjustment fund mode is the best choice in the initial stage because of its low risk, easy operation, taking into account regional mutual aid, risk management. Based on the data of the2021Analysis Report on the Operation of Medical Insurance in Guizhou Province, this study designed the centralization, allocation mechanism of the adjustment fund system. By explaining the adjustment mechanism, clarifying the adjustment logic, the adjustment effect was demonstrated. Firstly, the adjustment fee is divided into basic adjustment fee, additional adjustment fee. The basic adjustment fee is extracted at the proportions of5%, 8%, 10%. Secondly, the combination of deficit adjustment, assessment adjustment is carried out, during the implementation of the two mechanisms, dependency ratio, regional population aging rate is introduced respectively to eliminate the impact of uneven regional fund burden due to population aging. Finally, after comparing the cost, benefit of adjustment under the three proportions, it is concluded that the scheme of5% adjustment fee is the optimal scheme. On this basis, the characteristics of adjustment fee system in Guizhou Province are summarized, the matters needing attention in the implementation of adjustment fee overall planning in Guizhou Province are clarified. This study can provide reference for provinces, cities that will implement the provincial pooling system of adjustment funds, improve the scientificity, robustness of the reform