Research on the Financing and Compatibility Treatment Scheme of Urban Employee' Basic Medical Insurance Provincial Pooling

China Health Insurance ›› 2022, Vol. 0 ›› Issue (10) : 43-53.

China Health Insurance ›› 2022, Vol. 0 ›› Issue (10) : 43-53. DOI: 10.19546/j.issn.1674-3830.2022.10.009
Practice & Investigation

Research on the Financing and Compatibility Treatment Scheme of Urban Employee' Basic Medical Insurance Provincial Pooling

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Abstract

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.

Key words

urban employee basic medical insurance / provincial pooling / unified collection and allocation mode / financing criteria / treatment level

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Research on the Financing and Compatibility Treatment Scheme of Urban Employee' Basic Medical Insurance Provincial Pooling[J]. China Health Insurance. 2022, 0(10): 43-53 https://doi.org/10.19546/j.issn.1674-3830.2022.10.009

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