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544px;text-align:justify;white-space:normal;background-color:#FFFFFF;'>The "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System" clearly stated that it is necessary to "improve the financing sharing and adjustment mechanism" and "reasonably determine the rate and make dynamic adjustments.
" For the residents' medical insurance covering more than 1 billion people across the country, the importance of improving the financing mechanism has become increasingly prominent.
Under the fixed financing mechanism shared by the government and individuals, the resident medical insurance has strong administrative characteristics in determining the financing and subsidy standards, which is mainly based on the administrative directive documents issued by governments at all levels each year, and generally lacks sufficient and reasonable professional calculations.
It is not conducive to the sustainable development of the system.
544px;box-sizing:border-box ;overflow-wrap:break-word ;">How to improve the financing mechanism of residents' medical insurance and realize dynamic adjustment? The author believes that the most important thing is to improve the actuarial mechanism of financing adjustment.
How to improve the financing mechanism of residents' medical insurance and realize dynamic adjustment? The author believes that the most important thing is to improve the actuarial mechanism of financing adjustment.
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544px;text-align:justify;white-space:normal;background-color:#FFFFFF;'> As a long-term institutional arrangement, resident medical insurance is a dynamic operating system.
544px;box-sizing:border-box ;overflow-wrap:break-word ;">Under the pay-as-you-go system, it is not only necessary to emphasize the short-term "revenue to determine expenditure and balance the income and expenditure", but also to consider the long-term sustainability of the system.
This requires consideration of the adjustment of institutional variables from the perspective of long-term actuarial balance.
Resident medical insurance is essentially a risk mutual aid mechanism just like commercial insurance.
It needs to follow the law of large numbers and actuarial principles.
544px;box-sizing:border-box ;overflow-wrap:break-word ;">Under the pay-as-you-go system, it is not only necessary to emphasize the short-term "revenue to determine expenditure and balance the income and expenditure", but also to consider the long-term sustainability of the system.
544px;box-sizing:border-box ;overflow-wrap:break-word ;">The resident medical insurance that adopts government financing as the main financing method and personal financing as a supplementary financing method mainly involves two aspects when adjusting the financing mechanism: the resident medical insurance using government financing as the main financing method and personal financing as a supplementary financing method mainly involves the adjustment of the financing mechanism Two aspects:
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544px;text-align:justify;white-space:normal;background-color:#FFFFFF;'> 544px;box-sizing:border-box ;overflow-wrap:break-word ;">The most critical part of medical insurance financing adjustment based on actuarial mechanism is to reasonably determine the basis for adjustment.
Only when there is a real "proven evidence" can the financing adjustment be institutionalized and standardized.
Starting from the characteristics of the medical insurance system, a reasonable basis for adjustment should involve two mechanisms, daily early warning and regular evaluation.
Daily early warning is based on the indicator monitoring of the daily operation of the medical insurance system.
In order to balance fairness and efficiency, the establishment of the daily early warning indicator system must consider the protection effect of the system (including actual compensation ratio, self-pay burden, incidence of catastrophic expenditure, etc.
544px;box-sizing:border-box ;overflow-wrap:break-word ;">The most critical part of medical insurance financing adjustment based on actuarial mechanism is to reasonably determine the basis for adjustment.
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