Research On Factors Affecting The Balance Of Individual Accounts Of Urban Employees' Basic Medical Insurance And The Rationalization Of Balance Level

The basic medical insurance system for urban employees in China was formally established in 1998,using a combination of a unified account and a individual accounts.Over the years,individual accounts have accumulated a large amount of funds.By the end of 2017,the accumulated balance of individual accounts totaled 615.2 billion yuan.Experts expect that their growth momentum will remain unchanged in the next few years.However,from the perspective of the total amount,the balance of the individual accounts of urban workers,nedical insurance in China is very high,but there is a structural imbalance in the balance level.The balance level is unevenly distributed and even differentiated,such as between regions,young people and the elderly.There is a significant difference in the balance level.On the one hand,the individual accounts with high balance level has excessive accumulation of funds,and the flunds have not been transformed into current services to protect people,s health.Unlike the old-age insurance system,the medical insurance system should promote a moderate balance.However,China does not currently have an upper limit on the level of individual accounts balances.On the other hand,insufficient balance means that the income of the individual account is iiot enough to cover the current year's expenditure.The insured is faced with the problem of not meeting the medical needs.Although the accumulated balance of the individual accounts can be used to make up for the gap,it is lacking.For the specific provisions of the accumulated balance of individual accounts should be maintained,the accumulated balance of payment time is uncertain,and the future payment risk faced by employees is also uncertain.Therefore,it is necessary to empirically analyze the factors affecting the balance of individual accounts,build a model based on theoretical analysis,quantitatively detenmine the impact of various factors on individual account balances,and predict the trend of individual account balance levels and set up individual accounts.The balance range provides scientific indicator selection and parameter setting criteria.At the same time,it helps to adjust the balance of individual accounts in a timely and accurate manner when relevant factors change.Taking Shanghai as an example,this paper focuses on the relevant factors such as the average wage level,outpatient expenses,and changes in the number of employees participating in the insurance,the changes in the income and expenditure of individual medical insurance for employees in Shanghai from 2018 to 2040,and predicting individual accounts in Shanghai.At the time when the balance of income and expenditure gap appeared in the current year,the accumulated balance showed a negative value,and then the critical point of the rationalized balance level was found.The study found that the cumulative monthly balance of individual accounts in Shanghai should be at least 7.3 months.Below this standard,there is a high probability that the accumulated balance of-individual accounts in Shanghai will be negative,and the interests of employees insured are at risk of darnage.The appropriate balance of the individual accounts in Shanghai can be paid for the number of months to meet the policy.The cumulative balance of the urban employees' basic medical insurance fund can be paid for 6-9 months,and for Shanghai,7.3 months is the lower limit requirement for the better maintenance of medical insurance needs of employees.As for the upper limit,the excessive accumulation of individual accounts balances is not advocated.The principle should be based on the principle of moderate balance.The recommended upper limit is set to 9 months.At the same time,it is necessary to pay attention to the adjustment of the balance range according to the actual situation in different regions.The study is divided into the following six parts:Chapter One.Introduction.This paper introduces the background and significance of the topic selection.Based on the review of domestic and foreign literatures,the research methods and ideas are determined,and the innovations and deficiencies are explained.The second chapter is the basic concept of the important fund raising model of individual accounts and the theoretical basis for its establishment.The individual accounts mechanism is discussed in combination with the basic medical insurance supply and demand theory of urban employees,the principle of individual accounts financing and treatment payment,and the partial accumulation system of individual accounts and the theory of risk transfer across time.The third chapter analyzes the balance of the individual accounts of urban workers' medical insurance in China.Firstly,based on the national data,the overall balance level of-inciividual accounts is described,and the trend of the proportion of individual accounts in the employee medical insurance funds is analyzed.Then,from the spatial level,the balances of individual accounts balances in different regions are compared and analyzed,and the reasons for the differentiation of balance levels in different regions are analyzed in detail.The fourth chapter analyzes the influencing factors of the individual accounts balance of urban workers' medical insurance.The panel data of 31 provinces,municipalities and autonomous regions in China were selected from 2008 to 2017,and the accumulated balance of individual accounts was used as the explanatory variable.The average salary of the employed persons in urban units,the average medical expenses for outpatients,the number of patients in outpatient cliiiics,and the staff members were selected.The rate of insurance and the ratio of old-age dependency are explanatory variables.First,using the common fixed utility model(static)for analysis,considering the large number of individual account balances,the current accumulated balance level is largely affected by the inertia of the previous cumulative balance level,and the fixed effect model is found to be neglected.The endogenous problem,that is,the secondary average cost of the outpatient service and the accumulated balance level have a two-way causal relationship,which leads to biased estimation results.Therefore,it is finally determined to use the dynamic panel model to estimate the model using the systematic generalized moment estination method.The fifth chapter is the calculation of the rationalization level of the balance of individual accounts of urban workers,medical insurance in China.Taking Shanghai as the research object,based on the principle that the moderate balances and balances maintain dynamic balance in the long run,using the data published in Shanghai from 2008 to 2017 related to individual accounts income and expenditure,on the premise of making assumptions,When investigating the average wage of employed persons in urban units in Shanghai according to the gradient growth rate,outpatient expenses,and the number of employees participating iii the insurance according to a certain growth rate,the income of the Shanghai urban employee medical insurance individual accounts in 2018-2040 in three cases,The expenditure is measured and the balance is changed.Predicting the time when the balance of the individual accounts in Shanghai has a balance of income and expenditure,the time when the accumulated balance has a negative value,and then finding the critical point of the rationalized balance level,and obtaining the current year's balance ratio and accumulated balance rate of the Shanghai individual accounts at this critical point.The sixth chapter is the policy recommendations for rationalizing the balance of the individual accounts of urban workers' medical insurance in China.First,it is recommended that the regions with developed economies and average wages be at a high level should appropriately reduce the proportion of funds allocated to individual accounts.Secondly,some provincial and municipal individual account balance levels are highly dependent on "expansion"and "expansion" and the accumulated balance of individual accounts change in the same direction.If“expansion,is stagnant,for non-contributing retirees,their individual accounts.There is a hidden danger in the continuity of fimding sources.Therefore,it is recommended to conduct a stress test on the age structure of the insured in such areas,measure the critical point of individual accounts exposure,and make timely response measures.Thirdly,for areas with severe aging,the proportion of contributions for active employees should be appropriately reduced,and the number of months in which the accumulated balance of individual accounts can be paid is controlled within the range of 6-9 months.For retired employees,increase the proportion of funds allocated to their individual accounts.Finally,combined with the "treatment of disease" theory,the scope of use of individual accounts is appropriately expanded,'and individuals with more account balances are allowed to purchase preventive services.