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The author:(作者)delvpublished in(发表于) 2014/1/6 10:23:28 Urban health insurance fund balance more than 760 billion from the year before to waste challenge
2012 end of town 764.4 billion yuan on basic medical insurance fund accumulated balances, the number after the disclosure, raising social concern. Many people question the balance without using an insured person on the treatment cost. Medicare balance too much? Journalist interviewed the concerned departments and experts.
Medicare savings expected to reach 10.7 months ' average pay levels, and the Government set a target of 15 months
People Department 2012 statistical figures show that the annual income of 693.9 billion urban basic medical insurance fund, spending 554.4 billion yuan. Urban basic medical co-ordinating the accumulated balance at the end of 494.7 billion yuan (76 billion yuan on basic medical insurance for urban residents in the accumulated balances), individual account accumulation of 269.7 billion yuan.
Pooling funds and personal accounts add up, cumulative balance of urban basic medical insurance to 764.4 billion yuan. However, according to the 2009 human resources and social security, the Ministry of Finance of the guidance on further strengthening the management of basic medical insurance fund, the balance of size is not excessive. The opinion made it clear to co-ordinate regional pooling funds of basic medical insurance for urban employees accumulated balances in principle should be controlled at 6-9 months average pay levels. Balances of more than 15 months total average pay levels, to balance state.
764.4 billion worth of cumulative balances, 269.7 billion yuan of personal accounts cannot be taken into account, the money held by the individual. Solidarity Fund for 494.7 billion yuan, 10.7 months for average pay levels without hitting a 15-month average pay levels and, therefore, this balance is not considered as a "balance".
Journalists look at one calendar year Department statistical bulletin found that integrated and the cumulative balance in the level of the Fund remains above average pay levels in 10 months of the year, average pay level in 2006 at 18 months, declining thereafter.
While the overall balance of size does not exceed the targets set by the Government, spending also increased year by year, but rising in absolute terms, pooling funds an annual growth in absolute value of about 70 billion yuan, an annual growth of about 30 billion yuan of individual accounts. Meanwhile, personal spending remained at more than 30% per cent of total health expenditure, and total expenditure on health per capita has exceeded growth in per capita Medicare payments and gradually widened the gap.
"Medicare savings snowball on the one hand, higher doctor fees paid by individuals on the one hand, in this case, there is need to reduce Medicare savings, increase the proportion of insured to compensate. "One industry expert said.
Balances although not small, but more should pay attention to three basic medical insurance system and regional disparities
"764.4 billion dollars seems to be a very large number, but it obscures the gap between health care regions and systems. "Assistant Director of the Medical Department of Peking University, said Wu Ming, a Professor of health economics, urban basic medical insurance fund balance rate gaps between larger, urban employees ' medical insurance, medical insurance, urban residents ncms three basic medical insurance fund balance rate gap also exists between them.
2010 Department of Statistics Yearbook showed that Guangdong Province in 2009 average pay level of the cumulative surplus of 27.4 months, balances, compared to 5.4 months in Tianjin levels, significantly lower than in Guangdong. Gap between the systems is also larger, released in 2012, residents ' healthcare, ncms cumulative savings of more than 130 billion yuan, but the part in the new rural cooperative medical Fund and Manpower has not received arrived, 2011 employee health insurance pooling funds accumulated balance has reached more than 350 billion yuan, and has a large balance of personal account.
Wu Ming says, "Medicare savings is closely related to programme design, high and low level of compensation to the insured, is one of the key factors in determining level of Medicare savings. However, it really very hard to grasp. From the perspective of managers, generally adopted a more cautious attitude. Some worry about cost overruns, design is conservative, resulting in higher savings rates. ”
And for programme design of many consider, in views under in the can found answers: "prepared Fund income budget should integrated consider local economic development level, and workers wage income level, and medical insurance coverage, and medical insurance funding proportion, factors; prepared Fund expenditures budget should integrated consider local parameter insurance personnel age structure, and disease spectrum, and medical costs growth, and medical insurance benefit surface, and guarantees level and fund balances situation, factors. "Implement" in order to support, balance and a bit of balance "of management objectives.
Experts recommend improve the co-ordination levels, reduce regional disparities and reforming system of individual accounts
From the perspective of health economics, Wu Ming believes that health insurance model design is very important, health insurance fund used to improve compensation for insured persons as much as possible, reducing the economic risk for medical expenses of insured persons, and must keep a sufficient risk fund. "The cumulative balance to achieve the 6-9 months of average pay levels, the insured person pays a high proportion of cases, is questionable. In addition, the personal accounts does not play the role of risk-sharing, with strong precipitation in the future should be reformed. ”
Wu Ming proposes to increase co-ordinating level raised from county level to the municipal level, conditional regions can advance the provincial co-ordinating, narrow the gap between regions, better use of health insurance funds. For management's integration, then integration between systems, the last three in one.
Professor School of public administration at Renmin University, the National Social Security Institute lizhen believes that personal accounts by collecting funds in the name of insurance, but insurance is a risk-sharing mechanism. "Personal accounts are not a risk sharing mechanism, earmarking only, and cannot be used in Masonic, but because too many personal accounts fees and premiums wasted resources. "Lizhen said.
Lizhen in favor of personal accounts for city "a little old" healthcare, which solves the problem of existing personal account wasting money, but can also increase "a little old" coverage, addressing urban Medicare "family system" issue.
Experts pointed out that healthcare management also should pay attention to, such as for scientific measurement programmes should, try to raise the level of compensation, personal spending fell to 30% per cent. While dealing with rising costs of health problems, the establishment of medical insurance management and use accurate predictions of an early warning system. Health care rate and cumulative balances for the current year savings rate should be a guideline.
(Original title: Medicare savings did too much? (Dark Reading))
2012年末城镇基本医疗保险基金累计结存7644亿元，该数字经披露后，引发社会关注。不少人质疑结余过多，没有用在参保人的治病花费上。医保结余是否过多？记者采访了有关部门和专家。
医保结余规模为10.7个月的平均支付水平，而政府设定的指标是15个月
人社部2012年统计公报显示，全年城镇基本医疗保险基金总收入6939亿元，支出5544亿元。年末城镇基本医疗统筹基金累计结存4947亿元(含城镇居民基本医疗保险基金累计结存760亿元)，个人账户积累2697亿元。
统筹基金和个人账户相加后，城镇基本医疗保险累计结余达到7644亿元。不过，按照2009年人力资源和社会保障部、财政部《关于进一步加强基本医疗保险基金管理的指导意见》，该结余规模并不算过多。《意见》明确，统筹地区城镇职工基本医疗保险统筹基金累计结余原则上应控制在6—9个月平均支付水平。累计结余超过15个月平均支付水平的，为结余过多状态。
在7644亿元的累计结余中，2697亿元的个人账户金额不能算在内，这部分资金由个人保管。统筹基金为4947亿元，为10.7个月的平均支付水平，没有达到15个月的平均支付水平，因此，这笔结余并不算“结余过多”。
记者翻看人社部历年统计公报发现，统筹基金中的累计结余水平一直保持在当年10个月的平均支付水平之上，2006年达到18个月的平均支付水平，此后逐年下降。
虽然总体结余规模没有超过政府设定的指标，支出水平也在逐年增长，但是绝对数不断上涨，统筹基金以每年约700亿元的绝对值增长，个人账户以每年约300亿元的规模增长。与此同时，个人卫生支出占卫生总费用的比例仍然在30%以上，而且人均卫生总费用年均增长速度超过人均医保支付增长速度，并逐年拉大差距。
“一方面医保结余在滚雪球，一方面个人支付的看病费用仍然较多，这种情况下，确实有必要减少医保结余，提高参保人的补偿比例。”一位业内专家表示。
结余数虽然不小，但更应关注三种基本医保制度间和地区间的差距
“7644亿元看起来是一个很大的数，但实际上，掩盖了我国医保体系中地区间和制度间的差距。”北大医学部主任助理、卫生经济学教授吴明说，我国地区之间的城镇基本医保基金结余率差距较大，城镇职工医保、城镇居民医保、新农合三种基本医保之间的基金结余率也存在差距。
2010年人社部统计年鉴显示，2009年广东省累计结余为27.4个月的平均支付水平，结余已过多，而天津仅为5.4个月的水平，明显低于广东。制度之间的差距也较大，2012年公布的居民医保、新农合累计结余为1300多亿元，但新农合基金在部分统筹地区已收不抵支，而2011年职工医保统筹基金累计结余已达到3500多亿元，个人账户也有大量结余。
吴明说：“医保结余与方案设计息息相关，对参保人的补偿水平高低，是决定医保结余多寡的关键因素之一。但是，这确实比较难把握。从管理者角度来看，一般采取比较谨慎的态度。一些地区担心超支，方案设计得比较保守，导致较高的结余率。”
而对于方案设计的诸多考虑，在《意见》中可找到答案：“编制基金收入预算应综合考虑当地经济发展水平、职工工资收入水平、医疗保险覆盖面、医疗保险筹资比例等因素；编制基金支出预算应综合考虑当地参保人员年龄结构、疾病谱、医疗费用增长、医疗保险受益面、保障水平和基金结余情况等因素。”实现“以收定支，收支平衡，略有结余”的管理目标。
专家建议提高统筹层次，缩小地区差距，同时改革个人账户制度
从卫生经济学角度来看，吴明认为，医保的运行模式设计非常重要，医保基金尽量多用于提高参保人的补偿比，降低参保人的医药费用经济风险，同时要留足风险基金。“累计结余是否要达到6—9个月的平均支付水平，在参保人自付比例较高的情况下，值得商榷。此外，个人账户并没有起到分担风险的作用，资金大量沉淀，将来应该改革。”
吴明建议提高统筹层次，由区县一级提高到地市一级，有条件的地区可以推进全省统筹，缩小地区之间的差距，更好地利用好医保基金。先进行管理部门的整合，然后是制度之间的整合，最后实现三保合一。
中国人民大学公共管理学院教授、社保所所长李珍认为，个人账户的资金是以保险的名义收取的，而保险是一个风险分担的机制。“个人账户不是一个风险分担机制，只能专款专用，不能共济使用，反而因为个人账户缴费过多，浪费了保费资源。”李珍说。
李珍主张取消个人账户，用于城市“一老一小”的医疗保障，这样既可以解决现存个人账户资金浪费的问题，同时也可以提高“一老一小”的保障水平，解决城镇医保“一家多制”的问题。
专家指出，医保管理的问题也要重视，比如方案应该进行科学测算，尽量提高补偿水平，个人卫生支出占比降低到30%以下。同时应对好卫生费用上涨的问题，建立医保管理和使用的精确预测预警系统。医保当年结余率和累计结余率应该有一个指导标准。
(原标题：医保结余太多了吗？(深阅读))
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