People's Daily health client Zhang Meng
"The results of the seventh national census show that the trend of the mainland population being small and the aging is accelerating. The population is small and child-bearing, and the aging population not only poses a challenge to the sustainability of the pension insurance system, but also becomes a major factor affecting the sustainability of the medical security system. During this year's two sessions, Zheng Bingwen, member of the National Committee of the Chinese People's Political Consultative Conference and director of the World Social Security Research Center of the Chinese Academy of Social Sciences, suggested accelerating the preservation and appreciation of medical insurance funds.
Director Zheng Bingwen
On March 4, the National Medical Insurance Bureau released the "2021 Medical Security Development Statistical Express", showing that in 2021, the total income and total expenditure of the basic medical insurance fund (including maternity insurance) were 2871.028 billion yuan and 2401.109 billion yuan, respectively, and the cumulative balance of basic medical insurance (including maternity insurance) at the end of the year was 3612.154 billion yuan.
However, its preservation and appreciation still implements the 1998 Decision of the State Council on the Establishment of a Basic Medical Insurance System for Urban Workers, which stipulates that the funds raised in the current year shall be interested at the interest rate of demand deposits, and the accumulated balances of the past years shall be calculated according to the interest rate of the 3-year zero deposit and withdrawal savings deposit.
"According to the current rmb deposit benchmark interest rate of Chinese Min min bank, the 3-year zero deposit and round-up interest rate is only 1.3%, which is significantly lower than the CPI of 2.46% average in recent years, which is in a state of depreciation, which aggravates the unsustainability of the medical insurance fund." Zheng Bingwen stressed that in contrast, the basic endowment insurance for urban workers was entrusted to the National Social Security Fund Council in 2017 for market-oriented professional investment, and the average yield in the four years from 2017 to 2020 was 6.94%, which better achieved the goal of value preservation and appreciation. If the medical insurance fund implements the same investment strategy, theoretically, it can increase by about 170 billion yuan in 2020 alone.
According to the data of the "2020 National Medical Security Development Statistical Communiqué", among the basic medical insurance costs of urban workers, the total cost of medical institutions in the country in 2020 is 1,128.1 billion yuan, of which the medical expenses of active employees are 459.8 billion yuan and the medical expenses of retirees are 668.3 billion yuan. In contrast, the number of active employees insured is 254.2 million, while the number of retired employees is only 0.903 million, and the ratio of active employees to retirees is 2.82:1, but the ratio of expenses incurred is 0.69:1.
In other words, of the 344.6 million insured persons in the employee health insurance system, retirees account for only 26%, but the costs incurred are 59%. The number of people aged 60 and over in 2020 is 264 million, and according to the United Nations' "high forecast", it will increase by about 100 million by 2030 to 364 million.
"The surge in the number of retirees will inevitably drive a significant increase in medicare fund spending, and the sustainability of the healthcare system will face a severe test." Zheng Bingwen pointed out that according to the forecast data provided by the "100 Questions on the Study counseling of the Fifth Plenary Session of the 19th Central Committee of the Communist Party of China" published by the Learning Publishing House and the Party Building Reading Publishing House in November 2020, the cumulative deficit of the enterprise employee medical insurance pool fund will appear in 2024.
In order to cope with the huge pressure brought by the aging of the population and the aging of the population to the expenditure of the medical insurance fund, the "Medical Security Law (Draft for Comments)" released by the State Medical Insurance Bureau to the whole society in June 2021 proposed that "the medical security fund shall, under the premise of ensuring safety, invest and operate in accordance with the provisions of the State Council to achieve value preservation and appreciation." ”
Zheng Bingwen said that the legislation proposed by the central government on the investment and operation of medical insurance funds to achieve value preservation and appreciation is very timely and very necessary.
According to the current uneven status quo of the two systems and overall planning levels of urban and rural workers' medical insurance and urban and rural residents' medical insurance in the mainland, in order to accelerate the preservation and appreciation of the medical insurance fund and maximize the sustainability of the medical insurance system, Zheng Bingwen suggested that starting from the implementation of the "Medical Security Law", before the medical insurance fund deficit in 2024, three different reform models should be implemented for three different types of situations, so that these three types of reform models can cover both urban and rural levels of the national medical insurance system:
First, the basic medical insurance fund for urban and rural residents and the basic medical insurance fund for urban workers who have not yet achieved the provincial overall planning level have implemented "agreement deposits" and carried out a thorough reform of "3-year zero deposit and consolidation". In this way, the average interest rate level can reach about 3.0%, which is at least 1.7 percentage points higher than the current level.
Second, provinces that have achieved provincial co-ordination but have a smaller fund size can learn from the model of US bond investment and purchase medical insurance balance funds by issuing special government bonds to maintain and increase value.
Third, provinces that have achieved provincial overall planning and a large fund scale can learn from the investment model of the basic pension insurance fund, and the provincial government can entrust the national social security fund council to invest, and can also learn from the way of occupational annuity, and the provincial government can select professional investment institutions to invest.
"In short, regardless of the type of reform model, especially during the epidemic period, local governments should retain 6 months of payable liquidity to ensure that the security of medical security payment capacity is foolproof." Zheng Bingwen stressed.
