社会保障评论2025，Vol.9Issue(4)：105-123,19.
分层分类模式下医疗救助支出预测与政策优化
Expenditure Prediction and Policy Optimization of Medical Assistance under a Tiered and Categorized Model
摘要
Abstract
In the post-poverty-eradication era,medical assistance in China faces dual policy objectives:expanding coverage and improving efficiency.These goals call for more refined and targeted policy adjustments.This study combines macro-level data with micro-level data from the China Household Finance Survey(CHFS)to identify and forecast the number of medical assistance recipients under the tiered and categorized model from 2024 to 2035.Based on two major components-insurance premium subsidies and medical expense subsidies-the authors construct a forecasting model to estimate future expenditures for different recipient groups.The paper then proposes three policy optimization strategies:adjusting eligibility criteria,enhancing the integrated protection of the three-tier medical security system,and rebalancing the structure of outpatient and inpatient assistance.It further evaluates the impact of each parameter adjustment on overall funding needs and fiscal burden.The results suggest that while the number of recipients will gradually decline,total medical assistance expenditures are expected to continue rising.The most influential factors on spending include the coverage level of basic medical insurance and critical illness insurance,whether general outpatient assistance is implemented,hospitalization rates,and the growth rate of medical costs.Systematic adjustment of these parameters is essential to achieving sustainable and balanced medical assistance policy outcomes.关键词
医疗救助/分层分类救助/救助对象识别/支出预测Key words
medical assistance/tiered and categorized assistance/identification of recipients/expenditure prediction引用本文复制引用
周佳卉,朱铭来..分层分类模式下医疗救助支出预测与政策优化[J].社会保障评论,2025,9(4):105-123,19.基金项目
国家医疗保障局委托项目"健全重特大疾病医疗保险和救助制度实施情况总结评估". （）
