中国卫生事业管理2025，Vol.42Issue(10)：1126-1130,5.
上海市城镇职工基本医疗保险保障水平的适度性研究:实际补偿比视角
Research on The Moderation of The Basic Medical Insurance Security Level for Urban Employees in Shanghai From The Perspective of Actual Compensation Ratio
摘要
Abstract
Objective To measure the moderation of the basic medical insurance security for urban employees in Shanghai from the perspective of actual compensation ratio,and propose optimization suggestions for its development.Methods By designing the moderation level of the insurance security level,and using the actual compensation ratio calculation model based on the combination of the number of medical visits and the number of insured individuals,the moderation level of the basic medical insurance for urban employees in Shanghai from 2011 to 2023 was analyzed.Based on which,the GM(1,1)model was used to predict the trend of the actual compensa-tion ratio from 2024 to 2033,and calculate the future moderation status of the insurance security level.Results From 2011 to 2023,the actual compensation ratio of Shanghai's urban employee medical insurance rose from 61.18％to 81.85％,remaining at the"moderately adequate"level as defined in this study,which met the principle of"ensuring basic needs"and indicated the sustainability of the medi-cal insurance fund.It is predicted that from 2024 to 2033,the actual compensation ratio will increase from 75.33％to 91.78％,with an average annual growth rate of 2.22％,entering the"highly adequate"level and achieving a state of sufficient coverage.The out-of-pocket medical expenses for insured individuals will be relatively low.Conclusion In the next ten years,the actual compensation ratio of Shanghai's urban employee medical insurance will gradually increase,and the growth rate of fund expenditure will continue to be higher than that of total medical expenses,raising the sustainability risk of the medical insurance fund.It is suggested to establish a dynamic and resilient moderate level of protection,optimize the reform of medical insurance payment methods,build a multi-level medical secu-rity system,and strengthen the intelligent early warning and risk management of medical insurance funds,which can further promote the sustainable and high-quality development of urban employee medical insurance.关键词
城镇职工基本医疗保险/保障水平/适度性/实际补偿比/GM(1,1)模型Key words
urban employee basic medical insurance/security level/moderation/actual compensation ratio/GM(1,1)model分类
医药卫生引用本文复制引用
林小婷,李红艳..上海市城镇职工基本医疗保险保障水平的适度性研究:实际补偿比视角[J].中国卫生事业管理,2025,42(10):1126-1130,5.基金项目
国家社会科学基金项目"多层次医疗保障的政策效应与协同发展的整体性治理研究"(24BSH096) （24BSH096）
