城镇职工医保基金结余问题与基金费用给付模式协同研究——基于某省W区的实证研究

职工医保统筹基金的结余水平与基金所采取的费用给付模式息息相关,城镇职工医保费用给付运营模式决定着统筹基金的结余水平应当保持在什么样的水平。本文以审计人员特有的视角,利用大数据分析技术及审计成果将职工医保基金结余进一步细分为个人账户结余与统筹基金结余进行研究,通过审计研究成果与政策规定的冲突以及职工医保与城乡医保基金相互之间的比较,分析基金结余研究的关键因素,进而探讨医保统筹基金费用给付模式,并就现阶段我国执行现收现付制加弱积累制混合模式的历史原因及现实因素作进一步的深入分析,最后基于人口老龄化背景下缓解职工医保收支恶化趋势提出相应的对策与建议。

UEBMI Fund Balances in Fund Fees and Payment Mode Collaborative Study-Empirical Study Based on region W

The workersˊ medical insurance fund balance overall level of fees taken by fund payment mode is closely related to the cost of medical insurance for urban workers,the payment business model determines the level of the overall fund balance should be maintained at what level. In this paper,auditors unique perspective,the use of big data analysis techniques and the results of the audit staff health insurance fund balance is further broken down to study for the personal account balance and overall fund balances,through the audit findings and policy conflicts with the rural and urban workersˊ medical insurance and Medicare Compare mutual funds,the key factors of fund balances research,which led to research and discussion on health care costs overall fund payment models and historical reasons this stage of the implementation of the PAYG system plus weak accumulation system mixed mode and realistic factors for further in - depth analysis,based on the final aging population background alleviate the deteriorating trend in employee health insurance payments corresponding countermeasures and suggestions.