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目的:通过测算北京市实行三大基本医保城乡统筹后各筹资主体的可负担性,判断自由选择的医保城乡统筹模式是否可行。方法:以对北京市三年实证调查的数据为基础,结合ILO筹资模型的成本估计子模型和四部模型,测算各筹资主体的筹资额度,判断其可负担性。结果:如果实行基本医保城乡统筹,在调查年度内(2010、2012和2013年)居民个人缴费率分别为1.54%、2.45%和1.93%,远低于居民最大缴费能力;政府的筹资总额与政府实际医疗卫生筹资总额相比,需分别增加13.05亿元、21.67亿元和58.49亿元,占当年政府财政支出的比例均不到1%。结论:测算得个人与政府筹资额度具有可负担性,北京市实行三大基本医保自由选择的城乡统筹模式是可能的途径。
OBJECTIVE: To determine whether the freely-chosen medical insurance overall planning for urban and rural areas is feasible or not by measuring the affordability of each financing body after the implementation of the three basic medical insurance plans in Beijing. Methods: Based on the data from the three years of empirical investigation in Beijing, we combined the cost estimation sub-model and the four models of ILO financing model to measure the financing amount of each fund-raising subject and judge its affordability. Results: If the basic medical insurance for urban and rural areas is integrated, the personal contribution rates of residents during the survey year (2010, 2012 and 2013) are 1.54%, 2.45% and 1.93% respectively, much lower than the residents’ maximum contribution ability. The total amount of government funding and government actual Compared with the total amount of financing for health care, the total amount of funding for health care needs to be increased by 1.305 billion yuan, 2.167 billion yuan and 5.849 billion yuan respectively, accounting for less than 1% of the total government expenditure. CONCLUSION: It can be estimated that individual and government funding levels are affordable, and Beijing’s implementation of the three basic modes of urban and rural planning that are free to choose health insurance is a possible way.