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目的:分析福建省城镇职工医保统筹基金运行状况并对风险进行预测,为医保管理部门制定防范基金支付风险政策提供依据。方法:收集2001—2012年福建省城镇职工医保各统筹地区统筹基金收入和支出数据,采用灰色系统GM(1,1)模型对各统筹地区统筹基金收入、支出进行预测。结果:各统筹地区统筹基金支出的年平均增长率都高于收入的增长率,预测从2013年开始,陆续有多个统筹地区统筹基金将出险,不够支付。结论:建议相关部门加强医疗保险基金监管力度,建立统筹基金预警平台,保证基金安全健康运行。
OBJECTIVE: To analyze the operating status of medical insurance for urban workers in Fujian Province and to predict the risks, and provide evidences for the medical insurance administrations to formulate policies to prevent fund payment risks. Methods: Collecting the income and expenditure data of the pooling fund for all the urban workers in Fujian Province from 2001 to 2012, and using the gray system GM (1,1) model to forecast the income and expenditure of the pooling funds in each pooling area. Results: The average annual growth rate of overall planned fund expenditures in all co-ordinating regions is higher than the growth rate of income. It is predicted that from 2013 onwards, there will be more co-ordinating regional co-ordinating funds that will be out of coverage and not enough to pay. Conclusion: It is suggested that the relevant departments should strengthen supervision on the medical insurance fund and establish a unified fund early-warning platform to ensure the safe and healthy operation of the fund.