职工医保基金潜在风险及应对策略

摘要

There exists a notable structural risk in the accumulated surplus of the employee medical insurance fund.The part of one-time payment occupies 67% of the whole accumulated surplus of the fund, of which individual account funds compose 43%.As for medical consumption, the hospitalization expenditure of the retirees, who make up 36% of all the insured, accounts for 72% of the total expenditure.Provided with various risks, the connotation of development philosophy requires urgent intensification. Also, the structure of medical healthcare insurance funds ought to be optimized, and medical supervision must be strengthened.%　　职工医保基金累计结余中存在的结构性风险十分突出。某市一次性趸缴基金在医保基金累计结余中占比高达67%，个人账户基金占比达43%。在医疗消费中，占参保人员总数36%的退休人员其住院统筹支出占总支出的72%。面对诸多风险，亟待增强内涵发展理念，注重基金结构优化，加强医保监管。