截止2010年底，全国城镇职工基本医疗保险（以下简称“职工医保”）在职参保人员17791.2万人，退休参保人员5943.5万人，职工医保在保障职工健康方面发挥着越来越重要的作用。特别是随着《中华人民共和国社会保险法》的出台，职工医保制度以法律的形式被确定了下来。但是我国正处于人口老龄化形势严峻、速度不断加快的关键时期，人口老龄化对职工医保制度的持续发展构成了较大的威胁：（1）人口老龄化对职工医保基金收入产生负效应；（2）人口老龄化对职工医保基金支出产生正效应；（3）人口老龄化直接导致赡养危机。这些威胁将极大的影响职工医保基金的收支平衡情况，进而影响到职工医保制度的正常运行。本文从全国职工医保的制度设计和运行情况入手，紧紧把握住人口老龄化这一视角，通过对某市职工医保制度的实证分析，构建某市职工医保统筹基金收支平衡中长期预测模型，对未来10年某市职工医保统筹基金运行情况进行预测，发现职工医保统筹基金制度运行可能出现的中长期风险。最后，本文结合英国、新加坡和德国的案例，通过借鉴这三个国家在面临人口老龄化等类似情况的改革经验，为我国职工医保统筹基金未来的制度设计和改革探讨对策。通过对职工医保制度的实证分析，本研究发现职工医保制度面临一些威胁：（1）趸交资金造成基金结余“虚假”现象；（2）单位缴费划个人账户比例“攀升”；（3）统筹基金分担比例“冒顶”；（4）人口老龄化的影响隐性发展。同时也有积极的一面：（1）“三统一”理顺关系，医保覆盖“全市”并进入“全家”；（2）政策引导就医行为，减少了住院需求；（3）医保机构权威性和监督能力有所提高。通过对职工医保基金的中长期预测，本研究发现：（1）现行制度中期表现不佳；（2）现行制度长期表现很差，面临巨大的收支不平衡压力。通过制度设计模拟，本研究发现：（1）降低企业缴费计入个人账户比例有助于缓解统筹基金收支不平衡压力；（2）通过投资等手段提高累计结余统筹基金运营收益率对于改善基金收支平衡情况作用不大；（3）通过控制医疗行为等方式控制参保人员人均年统筹基金支出增长率能从根本上保证基金中长期收支平衡。通过对英国、新加坡和德国案例的研究，本研究发现有一些好的国际经验值得借鉴：（1）提高退休年龄的方法；（2）引入竞争借助市场的力量；（3）个人储蓄金额的安全投资运作以实现保值增值。
By the end of 2010, 177.9 million in-service workers and 59.4 million retired workers participated in the national basic medical insurance for urban workers, the basic medical insurance for urban workers is playing a broader role in protecting the health of workers. With the introduction of the Social Insurance Law of the People's Republic of China, the basic medical insurance system for urban workers was determined in the legal form. But the aging situation of our country is very severe, besides the pace of aging is accelerating. In such a critical period, the aging of the population constitutes a greater threat to the sustainable development of the basic medical insurance system for urban workers: (1) The aging of the population has a negative effect on the income of the basic medical insurance fund for urban workers; (2) The aging of the population has a positive effect on expenditures of the basic medical insurance fund for urban workers; (3) The aging of the population directly results in the maintenance crisis. These threats will be a great impact on the balance of payments of the basic medical insurance fund for urban workers, thereby affecting the normal operation of the basic medical insurance system for urban workers.This study reseaches on the design and operation of the basic medical insurance for urban workers as an entry point, and firmly grasp the perspective of an aging population.This study investigates the system operation through empirical analysis of the basic medical insurance system for urban workers in Chengdu, and then build Chengdu long-term forecasting model of the basic medical insurance pool fund for urban workers based on the existing system arrangements. Forcasting the operation of the basic medical insurance pool fund for Chengdu urban workers of the next 10 years forecast, this study found that in the medium term the pool fund may keep in balance, but in the long term, risk will occur. Finally, this study combined with the case of the United Kingdom, Singapore and Germany, by learning from the reform experience of the three countries in the face of the aging population in similar circumstances to explore countermeasures for the future system design and reform of China's basic medical insurance pool fund for urban workers.Empirical Analysis of the basic medical insurance system for urban workers, this study found that some of the threats facing the implementation of the basic medical insurance system for urban workers: (1) Barges pay resulted in the “false” balances phenomenon of the fund; (2) The proportion from unit pay to plan personal account was “over-rising”; (3) Co-ordinate sharing ratio of the pool fund appeared “roof fall”; (4) The risk of aging population was hidden. But the system implementation process had a positive side: (1) The “unification” strengthened relations, the coverage of “the whole city” entered “the whole family”; (2) The policy guided the seeking behavior, reduced the need for hospitalization; (3) Medicare institutional authority and oversight capacity increased.By the long-term forecasting of the basic medical insurance pool fund for urban workers, this study found that: (1) The current system won’t run well in the medium term; (2) The system will face huge imbalances pressure in the long term. With the design and simulation of the normal System , this study found that: (1) Reducing the the proportion of enterprises pay to personal accounts can help ease the pressure of the pool fund imbalances; (2) By means of investment to improve the rate of return of the cumulative pool fund has little effect; (3) Through the control of medical practices to control the fund expenditure growth rate can guarantee and long-term balance of payments.Studying the case of the United Kingdom, Singapore and Germany, this study found that some good international experience is worth learning: (1) Increase the retirement age; (2) The introduction of competition with the market forces; (3) The investment operation of the personal account in order to increase their value.
