The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China's urban and rural residents' medical insurance.
Fund sustainability
Rapidly ageing
Universal two-child policy
Urban and rural residents’ basic medical insurance (URRBMI)
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
22 07 2021
22 07 2021
Historique:
received:
15
04
2021
accepted:
18
06
2021
entrez:
23
7
2021
pubmed:
24
7
2021
medline:
6
8
2021
Statut:
epublish
Résumé
With the rapid growth of the ageing population, the operating burden of China's basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. We used an actuarial science method and took the urban and rural residents' basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.
Sections du résumé
BACKGROUND
With the rapid growth of the ageing population, the operating burden of China's basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability.
METHODS
We used an actuarial science method and took the urban and rural residents' basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds.
RESULTS
Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed.
CONCLUSIONS
The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.
Identifiants
pubmed: 34294053
doi: 10.1186/s12889-021-11367-7
pii: 10.1186/s12889-021-11367-7
pmc: PMC8297716
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1444Informations de copyright
© 2021. The Author(s).
Références
Health Policy. 2018 Jul;122(7):693-697
pubmed: 29729906
J Aging Health. 2016 Oct;28(7):1119-23
pubmed: 27590794
Int J Equity Health. 2017 Feb 27;16(1):39
pubmed: 28241826
PLoS One. 2018 Dec 19;13(12):e0209285
pubmed: 30566513
Soc Sci Med. 2020 Nov;265:113513
pubmed: 33199036
Int J Health Plann Manage. 2020 Jan;35(1):152-161
pubmed: 31270860
J Popul Econ. 1992 Nov;5(4):319-41
pubmed: 12285683
Health Policy. 2019 Aug;123(8):695-699
pubmed: 31208825