摘要
企业补充医疗保险能否实现收支平衡是资金能否可持续发展的重要前提,而预测企业补充医疗保险的赔付风险是判断资金收支能否平衡的前提。为了研究油气企业稳健可持续的补充医疗保障策略,采用保险精算学的基本原理,对A油气公司企业补充医疗保险保障情况进行分病种、性别及人员状态的精算模型构建,进而对单病种发病率、单病种次均赔付额、参保人数进行参数测算,预测补充医疗资金赔付风险,以期为相关政策的制定提供依据。研究结果表明:①从职工年龄结构来看,虽然总参保人数维持在一个较为稳定的数量,但随着老龄化进程加速,退休人数呈上升趋势,资金总赔付支出呈持续上升;②医疗支出随时间变化总体呈上升趋势;③通过补充医疗保险赔付精算模型的构建,为赔付风险预测提供了理论基础,为补充医疗资金收支平衡的可持续发展提供了研究依据,有利于油气企业站在全局的高度上制定稳健可持续的补充医疗保险政策。
For enterprise supplementary medical insurance,the balance between income and expenditure is an important premise to ensure the sustainable development of fund.And to predict compensation risks in this medical insurance is an important standard to determine this balance.In order to study the steady and sustainable supplementary medical security strategy for oil and gas enterprises,an actuarial model was developed for the medical security among the enterprise supple⁃mentary medical insurance in A oil and gas company in terms of disease type,and gender and personnel state(working/re⁃tired)according to basic principles of insurance actuarial sciences.Then,several parameters were calculated on incidence of single disease,average compensation of single disease and insured person,and the compensation risks were predicted.Finally,the direction to formulate policy was pointed out.Results show that(1)from the perspective of employees'age structure,the total insured employees'number is maintained at a relatively stable level,but as the people grow older,the retirees'number presents a rising trend,leading to a continuous increase of total compensation expenditure;(2)the medi⁃cal expenditure presents an overall rising trend over the time;and(3)constructing the actuarial model for the supplementa⁃ry medical insurance provides a theoretical basis for predicting the compensation risks and basis for the sustainable devel⁃opment of the balance between income and expenditure of supplementary medical fund,which is favorable for oil and gas enterprises to formulate steady and sustainable supplementary medical insurance policy standing at the height of whole situ⁃ation.
作者
俞强
兰正福
杨枢
廖丹凤
YU Qiang;LAN Zhengfu;YANG Shu;LIAO Danfeng(Social Security Center,PetroChina Southwest Oil&Gasfield Company,Chengdu,Sichuan 610051,China)
出处
《天然气技术与经济》
2021年第2期70-78,共9页
Natural Gas Technology and Economy
关键词
油气行业
补充医疗保险
赔付风险
精算模型
Petroleum industry
Supplementary medical insurance
Compensation risk
Actuarial model
