随着城镇职工医疗保险待遇的提高和赡养负担的加重,城镇职工医疗保险统筹基金面临收入下降和支出增长的挑战,部分城市的城镇职工医疗保险统筹基金已经出现当年亏损、几年之后将用尽累计结余的局面。本文在考虑老龄化背景的前提下,着重引入趸交分摊和个人账户划入比例两个因素,构建了“城镇职工基本医疗保险统筹基金综合因素精算模型”。以市级统筹地区C市为例,在其历史数据的基础上实证分析并预测市级统筹地区职工基本医疗保险统筹基金运行状况,发现医保基金存在虚假结余、个人账户划入比例偏高以及未来医保统筹基金将面临收支不平衡等问题。为缓解未来医保统筹基金收支不平衡状况,本文试模拟了三个参数的影响效果,即降低企业缴费划入个人账户的比例(参数A)、提高基金收益率(参数B)和控制支出增长率(参数C)。模拟结果表明:在目标期限内,参数A短期有效,参数B基本无效,参数C长期有效。由此,本文提出完善财务制度、界定个人账户功能和抑制支出增长的建议。 With the increase of medical insurance for urban employees and the burden of support, the urban medical insurance co-ordination fund faces the challenge of declining income and increasing expenditure. The urban medical insurance co-ordinating fund for urban workers in some cities has been making a loss for the current year and will be exhausted in a few years Cumulative balance of the situation. Based on the background of aging population, this paper focuses on the introduction of the single factor allocation and the proportion of individual accounts into account, and constructs the Actuarial Model of Integrated Factors for Co-ordinated Funds for Urban Employee Basic Medical Insurance. Take the municipal C city as an example, on the basis of its historical data, this paper empirically analyzes and predicts the operation status of the basic medical insurance pooling fund at the municipal level and finds that the medical insurance fund has a fictitious balance, the high proportion of personal accounts and the future Medical insurance co-ordination fund will face imbalances and other issues. In order to alleviate the unbalanced income and expenditure of future medical insurance co-ordination funds, this paper attempts to simulate the effect of three parameters, namely, reducing the proportion of enterprises’ contribution into individual accounts (parameter A), increasing the fund’s return rate (parameter B) and controlling expenditure growth Rate (parameter C). The simulation results show that parameter A is short-term effective, parameter B is basically invalid, and parameter C is valid for a long time within the target period. Therefore, this article puts forward some suggestions to improve the financial system, define the functions of individual accounts and restrain the growth of expenditure.