ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1641233
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 75 articles
Address Sustainability Risks in Health Insurance Funds: Generational Actuarial Balance and Intergenerational Equity Perspective
Provisionally accepted
- Central University of Finance and Economics, Beijing, China
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Background: Public health insurance systems worldwide face growing sustainability risks due to aging populations and rising medical costs. China's employee basic health insurance (CEBHI) system is particularly vulnerable, with concerns about generational actuarial imbalances and intergenerational inequities threatening its long-term viability.Methods: This study constructs an intergenerational accounting framework for the CEBHI system, analyzing its sustainability from the perspectives of generational actuarial balance and intergenerational equity. We evaluate the impact of potential policy adjustments, including delayed retirement age, retiree contributions, increased premium rates, and reduced reimbursement rates.Results: The findings reveal severe generational actuarial imbalances and intergenerational inequities within the EBHI system. While individual policy measures-such as delaying retirement, introducing retiree contributions, raising premiums, or lowering reimbursement rates-can partially mitigate sustainability risks, none alone achieves both actuarial balance and intergenerational equity. Policy coordination is essential. Notably, delayed retirement has a limited impact, whereas retiree contributions are critical in all effective policy combinations.To ensure the long-term sustainability of China's health insurance fund, the government must adopt synergistic policy combinations, prioritizing reforms in retirement age and retiree contribution policies. Isolated adjustments are insufficient; integrated strategies are necessary to address systemic risks.
Keywords: Health insurance systems, Sustainability risks, generational actuarial balance, Intergenerational equity, China's employee basic health insurance
Received: 04 Jun 2025; Accepted: 17 Jul 2025.
Copyright: © 2025 Qin and Ji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yi Qin, Central University of Finance and Economics, Beijing, China
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