农民工医疗保险关系转移接续问题研究

发布时间：2018-04-11 08:34

本文选题：农民工 + 基本医疗保险　；参考：《西南财经大学》2013年硕士论文

【摘要】：社会医疗保险制度作为社会保险体系中重要的保障制度之一,旨在满足广大民众基本的医疗需求的基础上,降低医疗成本,最终以实现全民健康状况的改善为目标,保障广大民众最基本的健康权益。农民工,一个中国特色社会主义建设过程中的特殊名词---这群来自于农村,服务于城市的群体,由于中国不健全的社会保障制度而处于社会福利的边缘。随着我国经济的迅猛发展,国家也开始着手对农民工群体的社会保障政策所存在的矛盾进行调和,陆续出台了多项重要政策,以针对农民工的各项权益进行修补和维护。而医疗保险制度是其核心政策。截止2013年1月,我国出台的针对农民工群体的社会医疗保险制度主要分为几大类：第一类将农民工群体划入城镇职工基本医疗保险制度的范畴,同城镇职工共享平等的医疗保险待遇：第二类即为专门针对农民工特点出台的地方性农民工大病医疗保险制度；第三类为少见的地方性综合医疗保险制度,目前这种制度仅上海还保存；最后一类则将农民工纳入城乡居民基本医疗保险制度体系内。但是这些制度存在一个当农民工变换工作地点或居住地点时,其在原工作地的社会医疗保险却不能顺畅转移衔接的问题。因而如何解决农民工医疗保险制度的转移衔接问题成为了近年来政府和学术界广泛关注和探讨的话题。文章从我国农民工和农民工医疗保险制度的起源出发,逐步开始探讨关于农民工医疗保险制度的转移接续问题。文章重点立足于详实的资料收集和整理,对我国农民工医疗保险制度转移接续的现状进行调研,从中分析衔接的困境何在、存在哪些问题,并分别从制度内和制度外两个方面探讨影响我国农民工医疗保险制度转移衔接难的主要因素。最终结合国外流动人员基本医疗保险转移衔接的相关做法和经验,提出了我国农民工医疗保险制度转移衔接的最终模式——“二位一体”的国民基本医疗保险体制。其改革路径主要分为制度内和制度外两个层面,提出只有逐步取消制度的“碎片化”,实现制度层面上的统一和待遇层面上的一体化,才能降低制度转移衔接成本,高效率完成转移衔接的最好方式。全文共分为六章,每一章的主要内容和思路如下：第一章为导论,主要分为序言和国内外文献综述。序言主要内容为该文所要论述的基本问题,即问题产生的背景和对问题研究存在的意义；国内外文献综述主要包括了写作之前所从事的文献搜集成果,以及对国内外文献的思考和想法,为之后的研究做好理论上的准备。由于农民工是在我国特殊国情下出现的一个群体,国外无农民工的说法,因此国外大部分的文献多是以流动人员为主进行的探讨；而国内关于农民工医疗保险制度的研究主要从两个层面出发：第一个层面直接以农民工为研究对象探讨其医疗保险制度问题；第二层面是间接地从医疗保险制度的城乡统筹角度来探讨问题,其中农民工医疗保险制度是核心部分。第二章为背景知识研究,主要针对农民工以及农民工医疗保险制度两个元素分别进行介绍和讨论,农民工作为我国独有的一个群体,具有其自身的起源和特征,尤其是目前我国的“第三代”农民工——90后农民工的出现,对目前的医疗保险制度提出了更多的挑战。由于我国各地针对农民工群体出台了多种不同的制度和模式,制度之间差异性又过大,因此衍生出了跨制度转移衔接的问题。第三章为农民工医疗保险制度的转移接续现状研究。该部分在继承上一章对于我国农民工医疗保险制度现状的分析后,介绍我国在农民工医疗保险制度转移接续方面做出的一些尝试和代表模式,试图能较为全面地了解在该问题上我国的一个主要发展概况。该部分以农民工医疗保险制度与其他不同的医疗保险险种之间的转移衔接为标准,针对每一种制度衔接做出归类比较,并提出一些具有代表意义的地区作为经验借鉴,如重庆,太仓,珠海等地。通过对每个模式的对比和分析,总结出我国在农民工医疗保险制度建设上所遵循的规律——逐步取消制度的“碎片化”,缩小制度水平的差异,是解决农民工医疗保险转移衔接的必由之路。第四章根据以上对我国农民工医疗保险转移接续问题的一个现状调查分析之后,做出进一步的思考阐述。从主要问题入手,如缴费年限的转移衔接,基金的跨制度划拨,逐步分析出问题产生的根源以及影响该问题的核心因素。对于问题的影响因素方面,分别以内部和外部两个角度来进行论述,得出影响我国农民工医疗保险制度转移衔接困难的内部根源就在于我国基本医疗保险体制发展的不健全,统筹层次过低,“碎片化”程度过高；外部根源则是我国长期以来的城乡二元体制,影响并阻碍了制度的发展。第五章是对国外流动人员基本医疗保险转移衔接的研究。该部分分别从国际和国家两个层面进行了相应探讨：其一是跨国间的流动带来的转移接续问题,其中就包含了许多经济合作区域设立的本区域内的社会保障公约和协议,以保障成员国公民在本区域内流动时的社会保险待遇问题；另一个则是一国内跨地之间流动的医疗保险转移衔接经验,比较具有代表性的国家多是一些经济发达国家,而还有部分国家则是通过实现全民基本医疗的方式间接地解决了流动人员的基本医疗需求的问题。从这两个层面得出一些规律和特性。进而为文章最终提出政策建议提供参考。第六章为本文的最后一章,主要介绍针对我国农民工医疗保险制度转移接续问题的对策建议,在该部分笔者提出了农民工医疗保险制度的最终发展模式——“二位一体”的国民基本医疗保险体制。实现最终模式的路径需要分别从内部和外部两个方面进行改善和发展,主要观点为唯有加快我国城乡一体化建设的进度,加快实现城镇化,实现城乡居民的平等公平发展,才能在整体层面上提升我国医疗保险制度的高度；另一方面,加快我国医疗保险制度的建设,逐步提高统筹层次,兼并医疗保险制度的“碎片”,减少制度险种,实现制度的一致性和统一性,才能更进一步的实现制度的顺畅转移衔接。本文的研究方法是以文献研究作为前提和基础,以实证研究为手段,通过定性分析和部分数据分析,使得文章的逻辑和内容显得尽量清晰和可靠。本文是作者平时的科研成果中总结和提炼出的一部分,是经过长期的思索和考证的成果,其中部分数据和结论是作者在实地调查后得到的,具有充分的可靠性和有效性。本文的创新之处在于：首先文章紧握政策脉搏,掌握最新的政策动态和信息,对部分代表地区的数据和信息做过详细的分析和对比,也通过电话采访的方式对代表地区负责人进行访谈,深入了解政策制定背后的考量,更加有助于对政策的深入理解和分析；此外文章最终提出了我国农民工医疗保险制度转移衔接的发展模式——“二位一体”的国民基本医疗保险模式,提出通过逐步消除制度的“碎片化”和平衡制度间的水平差距来减轻和消除制度转移衔接的成本和障碍的路径建议。
[Abstract]:As one of the important guarantee systems in the social insurance system , the social medical insurance system aims at satisfying the basic medical needs of the general population , reducing the medical cost , and finally realizing the basic health rights and interests of the general public .
The third category is a rare local comprehensive medical insurance system , which is currently held only in Shanghai ;
In the last category , the migrant workers are included in the basic medical insurance system of urban and rural residents . However , there is a problem that the social medical insurance of the migrant workers can not smoothly transfer the connection when the migrant workers transform the duty station or the place of residence , so how to solve the problem of the transfer and cohesion of the medical insurance system of migrant workers has become a topic which has been widely watched and discussed in the government and the academic community in recent years .

Based on the origin of the rural migrant workers and the rural migrant workers ' medical insurance system , this paper studies the transfer connection of the rural migrant workers ' medical insurance system gradually .

The full text is divided into six chapters , the main contents and thinking of each chapter are as follows :

The first chapter is the introduction , which is mainly divided into the preface and the literature review at home and abroad . The main contents of the preface are the basic problems to be discussed in this paper , namely the background of the problem and the significance of the research on the problem ;
At home and abroad , the literature review mainly includes the literature collection results before writing , as well as the thinking and thinking of the literature at home and abroad , which is the theoretical preparation for the later research . As the migrant workers are a group that appears in our country ' s special circumstances , there are no migrant workers abroad , so most of the literatures abroad are mainly based on mobile workers ;
At the first level , we discuss the medical insurance system directly with the migrant workers .
The second level is indirectly from the urban - rural integration angle of the medical insurance system , in which the rural migrant workers medical insurance system is the core part .

The second chapter introduces and discusses the background knowledge , mainly aiming at the rural migrant workers and the two elements of the rural migrant workers ' medical insurance system . The migrant workers , as a special group in our country , have their own origin and characteristics , especially the emergence of the " third generation " migrant workers in our country .

The third chapter introduces the current situation of rural migrant workers ' medical insurance system . After analyzing the current situation of migrant workers ' medical insurance system in China , this part introduces some attempts and representative patterns of China ' s transfer of medical insurance system of migrant workers .

In the fourth chapter , according to the above analysis of the current situation of the transfer of medical insurance for migrant workers in China , the author makes a further consideration . From the main problems , such as the transfer of payment years , the cross - system allocation of funds , the root causes of problems and the core factors that influence the problem are analyzed .
The external root cause is China ' s long - term urban and rural dual system , which has hindered the development of the system .

The fifth chapter deals with the connection of the transfer of basic medical insurance for foreign mobile workers , which are discussed from the international and national levels respectively : one is the transfer succession of cross - border movement , which includes the social security conventions and agreements in the region set up by many economic cooperation regions , so as to guarantee the social insurance treatment problem of citizens of member countries in the region ;
The other is the transfer of medical insurance transfer between domestic and trans - lands , and more representative countries are economically developed countries , while others indirectly solve the problem of basic medical needs of mobile workers through the way of realizing universal basic medical care . Some laws and characteristics are drawn from these two levels .

The sixth chapter is the final chapter of this paper , mainly introduces the countermeasure suggestion for the transfer connection problem of the rural migrant workers medical insurance system . In this part , the author puts forward the basic medical insurance system of the national basic medical insurance system of the migrant worker ' s medical insurance system . The path of the final mode needs to be improved and developed from both inside and outside . The main point of view is that only the progress of the urban and rural integration construction is accelerated , the urbanization is accelerated , the equal and equitable development of the urban and rural residents can be realized , and the height of the medical insurance system in China can be promoted at the whole level ;
On the other hand , accelerate the construction of the medical insurance system in our country , gradually improve the integrated level , combine the " debris " of the medical insurance system , reduce the system risks , realize the consistency and unity of the system , and realize the smooth transfer of the system .

The research method of this paper is based on the literature research , by qualitative analysis and partial data analysis , so that the logic and content of the article appear as clear and reliable as possible . This paper is a part of summarizing and refining the results of the author ' s ordinary scientific research . Some of the data and conclusions are obtained after the field investigation , and have sufficient reliability and effectiveness .

The innovation of this paper is : Firstly , the author holds the policy pulse , grasps the latest policy dynamics and information , makes detailed analysis and comparison of the data and information in the part of the representative area , and interviews the representative district head by telephone interview . It is helpful to deeply understand and analyze the policy .
In addition , the paper finally puts forward the development model of the transfer of the rural migrant workers ' medical insurance system and the basic medical insurance model of the national basic medical insurance , and puts forward the path suggestion to reduce and eliminate the cost and obstacle of the system transfer connection through the gradual elimination of the gap between the " fragmentation " and the balance system .

【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

【参考文献】