老年流动人口异地就医:行为特征、支持体系与制度保障
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摘要
随着老年流动人口规模的不断扩大,传统的医疗服务供给模式难以适应流动人口现状。借助2015年度"流动老人医疗卫生服务专题调查"数据,对老年流动人口的异地就医行为进行分析,发现患病流动老人选择异地就医的比例达六成。目前老年流动人口的参保地路径依赖影响其就医流向,且门诊费用未能异地直接结算阻碍老人异地就医习惯形成,其"边际人"身份容易催生消极就医心态。本文认为,老年流动人口实现异地就医有赖于"家庭-社交网络"提供的支持体系与异地就医制度保障:家庭为流动老人提供情感支持、亲属照料与代际资源转移,社交网络则具有获取信息、病友共情与朋辈示范的效应;国家基本医疗保险异地就医结算系统解决了异地就医的技术难题,同时医保待遇整合使跨省结算成为可能。建议继续强化家庭支持,鼓励流动老人重建社交网络,扩大国家异地就医结算系统的知晓度,优化备案流程,逐步完善"住院+门诊"的全方位医疗费用结算体系,帮助流动老人更方便有效地实现异地就医。
With the continuous expansion of the scale of the elderly floating population, the traditional mode of medical service supply is difficult to adapt to the "new normal" of the floating population. Based on the data of the "Special Survey on Medical and Health Services for Migrant Elderly" in 2015, this paper analyzes the behavior of migrant elders in seeking medical treatment in different places, and finds that 60% of the sick migrant elders chose to seek medical treatment in different places. At present, the path dependence of the elderly migrant population in the insured places affects the flow of medical treatment,and the failure to settle the outpatient expenses directly in different places hinders the formation of the habit of medical treatment in different places, and the "marginal person" status can easily lead to negative medical mentality. The paper holds that the realization of medical treatment in different places for the elderly floating population depends on the support system provided by the " family-social network" and the guarantee of medical treatment system in different places: Families provide emotional support, kinship care and intergenerational resource transfer for migrant elderly, while social networks have the effects of information acquisition, patient-friend empathy and peer demonstration; the national basic medical insurance settlement system solves the technical problems of medical treatment in different places, and the integration of medical insurance benefits makes cross-provincial settlement possible. It is suggested that we should continue to strengthen family support, encourage floating elderly people to rebuild social networks, expand the awareness of the national off-site medical settlement system, optimize the filing process, and gradually improve the comprehensive medical expense settlement system of " hospitalization+ outpatient service", so as to better realize the accessibility and availability of migrant elderly medical treatment in different places.
With the continuous expansion of the scale of the elderly floating population, the traditional mode of medical service supply is difficult to adapt to the "new normal" of the floating population. Based on the data of the "Special Survey on Medical and Health Services for Migrant Elderly" in 2015, this paper analyzes the behavior of migrant elders in seeking medical treatment in different places, and finds that 60% of the sick migrant elders chose to seek medical treatment in different places. At present, the path dependence of the elderly migrant population in the insured places affects the flow of medical treatment,and the failure to settle the outpatient expenses directly in different places hinders the formation of the habit of medical treatment in different places, and the "marginal person" status can easily lead to negative medical mentality. The paper holds that the realization of medical treatment in different places for the elderly floating population depends on the support system provided by the " family-social network" and the guarantee of medical treatment system in different places: Families provide emotional support, kinship care and intergenerational resource transfer for migrant elderly, while social networks have the effects of information acquisition, patient-friend empathy and peer demonstration; the national basic medical insurance settlement system solves the technical problems of medical treatment in different places, and the integration of medical insurance benefits makes cross-provincial settlement possible. It is suggested that we should continue to strengthen family support, encourage floating elderly people to rebuild social networks, expand the awareness of the national off-site medical settlement system, optimize the filing process, and gradually improve the comprehensive medical expense settlement system of " hospitalization+ outpatient service", so as to better realize the accessibility and availability of migrant elderly medical treatment in different places.
引文
[1]赵斌.异地就医管理服务机制研究[M].北京:社会科学文献出版社,2017.
[2]王虎峰.全民医保制度下异地就医管理服务研究——欧盟跨国就医管理经验借鉴[J].中共中央党校学报,2008(12):77-82.
[3]李芬,陈燕妮.基本医疗保险异地就医结算服务研究——以海南省跨省异地就医结算服务为例[J].中国卫生事业管理,2015(3):197-200.
[4]郭珉江,郭琳.流动人口异地就医即时结算现状与问题研究[J].中国卫生经济,2014(1):26-28.
[5]杜本峰,苗锋.青年流动人口就医流向选择的影响因素与测度分析——基于北京、上海和深圳调查[J].人口研究,2012(6):71-86.
(1)参见国家人社部2016年12月8日发布的《基本医疗保险跨省异地就医住院医疗费用直接结算经办规程(试行)》,网址为:http://www. mohrss. gov. cn/gkml/zcfg/gfxwj/201612/t20161215_262040. html。
(1)参见国家人社部2018年6月6日发布的“基本医疗保险跨省异地就医住院医疗费用直接结算公共服务信息发布(第十期)”,网址为:http://www. mohrss. gov. cn/SYrlzyhshbzb/dongtaixinwen/buneiyaowen/201806/t20180606_295087. html。
[2]王虎峰.全民医保制度下异地就医管理服务研究——欧盟跨国就医管理经验借鉴[J].中共中央党校学报,2008(12):77-82.
[3]李芬,陈燕妮.基本医疗保险异地就医结算服务研究——以海南省跨省异地就医结算服务为例[J].中国卫生事业管理,2015(3):197-200.
[4]郭珉江,郭琳.流动人口异地就医即时结算现状与问题研究[J].中国卫生经济,2014(1):26-28.
[5]杜本峰,苗锋.青年流动人口就医流向选择的影响因素与测度分析——基于北京、上海和深圳调查[J].人口研究,2012(6):71-86.
(1)参见国家人社部2016年12月8日发布的《基本医疗保险跨省异地就医住院医疗费用直接结算经办规程(试行)》,网址为:http://www. mohrss. gov. cn/gkml/zcfg/gfxwj/201612/t20161215_262040. html。
(1)参见国家人社部2018年6月6日发布的“基本医疗保险跨省异地就医住院医疗费用直接结算公共服务信息发布(第十期)”,网址为:http://www. mohrss. gov. cn/SYrlzyhshbzb/dongtaixinwen/buneiyaowen/201806/t20180606_295087. html。