农村人口流动对新型农村合作医疗制度影响的研究
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摘要
农村人口流动打破了依据户籍的人口分类模式,流动人口成为一类“边缘群体”,他们的医疗保障问题已成为我国社会保障体系亟待解决的严峻问题。由于流动人口流动性非常大,参保不连续;自身健康行为意识较弱;而且政府对流动人口参加医疗保险缺乏强制性的法律保障,所以流动人口在城市参加医疗保险确实有一定难度。原则上,农村流出人口是农村居民,属于新型农村合作医疗制度的保障对象;而且大量在城市短期务工的农民,日后还要回到农村,他们还是更多倾向于依赖新型农村合作医疗制度的保障。但新型农村合作医疗制度可持续发展的筹资机制、合作医疗基金管理与监督、合作医疗的经济补偿机制、合作医疗的组织管理,并没有合理、科学地考虑农村人口流动现象。由于合作医疗属地化管理,农村流出人口参加及享有合作医疗保障皆面临一定障碍。因此本研究把农村人口流动作为影响新型农村合作医疗制度的一个重要变量,考察流动人口的医疗保障问题,为卫生行政部门完善新型农村合作医疗制度提供科学依据。
目的
通过本课题的研究,探索农村人口流动对新型农村合作医疗制度产生怎样影响。从而规避消极影响,发挥积极影响,为卫生行政部门完善新型农村合作医疗制度提供科学依据。
方法
1.文献研究法查阅国内外有关人口流动与合作医疗制度的研究文献,结合课题研究的内容,分析值得借鉴的措施和策略。
2.深入访谈法使用半结构式访谈对重庆市黔江区卫生局合作医疗办公室管理人员和卫生局领导进行个体访谈。定性了解外出流动人口参加及享有新型农村合作医疗保障的障碍及解决问题的建议与对策。
3.专题小组讨论法邀请村干部、受尊重的长者、普通农民、党员对外出流动人口参加和享有合作医疗保障的障碍进行讨论分析,并提出有针对性的建议和改进措施。
4.问卷调查法采用规范、标准化问卷调查,调查表包括家庭基本情况调查表、有人口流动的家庭调查表和无人口流动的家庭调查表。
5.统计分析方法调查问卷采用SPSS11.5录入数据,采用Microsoft Office Excel2003和SPSS11.5处理所有数据。根据资料的性质进行统计学描述性分析、单因素卡方检验。
结果
影响流出人口参合因素颇多,不仅有经济因素,而且有人口社会学因素:婚姻状况、外出务工性质、是否参加商业保险和社会保险、外出回家时间
结论
1.人口流动背景下,采用以“家庭为单位”筹资对合作医疗制度运行的影响
1.1.采用以“家庭为单位”筹资增加了政府在农村全面实施新型农村合作医疗的难度
1.2.采用以“家庭为单位”筹资不能真正地发挥合作医疗互助共济、健康保障的功能;不能达到缓解农村因病致贫、因病返贫的目的
1.3.采用以“家庭为单位”筹资没有考虑到农村外出人口在外地参加的其他医疗保险
2.人口流动背景下,合作医疗组织管理者应满足农民需求,完善合作医疗制度
2.1.合作医疗组织管理者准确把握筹资对象,更好适应人口流动大的背景
2.2.合作医疗组织管理者为流出人员制定科学、合理的补偿比例,简化其报销程序
3.人口流动背景下,合作医疗组织管理者确保合作医疗基金运行的安全
建议
政府解决流动人口医疗保障问题不能一蹴而就,应分阶段、分步骤地进行。
1.从短期来看,以某一地域为参照,把流动人口分为流入人口和流出人口,再根据打工时间长短分为长期流动人口和短期流动人口。流动人口参加新型农村合作医疗的原则应根据其流动特点采取具体灵活的措施。
2.长期的解决办法:政府最终要打破城乡二元结构,建立全国统一的社会保障体系。
打破城乡二元结构是社会公平、效益、稳定的迫切要求,也必将推动城乡一体的社会保障体系的建立,达到人人享有医保,维护人们的健康权利的目标。
The rural population's mobility broke the mode of population classification according to household registration, the floating population becomes a kind of“Marginal Group”, and their health security has become the serious problem that the Social Security system will deal with. Flow ability of the floating population is extremely big, the factor cause to participate in medical insurances interruptedly, own healthy behavior consciousness is weak; moreover the government lacks the compulsory legal safeguard to the floating population participating in medical insurances, therefore the floating population really has certain difficulty to participate in the medical insurances in the city. In principle, the countryside floating population is the countryside resident, belongs to the object to guarantee by new rural cooperative medical system; Moreover the short-term working farmers in the city, in the future they also will have to return to one's native village massively, they will depend on the new rural cooperative medical system. But the new rural cooperative medical system sustainable development mechanism raising fund, the cooperative medical system fund management and surveillance, cooperative medical system economical compensation mechanism, cooperative medical system organization management and so on, the factors have not considered of the countryside floating populations, Reasonably and scientifically Because of Localization management of the cooperative medical system, the countryside floating population to participate in and to enjoy the cooperative medical system faces many inconveniences. Therefore this research takes the rural population flowing as an important variable to influence the new rural cooperative medical system, according to the above to survey the countryside floating population medical security question, in order to offer foundation of protecting new rural cooperatives medical system for health administrative department
Objective
Through studying this paper, explore the rural population flowing to produce the effect on new type rural cooperative medical system, then to avoid negative effect, to give full play to positive effect, to perfect the new rural cooperative medical system for the administration of public health department to provide the policy suggestion.
Methods
1. Document study:
Consulting the domestic and foreign related population flowing and the cooperative medical system research literature, uniting topic research content; analyzing the measure and the strategy which profits from.
2. In-depth interviews:
Interviewing the leader of the Qianjiang of Chongqing city health bureau cooperative medical system office administrative and other leaders by half-structural interviews. Qualitatively understand the limitation about the floating population to participate in and to enjoy the new type rural cooperative medical system and to seek suggestion and the countermeasure of the question.
3. Focus-group discussion:
Inviting the village cadres, the elders, the party members to analyze the limitation to carry on the discussion of the floating population participating in and enjoying the cooperative medical system, and to propose the improvement measure and advise.
4. Questionnaire survey method:
Using the standard, the standardized questionnaire survey, the questionnaire includes the family basic situation questionnaire, the population mobile family questionnaire and the population immobile family questionnaire.
5. Statistical analyses method:
Data are input in the questionnaire by using the SPSS11.5 and Microsoft Office Excel 2003 and deal with by the SPSS11.5 and Microsoft Office Excel 2003. Carrying on statistics descriptive analysis, the single factor chi-square test according to the data nature.
Results
The factors to influence the floating population to participate in the new type rural cooperative medical system, not only has the economic factor, but also has the demographic sociology factors: The marital status, the floating population’s the work nature, whether to participate in the commercial insurance and the social medical security or not , the time to go home
Conclusions
1. But in the population mobile situation, this principle of“the family as unit”financing brings effect on the new rural cooperative medical system:
1.1. The principle increases difficulty which the government implements new rural cooperative medical system in the countryside comprehensively
1.2. The principle cannot truly display cooperation of the cooperative medical system altogether to aid, the health security function; Cannot achieve to alleviate the countryside the poverty due to illness, return-to-poverty
1.3. The principle cannot consider the floating population in the outside areas to participate in other medical insurances
2. Under the population floating Background, the management of the rural cooperative medical system adapts the need of parents, prefect the rural cooperative medical system
2.1. The management of the rural cooperative medical system should grasp the object of fund raising, adapt to the population floating background
2.2. The management of the rural cooperative medical system should plan scientific and logical compensating proportion, for the floating population, Simplify the compensating Procedures
3. Under the population floating Background, the management of the rural cooperative medical system is sure to the fund safe
Suggestions:
The government solves the floating population medical security problem not to be able to get it done in one action, we should divide the stage, gradually carry on.
1. From the short-term, take some region as the reference, divides into the floating population the in population mobile and the population immobile, according to the working time length to divide into the long-term floating population and the short-term floating population. The floating population should act the concrete. Measure to participate in the new rural cooperatives medical system according to its mobile characteristic.
2. Long-term solution: the government finally must break the mode of the city and countryside dual structure; establish the national Unified social security system.
To break the mode of the city and countryside dual structure is the urgent need of social justice, benefit, and stable, also it will push to establish the social security system to satisfy the city and countryside population, make everybody enjoy the medical insurances, maintain people’s healthy goal.
目的
通过本课题的研究,探索农村人口流动对新型农村合作医疗制度产生怎样影响。从而规避消极影响,发挥积极影响,为卫生行政部门完善新型农村合作医疗制度提供科学依据。
方法
1.文献研究法查阅国内外有关人口流动与合作医疗制度的研究文献,结合课题研究的内容,分析值得借鉴的措施和策略。
2.深入访谈法使用半结构式访谈对重庆市黔江区卫生局合作医疗办公室管理人员和卫生局领导进行个体访谈。定性了解外出流动人口参加及享有新型农村合作医疗保障的障碍及解决问题的建议与对策。
3.专题小组讨论法邀请村干部、受尊重的长者、普通农民、党员对外出流动人口参加和享有合作医疗保障的障碍进行讨论分析,并提出有针对性的建议和改进措施。
4.问卷调查法采用规范、标准化问卷调查,调查表包括家庭基本情况调查表、有人口流动的家庭调查表和无人口流动的家庭调查表。
5.统计分析方法调查问卷采用SPSS11.5录入数据,采用Microsoft Office Excel2003和SPSS11.5处理所有数据。根据资料的性质进行统计学描述性分析、单因素卡方检验。
结果
影响流出人口参合因素颇多,不仅有经济因素,而且有人口社会学因素:婚姻状况、外出务工性质、是否参加商业保险和社会保险、外出回家时间
结论
1.人口流动背景下,采用以“家庭为单位”筹资对合作医疗制度运行的影响
1.1.采用以“家庭为单位”筹资增加了政府在农村全面实施新型农村合作医疗的难度
1.2.采用以“家庭为单位”筹资不能真正地发挥合作医疗互助共济、健康保障的功能;不能达到缓解农村因病致贫、因病返贫的目的
1.3.采用以“家庭为单位”筹资没有考虑到农村外出人口在外地参加的其他医疗保险
2.人口流动背景下,合作医疗组织管理者应满足农民需求,完善合作医疗制度
2.1.合作医疗组织管理者准确把握筹资对象,更好适应人口流动大的背景
2.2.合作医疗组织管理者为流出人员制定科学、合理的补偿比例,简化其报销程序
3.人口流动背景下,合作医疗组织管理者确保合作医疗基金运行的安全
建议
政府解决流动人口医疗保障问题不能一蹴而就,应分阶段、分步骤地进行。
1.从短期来看,以某一地域为参照,把流动人口分为流入人口和流出人口,再根据打工时间长短分为长期流动人口和短期流动人口。流动人口参加新型农村合作医疗的原则应根据其流动特点采取具体灵活的措施。
2.长期的解决办法:政府最终要打破城乡二元结构,建立全国统一的社会保障体系。
打破城乡二元结构是社会公平、效益、稳定的迫切要求,也必将推动城乡一体的社会保障体系的建立,达到人人享有医保,维护人们的健康权利的目标。
The rural population's mobility broke the mode of population classification according to household registration, the floating population becomes a kind of“Marginal Group”, and their health security has become the serious problem that the Social Security system will deal with. Flow ability of the floating population is extremely big, the factor cause to participate in medical insurances interruptedly, own healthy behavior consciousness is weak; moreover the government lacks the compulsory legal safeguard to the floating population participating in medical insurances, therefore the floating population really has certain difficulty to participate in the medical insurances in the city. In principle, the countryside floating population is the countryside resident, belongs to the object to guarantee by new rural cooperative medical system; Moreover the short-term working farmers in the city, in the future they also will have to return to one's native village massively, they will depend on the new rural cooperative medical system. But the new rural cooperative medical system sustainable development mechanism raising fund, the cooperative medical system fund management and surveillance, cooperative medical system economical compensation mechanism, cooperative medical system organization management and so on, the factors have not considered of the countryside floating populations, Reasonably and scientifically Because of Localization management of the cooperative medical system, the countryside floating population to participate in and to enjoy the cooperative medical system faces many inconveniences. Therefore this research takes the rural population flowing as an important variable to influence the new rural cooperative medical system, according to the above to survey the countryside floating population medical security question, in order to offer foundation of protecting new rural cooperatives medical system for health administrative department
Objective
Through studying this paper, explore the rural population flowing to produce the effect on new type rural cooperative medical system, then to avoid negative effect, to give full play to positive effect, to perfect the new rural cooperative medical system for the administration of public health department to provide the policy suggestion.
Methods
1. Document study:
Consulting the domestic and foreign related population flowing and the cooperative medical system research literature, uniting topic research content; analyzing the measure and the strategy which profits from.
2. In-depth interviews:
Interviewing the leader of the Qianjiang of Chongqing city health bureau cooperative medical system office administrative and other leaders by half-structural interviews. Qualitatively understand the limitation about the floating population to participate in and to enjoy the new type rural cooperative medical system and to seek suggestion and the countermeasure of the question.
3. Focus-group discussion:
Inviting the village cadres, the elders, the party members to analyze the limitation to carry on the discussion of the floating population participating in and enjoying the cooperative medical system, and to propose the improvement measure and advise.
4. Questionnaire survey method:
Using the standard, the standardized questionnaire survey, the questionnaire includes the family basic situation questionnaire, the population mobile family questionnaire and the population immobile family questionnaire.
5. Statistical analyses method:
Data are input in the questionnaire by using the SPSS11.5 and Microsoft Office Excel 2003 and deal with by the SPSS11.5 and Microsoft Office Excel 2003. Carrying on statistics descriptive analysis, the single factor chi-square test according to the data nature.
Results
The factors to influence the floating population to participate in the new type rural cooperative medical system, not only has the economic factor, but also has the demographic sociology factors: The marital status, the floating population’s the work nature, whether to participate in the commercial insurance and the social medical security or not , the time to go home
Conclusions
1. But in the population mobile situation, this principle of“the family as unit”financing brings effect on the new rural cooperative medical system:
1.1. The principle increases difficulty which the government implements new rural cooperative medical system in the countryside comprehensively
1.2. The principle cannot truly display cooperation of the cooperative medical system altogether to aid, the health security function; Cannot achieve to alleviate the countryside the poverty due to illness, return-to-poverty
1.3. The principle cannot consider the floating population in the outside areas to participate in other medical insurances
2. Under the population floating Background, the management of the rural cooperative medical system adapts the need of parents, prefect the rural cooperative medical system
2.1. The management of the rural cooperative medical system should grasp the object of fund raising, adapt to the population floating background
2.2. The management of the rural cooperative medical system should plan scientific and logical compensating proportion, for the floating population, Simplify the compensating Procedures
3. Under the population floating Background, the management of the rural cooperative medical system is sure to the fund safe
Suggestions:
The government solves the floating population medical security problem not to be able to get it done in one action, we should divide the stage, gradually carry on.
1. From the short-term, take some region as the reference, divides into the floating population the in population mobile and the population immobile, according to the working time length to divide into the long-term floating population and the short-term floating population. The floating population should act the concrete. Measure to participate in the new rural cooperatives medical system according to its mobile characteristic.
2. Long-term solution: the government finally must break the mode of the city and countryside dual structure; establish the national Unified social security system.
To break the mode of the city and countryside dual structure is the urgent need of social justice, benefit, and stable, also it will push to establish the social security system to satisfy the city and countryside population, make everybody enjoy the medical insurances, maintain people’s healthy goal.
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[1]http://www.39kf.com/focus/trend/2005-04-22-59162.shtml.深圳开展劳务工合作医疗试点300万人受益
[2]江渝.农村新型合作医疗模式发慌问题的探析.中共四川省委校学报.2004.6(2)
[3] www.gh.pku.edu.cnshfl/shfldocl-htm.北京大学工会的网页
[4]杨玲.以家庭为单位参加新型农村合医疗与城镇化的两难选择.中国农村经济.2004.12:59-63
[5]彭芳,陈迎春,张全红,等.农村人口流动对新型农村合作医疗的影响.中国卫生事业管理.2005.4:245-246
[6]王芳,程茂金,王红.探索我国二元经济中农村流动人口医疗保险模式.中国卫生经济.2002.7:31
[7]罗传善.外来流动人口计划免疫工作难点与对策.中国卫生事业管理.1998.12:31
[8]胡善联.21世纪疾病防治任务的探讨.上海预防医学杂志.1999.11(7):24-25
[9]杨纯娟,翁佩玲.徐家汇街道外来妇女生活善与卫生需求的调查.中国初级卫生保健.2002.16(10):28-29
[10]张建端,张静,石淑华,等.未婚流动人口生殖健康需求研究.中国妇幼保项原则健.2004.19:106-108
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[12]严征,李鲁,叶旭军.进城农民工的健康问题及对策分析.中国农村卫生事业管理.2005.7(25):9-10
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[15]王红.农民工的医疗保障问题.人民日报,1998-3-24(10)
[16]http://www.southcn.com/.南方周末:专家媒体争论全民医保是否可能
[17]http://www.stock.163.com/05/09/1TJPU8T200251GRO.htm1.“全民医保”如何保民2005-09-14
[18]卢祖洵,金生国.国外社区卫生服务.北京:人民卫生出版社,2001:12、36、63-68
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[20]鞠秋锦,邓卫华.建立符合农民工特点的社会保险体系.社会保障.2004,11:38
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[22]http://live.people.com.cn-bbs/index.php?id=21050923105844.卫生政策研究主任石光:医改改什么.
[23]Zhan Shaokang, Sun Zhenwei, Erik Blas, Economic transition and maternal health care for internal migrants in Shanghai, China. Health Policy and Planning. 2002.17(1):47
[24]Pongpisut Jongudomsuk. Effect of capitation payment on resource allocation and financing of public hospital in Thailand. Conference paper. Asia Health & insurance. 2003(6).26-27