發(fā)布時間：2018-04-11 08:34

  本文選題：農(nóng)民工 + 基本醫(yī)療保險　； 參考：《西南財經(jīng)大學(xué)》2013年碩士論文

【摘要】：社會醫(yī)療保險制度作為社會保險體系中重要的保障制度之一,旨在滿足廣大民眾基本的醫(yī)療需求的基礎(chǔ)上,降低醫(yī)療成本,最終以實現(xiàn)全民健康狀況的改善為目標(biāo),保障廣大民眾最基本的健康權(quán)益。農(nóng)民工,一個中國特色社會主義建設(shè)過程中的特殊名詞---這群來自于農(nóng)村,服務(wù)于城市的群體,由于中國不健全的社會保障制度而處于社會福利的邊緣。隨著我國經(jīng)濟(jì)的迅猛發(fā)展,國家也開始著手對農(nóng)民工群體的社會保障政策所存在的矛盾進(jìn)行調(diào)和,陸續(xù)出臺了多項重要政策,以針對農(nóng)民工的各項權(quán)益進(jìn)行修補(bǔ)和維護(hù)。而醫(yī)療保險制度是其核心政策。截止2013年1月,我國出臺的針對農(nóng)民工群體的社會醫(yī)療保險制度主要分為幾大類：第一類將農(nóng)民工群體劃入城鎮(zhèn)職工基本醫(yī)療保險制度的范疇,同城鎮(zhèn)職工共享平等的醫(yī)療保險待遇：第二類即為專門針對農(nóng)民工特點出臺的地方性農(nóng)民工大病醫(yī)療保險制度；第三類為少見的地方性綜合醫(yī)療保險制度,目前這種制度僅上海還保存；最后一類則將農(nóng)民工納入城鄉(xiāng)居民基本醫(yī)療保險制度體系內(nèi)。但是這些制度存在一個當(dāng)農(nóng)民工變換工作地點或居住地點時,其在原工作地的社會醫(yī)療保險卻不能順暢轉(zhuǎn)移銜接的問題。因而如何解決農(nóng)民工醫(yī)療保險制度的轉(zhuǎn)移銜接問題成為了近年來政府和學(xué)術(shù)界廣泛關(guān)注和探討的話題。 文章從我國農(nóng)民工和農(nóng)民工醫(yī)療保險制度的起源出發(fā),逐步開始探討關(guān)于農(nóng)民工醫(yī)療保險制度的轉(zhuǎn)移接續(xù)問題。文章重點立足于詳實的資料收集和整理,對我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移接續(xù)的現(xiàn)狀進(jìn)行調(diào)研,從中分析銜接的困境何在、存在哪些問題,并分別從制度內(nèi)和制度外兩個方面探討影響我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移銜接難的主要因素。最終結(jié)合國外流動人員基本醫(yī)療保險轉(zhuǎn)移銜接的相關(guān)做法和經(jīng)驗,提出了我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移銜接的最終模式——“二位一體”的國民基本醫(yī)療保險體制。其改革路徑主要分為制度內(nèi)和制度外兩個層面,提出只有逐步取消制度的“碎片化”,實現(xiàn)制度層面上的統(tǒng)一和待遇層面上的一體化,才能降低制度轉(zhuǎn)移銜接成本,高效率完成轉(zhuǎn)移銜接的最好方式。 全文共分為六章,每一章的主要內(nèi)容和思路如下： 第一章為導(dǎo)論,主要分為序言和國內(nèi)外文獻(xiàn)綜述。序言主要內(nèi)容為該文所要論述的基本問題,即問題產(chǎn)生的背景和對問題研究存在的意義；國內(nèi)外文獻(xiàn)綜述主要包括了寫作之前所從事的文獻(xiàn)搜集成果,以及對國內(nèi)外文獻(xiàn)的思考和想法,為之后的研究做好理論上的準(zhǔn)備。由于農(nóng)民工是在我國特殊國情下出現(xiàn)的一個群體,國外無農(nóng)民工的說法,因此國外大部分的文獻(xiàn)多是以流動人員為主進(jìn)行的探討；而國內(nèi)關(guān)于農(nóng)民工醫(yī)療保險制度的研究主要從兩個層面出發(fā)：第一個層面直接以農(nóng)民工為研究對象探討其醫(yī)療保險制度問題；第二層面是間接地從醫(yī)療保險制度的城鄉(xiāng)統(tǒng)籌角度來探討問題,其中農(nóng)民工醫(yī)療保險制度是核心部分。 第二章為背景知識研究,主要針對農(nóng)民工以及農(nóng)民工醫(yī)療保險制度兩個元素分別進(jìn)行介紹和討論,農(nóng)民工作為我國獨有的一個群體,具有其自身的起源和特征,尤其是目前我國的“第三代”農(nóng)民工——90后農(nóng)民工的出現(xiàn),對目前的醫(yī)療保險制度提出了更多的挑戰(zhàn)。由于我國各地針對農(nóng)民工群體出臺了多種不同的制度和模式,制度之間差異性又過大,因此衍生出了跨制度轉(zhuǎn)移銜接的問題。 第三章為農(nóng)民工醫(yī)療保險制度的轉(zhuǎn)移接續(xù)現(xiàn)狀研究。該部分在繼承上一章對于我國農(nóng)民工醫(yī)療保險制度現(xiàn)狀的分析后,介紹我國在農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移接續(xù)方面做出的一些嘗試和代表模式,試圖能較為全面地了解在該問題上我國的一個主要發(fā)展概況。該部分以農(nóng)民工醫(yī)療保險制度與其他不同的醫(yī)療保險險種之間的轉(zhuǎn)移銜接為標(biāo)準(zhǔn),針對每一種制度銜接做出歸類比較,并提出一些具有代表意義的地區(qū)作為經(jīng)驗借鑒,如重慶,太倉,珠海等地。通過對每個模式的對比和分析,總結(jié)出我國在農(nóng)民工醫(yī)療保險制度建設(shè)上所遵循的規(guī)律——逐步取消制度的“碎片化”,縮小制度水平的差異,是解決農(nóng)民工醫(yī)療保險轉(zhuǎn)移銜接的必由之路。 第四章根據(jù)以上對我國農(nóng)民工醫(yī)療保險轉(zhuǎn)移接續(xù)問題的一個現(xiàn)狀調(diào)查分析之后,做出進(jìn)一步的思考闡述。從主要問題入手,如繳費年限的轉(zhuǎn)移銜接,基金的跨制度劃撥,逐步分析出問題產(chǎn)生的根源以及影響該問題的核心因素。對于問題的影響因素方面,分別以內(nèi)部和外部兩個角度來進(jìn)行論述,得出影響我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移銜接困難的內(nèi)部根源就在于我國基本醫(yī)療保險體制發(fā)展的不健全,統(tǒng)籌層次過低,“碎片化”程度過高；外部根源則是我國長期以來的城鄉(xiāng)二元體制,影響并阻礙了制度的發(fā)展。 第五章是對國外流動人員基本醫(yī)療保險轉(zhuǎn)移銜接的研究。該部分分別從國際和國家兩個層面進(jìn)行了相應(yīng)探討：其一是跨國間的流動帶來的轉(zhuǎn)移接續(xù)問題,其中就包含了許多經(jīng)濟(jì)合作區(qū)域設(shè)立的本區(qū)域內(nèi)的社會保障公約和協(xié)議,以保障成員國公民在本區(qū)域內(nèi)流動時的社會保險待遇問題；另一個則是一國內(nèi)跨地之間流動的醫(yī)療保險轉(zhuǎn)移銜接經(jīng)驗,比較具有代表性的國家多是一些經(jīng)濟(jì)發(fā)達(dá)國家,而還有部分國家則是通過實現(xiàn)全民基本醫(yī)療的方式間接地解決了流動人員的基本醫(yī)療需求的問題。從這兩個層面得出一些規(guī)律和特性。進(jìn)而為文章最終提出政策建議提供參考。 第六章為本文的最后一章,主要介紹針對我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移接續(xù)問題的對策建議,在該部分筆者提出了農(nóng)民工醫(yī)療保險制度的最終發(fā)展模式——“二位一體”的國民基本醫(yī)療保險體制。實現(xiàn)最終模式的路徑需要分別從內(nèi)部和外部兩個方面進(jìn)行改善和發(fā)展,主要觀點為唯有加快我國城鄉(xiāng)一體化建設(shè)的進(jìn)度,加快實現(xiàn)城鎮(zhèn)化,實現(xiàn)城鄉(xiāng)居民的平等公平發(fā)展,才能在整體層面上提升我國醫(yī)療保險制度的高度；另一方面,加快我國醫(yī)療保險制度的建設(shè),逐步提高統(tǒng)籌層次,兼并醫(yī)療保險制度的“碎片”,減少制度險種,實現(xiàn)制度的一致性和統(tǒng)一性,才能更進(jìn)一步的實現(xiàn)制度的順暢轉(zhuǎn)移銜接。 本文的研究方法是以文獻(xiàn)研究作為前提和基礎(chǔ),以實證研究為手段,通過定性分析和部分?jǐn)?shù)據(jù)分析,使得文章的邏輯和內(nèi)容顯得盡量清晰和可靠。本文是作者平時的科研成果中總結(jié)和提煉出的一部分,是經(jīng)過長期的思索和考證的成果,其中部分?jǐn)?shù)據(jù)和結(jié)論是作者在實地調(diào)查后得到的,具有充分的可靠性和有效性。 本文的創(chuàng)新之處在于：首先文章緊握政策脈搏,掌握最新的政策動態(tài)和信息,對部分代表地區(qū)的數(shù)據(jù)和信息做過詳細(xì)的分析和對比,也通過電話采訪的方式對代表地區(qū)負(fù)責(zé)人進(jìn)行訪談,深入了解政策制定背后的考量,更加有助于對政策的深入理解和分析；此外文章最終提出了我國農(nóng)民工醫(yī)療保險制度轉(zhuǎn)移銜接的發(fā)展模式——“二位一體”的國民基本醫(yī)療保險模式,提出通過逐步消除制度的“碎片化”和平衡制度間的水平差距來減輕和消除制度轉(zhuǎn)移銜接的成本和障礙的路徑建議。
[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 .

【學(xué)位授予單位】：西南財經(jīng)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：F842.684

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