农民工医疗保障与服务的缺失及改进路径——基于湘潭市354名农民工的调查

Deficiency and improvement path of migrant workers' medical security and service mechanism:Based on the investigation in Xiangtan City

以湖南省湘潭市354名农民工样本作为研究对象,就农民工患病就诊、治疗支出以及医疗保险提供等情况进行分析,结果表明:农民工患病率高,就医费用过高,多选择非正规治疗,应对疾病风险能力低下,医疗保险方案实施效果与政策目标间存在较大差距。这显示出医疗保障制度难以适应农民工的不同生存境况,城市医疗资源过度市场化制约了农民工分享公共医疗资源,农民工公共卫生服务体系政策监管滞后。基于此,提出应建立多层次、开放式农民工医疗保障体系,完善医疗保险制度,应强化政府主导责任,构建农民工医疗安全网,优化医疗服务供给制度等方式促进农民工合法医疗权的实现。

Taking 354 migrant workers in Xiangtan City, Hunan Province as samples, this study analyzed the ill treatment, treatment expenses and medical insurance providers and found out that the prevalence rate of migrant workers and the cost of medical care are high, migrant workers tend to choose non-formal treatment, their ability to cope with disease risk is low, there exists a big gap between implementation effect and policy goals of medical insurance plan. The above results indicate that： health care system can not adapt to different living situation of migrant workers, the excessive marketization of urban medical resources constraints the migrant workers to share public health resources, the regulatory policy of public health service system for migrant workers is lagging. Based on these, this article proposes that it is necessary to establish a multi-level, open health care system of migrant workers, to improve the medical insurance system,to strengthen the lead responsibility of government, to build medical safety net for migrant workers, to optimize the supply of medical services system in order to promote the legitimate medical right of migrant workers realize.