城市外来务工人口医疗保障与卫生服务需求——基于上海市487名外来务工人员的调查

Social medical insurance and health service demand of out-of-town employees:On the basis of questionnaire survey of 487 out-of-town employees

以上海为例分析城市外来务工人员的医疗保障和卫生服务使用特点,为制定完善的针对外来务工人员的医疗保障制度提供实证参考。结果显示,上海现行的外来从业人员综合保险效果不理想,基层医疗机构是满足外来人口医疗需求的主要力量,但财政配套措施不健全,费用和配套服务是影响外来人口就医的主要问题。为应对这些问题,对外来务工人员的医保要覆盖门诊,并制定合理的报销比例引导合理消费,尝试在社区建立首诊制度,开展就医指导,对外来人口集中的社区卫生机构提供专项补贴。

In order to give references to formulating a better medical insurance for out-of-town employees,this paper analyzed their health service demand and medical insurance status on the basis of questionnaire survey taking Shanghai as an example.It is founded that the current comprehensive insurance is unsatisfactory,primary medical institutions are the major force to satisfy out-of-town employees＇ medical demand,price and supporting services are main problems arresting medical service utilization.For this reason,outpatient services should be covered,reasonable reimbursement ratio should be made to guide rational consumption,a gate keeping refferral system should be established at the community level,medical guide services should be carried out,and special subsidies should be given to communities where out-of-town employees concentrated.