生育医疗待遇:政策演变、人群差异及优化策略

Medical Reimbursement of Childbirth:Policy Evolution,Group Differences,and Optimization Strategies

生育医疗待遇是包括产前检查、住院分娩、生育并发症、计划生育手术及并发症等费用报销的一揽子政策,它是母婴保健、"全面二孩"生育配套服务、全民生育保障的一项重要内容。通过回顾相关政策演进过程可以看出,改革开放后生育医疗待遇是按户籍、职业区分参保对象的,城镇职工的生育保障起步较早,也相对成熟,而灵活就业人员、职工未就业配偶、农村广大妇女的生育医疗待遇则起步较晚。基于2010年第三期中国妇女社会地位调查数据,从住院分娩费用报销这一主要方面来反映生育医疗待遇总体情况,结果表明,不同人口学特征、政策时期和从业性质的母亲在分娩费用报销方面存在显著性差异。由于在分析期间1989-2010年内母亲生育医疗待遇主要是职工的权益,来自于生育保险基金支付。因此,女性就业非正规化将弱化职工的生育医疗待遇这一政策的保障作用。改变这一状况我们需要:将生育保险中的生育医疗待遇纳入医疗保险中,打破就业身份对生育保障的限制,建立全民性的生育福利制度;推广孕前检查、计划生育手术并发症等服务,扩展生育医疗待遇项目,深化孕产妇保健工作;规范生育的医疗费用支付标准和整合现有法规。

Medical reimbursement of childbirth expenses is an important part of maternal and child health care, fertility support services of two--children policy, and the universal reproduc- tive protection system. This article first reviews the evolution of the policy of medical treatment of childbirth, detailing the policies and regulations of the three groups of urban workers, urban non--employed women and rural women. Then, based on the data of social status survey of Chi- nese women in 2010, this paper analyzes the reimbursement of mothers＂ childbirth expenses. The results show that there are significant differences in the reimbursement of childbirth expenses be- tween different demographic characteristics, policy period and nature of employment. At the same time, the informalization of female employment will weaken the protection of the reproduc- tive health of female workers.