流动人口跨省异地就医困局的缘起、政策分析与制度破解

The Dilemma of the Cross-provincial Medical Treatment of Migrant Population:The Origin,Policy Analysis and Removal of Institutional Barriers

在人口流动日益普遍的时代背景下,非参保地医疗资源的可及可得与跨省流动人口医疗需求的矛盾愈发突出,如何破解跨省流动者异地就医的困局成了亟待研究的问题。由于流动人口的家庭化与老龄化催生异地就医诉求,同时医疗资源分布的失衡加剧异地就医导向,加之过低的基本医疗保险基金统筹层次阻碍医疗费用即时结算,流动人口跨省异地就医困局逐步形成。通过分析流动人口跨省异地就医政策发现,当前政策的破局得益于信息化技术对制度壁垒的消解,政策的推进得益于流动人口不断突破资格限制并获得健康保障权利,政策的落地则归功于高位推动和地方合作。然而,当前流动人口跨省异地就医仍然面临多重挑战。首先,由于基本医疗保险基金的统筹层次仍旧偏低、基金支付的压力在地区间出现不平衡、医保支付方式改革增加结算难度以及跨省就医对欠发达地区的医保基金形成虹吸等原因,现行的医保基金管理制度仍然限制着异地就医费用的结算。其次,由于依托分级诊疗的异地就医秩序尚未建立,且异地就医结算系统忽视流入地的疾病谱因素,因此当前的异地就医制度未能结合并有序利用流入地医疗资源。再次,随着国家异地就医结算平台压力不断增大,且跨省异地就医备案流程冗长并手续繁琐,导致当前技术平台与管理服务有待升级。因此,需要借助以下三个途径破解流动人口跨省异地就医困局:途径一是打破"制度碎片化—统筹层次低"的逻辑链条,通过建立国民健康保险,从顶层设计上实现医保制度的一体化,消除异地困境。途径二是主动结合流入地的医疗资源,并依托流动人口基层首诊、优先结算社区门诊慢性病治疗费用等激励机制,在跨省流动人口群体中构建异地就医秩序,引导流动人口有序就医,最终合理有序地利用流入地医疗资源。途径三是通过强化结算系统数据承载与共享功能,实现备案过程的简便化和手段的电子化,以完善数字化服务,提升流动人口服务体验。

Under the background of increasing population floating,the contradiction between the settlement of non-local hospitalization bill and the increasing medical need of migrant people become more prominent.It is important to solve the cross-provincial medical treatment problem of migrant population.Due to the familization and aging of the migrant population,the imbalance of medical resources distribution intensifies the orientation of medical treatment in different places,and the low overall level of basic medical insurance funds hinders the immediate settlement of medical expenses.The cross-provincial medical difficulties of migrant people gradually formed.Through analyzing cross-provincial medical policies,this paper finds that the progress of policies get benefit not only from technical support,but also from the migrant population getting their health protect rights,and also from higher-level authorities drive and inter-governmental cooperation.However,the cross-provincial medical care policies still face so many challenges.First,the low planning level of health insurance,imbalance payment pressure of health insurance in different places,increasing difficulties of settlement for changing of health insurance payment way,and the siphon function of health insurance funds between regions all result in the difficulties of settlement of medical expenses.Second,since the order of cross-provincial medical treatment which relies on hierarchical medical system has not been established and the disease spectrum factors are ignored,current system and policies fail to combine and orderly utilize the medical resources of non-local insurance system.Third,for the increasing pressure on the national cross-provincial medical settlement platform and the unnecessary procedures for putting on records on this platform,the current technology platform and management services need to be upgraded.There are three ways to solve the problems mentioned above.First,it is suggested to integrate current medical insurance systems and establish National Health Insurance to breakdown the logic chain of fragmented institution and low funds planning levels,and finally eliminate the so called cross-provincial problem.Second,it is advisable to combine the medical resources actively and create incentive mechanism such as introducing first consultation to primary hospitals,giving medical expenses settlement priority for diagnoses of primary hospitals to create the order of cross-provincial medical treatment and utilize the medical resources reasonably.Finally,through strengthening the data carrying and sharing function of settlement system,we can realize the simplicity and the electronic means of the filing process to improve the digital service and enhance the service experience of the migrant population.