医疗保险参保地对我国流动人口卫生服务利用和健康状况影响及对策研究:一个范畴综述

A Scoping Review of the Impact of Medical Insurance Enrollment Location on the Health Service Utilization and Health Status of the Migrants Population in China and Its Countermeasures

目的:系统分析和探索医疗保险参保地点对我国流动人口卫生服务利用及健康状况的影响及作用机制。方法:利用范畴综述方法,以Web of Science、PubMed、Scopus和中国知网为数据源,“流动人口”“卫生服务利用”和“健康状况”等为主题词,系统检索并下载相关文献560篇,通过制定严格的筛选标准最终纳入24篇相关研究。结果:我国流动人口参保地点选择导致的异地就医问题逐渐升温。流入地参保可以通过降低就医经济负担、提高社会融合水平显著提高流动人口卫生服务可及性和利用水平。流入地参保可以通过促进社会融合、提高公共卫生和医疗服务利用等路径改善流动人口健康状况,同时,健康状况反向影响流动人口的参保地点选择行为,流动人口参保地点选择过程中存在“逆向选择”现象。结论:参保地点显著影响流动人口卫生服务利用,且与流动人口健康状况呈双向作用关系。建议通过提高医保统筹层次、畅通医保转移接续通道和拓展落实异地就医即时结算等多维政策路径,破解参保地点导致的健康不平等问题。

Objective To systematically analyze and explore the impact and mechanism of medical insurance enrollment location on the health services use and health status of the migrants in China. Methods Based on scoping review method, documents related to “internal migrants”, “health service use” and “health status” were retrieved from Web of Science, PubMed, Scopus and CNKI Database, and finally included based on scientific screening standards and process. Results There were more and more researches on the issue of out-of-town medical treatment caused by the choice of medical insurance enrollment location for the internal migrants. Participating in medical insurance in the place of residence can significantly improve the accessibility and level of health services utilization for internal migrants by reducing the economic burden and improving the level of social integration, and can improve the health status of the internal migrants by promoting social integration, increasing the utilization rate of public health services and medical services. Meanwhile, health status can affect the internal migrants’ choice of medical insurance enrollment location, and "adverse selection" exited in the choice process. Conclusion Medical insurance enrollment location significantly influenced the utilization of health services for the internal migrants, and interacted with health status of the internal migrants. It was recommended to improve the health inequality caused by medical insurance enrollment locations by upgrading the budget fund coordination level, making medical insurance transfer and connecting conveniently, and expanding the implementation of on-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location.