With the accelerated pace of industrialization and urbanization in our country, the medical insurance system designed mainly for the urban population has been unable to meet the increasingly prominent medical security needs of migrant farmers and landless farmers; a large number of young and middle-aged farmers have left their hometowns. For a long time, they were unable to participate in the new rural cooperative medical system and the serious disease co-ordination plan in rural areas; after migrating to cities to work, their units or employers failed to pay medical insurance premiums for them; and their own awareness of insurance was not strong; so that migrant workers in cities became There are gaps and missing groups in the arrangements of the formal medical insurance system. Although various localities have actively explored medical insurance policies applicable to migrant workers, the proportion of participants in various formal medical insurance systems is still very low. Their legitimate medical rights and interests are not effectively protected, and medical risks are also high. The failure to fundamentally resolve the issue has triggered some social conflicts and disputes and attracted widespread attention from all aspects of society. Article 6 of the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System" (hereinafter referred to as the "Opinions on Deepening the Reform of the Medical and Health System") issued not long ago clearly states: "Properly resolve the issue of basic medical insurance for migrant workers." "Actively carry out the transfer and continuation of basic medical insurance relationships with a focus on migrant workers in urban and rural areas." This shows that basic medical insurance for migrant workers is also one of the major livelihood issues.
In fact, as early as 2006, the State Council issued the "Several Opinions on Solving the Problems of Migrant Workers" (Guofa [2006] No. 5), which clearly stated: "We should promptly solve the problem of migrant workers." The issue of medical insurance for serious illnesses. All coordinating regions should adopt the method of establishing a coordinating fund for serious illness medical insurance to focus on solving the problem of hospitalization medical insurance for migrant workers when they go to work in cities." The Ministry of Social Security and the Ministry of Health have also formulated regulations on the implementation of Guofa [2006] No. 5, and the Ministry of Social Security has also launched special actions to implement medical insurance for migrant workers. Beginning in the second half of 2006, some large and medium-sized cities where migrant workers are concentrated, in order to implement the Guofa [2006] No. 5 document, have vigorously promoted serious illness medical insurance for migrant workers across the country. The methods and measures formulated are highly targeted and to a certain extent. The medical security situation of migrant workers has been improved.
However, since the implementation of the system mainly relies on administrative promotion, it is somewhat hasty. There is a lack of comprehensive and in-depth baseline research on the characteristics and disease status of migrant workers. Some regulations are not clear enough and the operability is not strong enough. Farmers The labor participation insurance rate is not high. There are still many contradictions and problems before the establishment of a low-rate, wide-coverage, transferable, and transferable medical insurance scheme for migrant workers that can be connected with the current medical insurance system; how to ensure their medical insurance rights institutionally and institutionally, and truly realize the "2020 "Everyone has basic medical security" still has a long way to go, and it also poses severe challenges and tests to decision-makers and management. Judging from the current design and policy implementation of the medical insurance system for migrant workers, there are the following problems:
First of all, there are still omissions and deficiencies in the design of the current medical insurance system. The current medical insurance system is divided into urban employees, residents, and the New Rural Cooperative Medical System according to employed and non-employed groups and occupations. Judging from the system design and policy regulations, it seems that they can cover migrant workers. However, the reality is another matter.
First, some migrant workers are excluded from the system. In the urban dual labor market, the participation rate of migrant workers in serious illness medical insurance is low. Some migrant workers adopt informal employment methods and are concentrated in small-scale, unorganized structures, simple business and service industries with poor management, or become "Temporary workers" who are treated differently from regular employees generally do not sign labor contracts. Some scholars believe that informal employment is the main form of employment for hundreds of millions of migrant workers in large and medium-sized cities. However, the current design of the serious illness medical insurance system for migrant workers is based on the premise of signing a labor contract with the employer and formal employment. This first excludes from the system migrant workers who come to work in cities and local township and village enterprises, as well as some migrant workers who have not signed a formal labor relationship, are frequently mobile, and are engaged in domestic services and other flexible employment. According to surveys, the number of migrant workers in some cities who have not signed labor contracts is as high as 65.3%, making the number of people covered by serious illness medical insurance very limited.
The second is the omissions and deficiencies in the design of the new rural cooperative medical system. The design of the new rural cooperative medical system mainly targets the permanent agricultural population in rural areas and ignores the floating migrant workers. It generally adopts a door-to-door charging method for financing, and there is a lack of clear and specific regulations on charging time. Some payment policies are not precise, and missed insurance and late insurance do not count. This is very unfair to migrant workers who have been mobile for a long time, and their participation is extremely limited. ; Participating medical policies and treatment benefits also lack flexibility.
The 2005 National Audit Office report clearly pointed out that some places have strict restrictions on the reimbursement of medical expenses for migrant workers, resulting in a low proportion of migrant workers participating in cooperative medical care and affecting the degree of benefit. Some counties (cities) require migrant workers to return to their local area for reimbursement once they get sick and receive treatment in other places. The scope of reimbursement is relatively narrow, the reimbursement catalog has many restrictions, and the deductible is high. Even if reimbursement is available, it can only be about 20% or lower. . As a result, there is a large gap between the cost burden expectations of migrant workers after illness and the benefits they can actually receive. In addition, it is subject to the principle of territoriality and is difficult to adapt to the medical security and health needs of industrialization and urbanization to promote and protect labor mobility, which directly affects the enthusiasm for participation.
Third, the urban residents’ medical insurance system has no connection with it. Since social security policies have classified migrant workers as an employment group and included them in the urban employee medical insurance system, they are not eligible for the urban residents' medical insurance that was launched in 2007 and can receive government subsidies. It can be said that migrant workers are outside the entire medical insurance "safety net". The migrant workers' medical insurance policy is in the gray integration area of ??the three major systems of urban employees, resident medical insurance and new rural cooperative medical insurance, which puts migrant workers' participation in insurance in an embarrassing situation.
Fourthly, the situation of medical assistance for migrant workers is also worrying. Although medical assistance for the rural poor has been implemented in 2003, they have been working abroad for a long time and have suffered from major or serious illnesses. They cannot quench their thirst with water far away and cannot get the benefits of the rural medical assistance system in a timely manner. The urban medical assistance launched in 2005 has no role for them at all. Migrant workers are on the edge of the social and medical security systems. Although they are in the city, they do not belong to the city. Urban community health services do not include their public health services and minor injuries and illnesses in the management. They are far away from their hometowns. When they suffer from serious illness, they have neither family support nor neighbor mutual assistance and community management. Secondly, the existing serious illness medical insurance system is not well connected. The localized management of medical insurance and the disconnect between urban and rural medical security systems are important obstacles that make it difficult for migrant workers to enjoy medical insurance benefits.
Migrant workers are on the move. Some only use their leisure time to work in cities and frequently travel between cities and rural areas; some have not determined a suitable place to work and shuttle between different provinces and cities; some are looking for suitable jobs in a certain city and change their jobs. between different types of work or positions. The localized management of medical insurance and the disconnect between urban and rural medical security systems are seriously incompatible with the mobility characteristics of migrant workers. The first is the contradiction between the regional coordination of social insurance funds and the inter-provincial flow of migrant workers; the second is the lack of effective connection between urban and rural medical insurance systems. Migrant workers have broken through the binary opposition model with clear boundaries between agricultural population and urban population, and created a new group in the population structure that has the characteristics of both. The current medical insurance system implements an urban-rural dual-track system that separates urban and rural populations. The boundaries of the covered objects are clear, and the dual medical insurance systems operate independently of each other. A considerable number of migrant workers have become a "three-nothing" vacuum group. In addition, it takes a long time to enjoy critical illness medical insurance benefits, and migrant workers move frequently, making it difficult to connect fund transfers and reimbursements between regions, and reimbursement for medical treatment in other places is even more difficult.
Thirdly, the policies and measures for large-scale medical insurance are not perfect and their implementation is insufficient. This is reflected in the following: ① The policy of "only the current period of coverage, regardless of the insurance period" makes the insurance coverage of migrant workers "looked at differently" by urban residents as a temporary measure; the coverage of the current period ignores the identity transformation of migrant workers and the overall planning of urban and rural medical insurance development. Practice; ② Medical insurance types are not perfect, payment standards are not uniform, and benefits are low. The critical illness medical insurance for migrant workers only covers outpatient critical illness and hospitalization, and no personal account is established. Outpatient critical illness is limited to radiotherapy and chemotherapy for malignant tumors, hemodialysis (including peritoneal dialysis) treatment for severe uremia, and anti-rejection treatment after kidney transplant surgery, etc. . The insurance regulations are obviously very different from the reality that the vast majority of migrant workers are young and middle-aged and have a low chance of serious illness and are difficult to obtain reimbursement from the system; while regular minor injuries and illnesses do not have personal accounts and are difficult to obtain reimbursement; ③Medical insurance There is a lack of enforcement of rights protection. Although the insurance (hospitalization) policies or methods for migrant workers currently promulgated in most areas clearly stipulate that employers must apply for insurance for them, if they fail to do so on time and pay in full, migrant workers can report it and can also file a labor dispute complaint Arbitration Commission application for arbitration and other provisions. However, the reality is that some business owners are unwilling to pay medical insurance premiums in order to reduce costs. According to a survey, more than 60% of employers do not sign labor contracts with migrant workers in accordance with the law, abuse their probation periods, and use migrant workers as cheap temporary workers who can be fired at any time. Most small businesses and service industries do not pay comprehensive insurance in accordance with regulations.
Migrant workers who are at the bottom of society leave their hometowns to work in cities. They have no relatives and are weak in power. It is not easy to report and apply for arbitration for their own interests! Under such circumstances, regulations such as requiring migrant workers to report and lodge complaints on their own are in vain. Once migrant workers or their family members suddenly become seriously ill, they will be plunged into a catastrophic crisis.
In short, migrant workers are a special group during my country's transformation period. They are outside the urban health and medical security system and face the dual dilemma of health and medical insecurity. It not only brings public health and safety hazards, but also affects social stability and harmony. In order to relieve the worries of farmers who migrate to cities to seek medical treatment, and to effectively eliminate their worries and worries about reimbursement for medical treatment, their awareness needs to be further improved, policies and measures need to be improved, and the system needs to be innovated.
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