用户名: 密码: 验证码:
深圳市劳务工医疗保险卫生服务研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
深圳市劳务工医疗保险卫生服务研究
     研究目的
     全面系统地了解深圳市劳务工卫生服务需要、需求和利用、卫生服务供给、劳务工医疗保险运行等情况,总结经验,发现问题,为进一步完善相关医疗保险政策和卫生服务制度设计提供依据。
     研究方法
     本课题主要采用文献研究、现场调查、深入访谈、案例研究、比较研究方法对深圳市劳务工医疗保险卫生服务进行了调查分析。将定量分析和定性分析结合起来,从需方、供方和管理方三个层面试图对卫生服务项目进行系统评价。具体来说,采用描述性分析和卡方检验分析卫生服务供给、需要、利用情况及其影响因素,采用广义线性回归模型分析参保劳务工对社区卫生服务的反应性和满意度的影响因素。
     研究结果
     研究表明,1.劳务工卫生服务供给情况:①定点社区健康服务中心共有337家,平均服务半径为1.59公里,平均服务人口为4.86万人,其总体状况经营状况较差,45.45%处于亏损状态。②受调查的参保劳务工中,到最近医疗点用时10~19分钟占30.28%,用时30分钟及以上占37.32%。⑧专业人员构成不合理,尤其缺乏公共卫生医师;平均每所社区健康服务中心有工作人员14人,医护比为1:0.76(高于全国1:0.61);职称构成多以初级职称为主:学历以中专学历为主。
     2.劳务工卫生服务需要情况:参保人员与未参保人员两周患病率分别为22.24%、25.52%,慢性病患病率分别为21.06%、16.68%,均高于第三次国家卫生服务调查报告的城市人口两周患病率、慢性病患病率(15.23%、17.73%)。
     3.劳务工卫生服务利用情况:①参保人员与未参保人员两周就诊率分别为20.10%、15.47%,两周患病未就诊率分别为57.63%和64.61%;参保患者和未参保患者自我医疗的者比例分别为:34.09%、46.13%,未采取任何措施的比例分别为23.54%、20.07%。未治疗的主要原因中,超过50%的患者自感病情较轻,而由于经济困难而没有治疗仍有25%。参保患者在社区健康服务中心就诊的比例为42.44%,未参保患者为23.4%。②参保人员住院率为3.56%,未参保人员为3.05%,均低于第三次国家卫生服务调查分析报告城市人口住院率4.2%;参保人员和未参保人员在镇级医院住院的比例在各级别医疗机构中最高,分别为:42.86%、36.67%。参保人员与未参保人员应住院而未住院率分别为50.67%、46.58%。参保患者和未参保患者应住院而未住院的主要原因都是由于经济困难,比例分别为74.36%、58.82%。参保与未参保人员的住院率间差异无统计学意义(P>0.05),未住院率间亦差异无统计学意义(P>0.05)。
     4.劳务工医疗保险卫生服务反应性:反应性各要素评分中保密性平均分最高(3.65),环境和可及性得分最低(3.07)。对劳务工医疗保险卫生服务反应性的总体评价中,12.31%的就诊者认为“很差”或“差”,53.08%认为“好”或“很好”。广义线性模型分析结果表明,职业性质和卫生机构硕士以上学历人员比例对反应性的影响均有统计学意义(P<0.05)。
     5.劳务工医疗保险卫生服务满意度:各要素评分中服务态度平均分最高(3.49),费用平均分最低(3.06)。399名就诊者对医疗机构满意度的总体评价中,13.07%的就诊者表示“很不满意”或“不太满意”。广义线性模型分析结果表明,每年支出的医疗费用、卫生机构硕士以上学历人员比例对满意度的影响均有统计学意义。
     研究结论
     劳务工医疗保险及其卫生服务工作取得了一些成效:人力资源已经基本到位;引导劳务工就医的合理流向;参保劳务工的医疗费用有所控制;提高了门诊卫生服务利用水平;拓展社区卫生服务的发展空间,提高了卫生服务可及性:卫生服务反应性和满意度较好。但是存在一些问题,主要是:供方定点医疗机构和服务人员数量严重不足,人员结构和机构布局不合理,服务水平和质量有待改善,诱导需求现象仍然存在;劳务工门诊和住院服务需要量较大,而住院服务利用较少;劳务工医疗保险政策本身有待进一步完善;社区卫生服务机构亏损约占到一半;劳务工医疗保险政策宣传力度不够,影响参保企业和个人的积极性。
     政策建议
     正确认识劳务工医疗保险,明确政府在劳务工医疗保险中的主导作用和功能;通过提高卫生服务供给能力提高劳务工卫生服务利用水平;提高办卡效率和质量,简化报销、转诊手续,提高定点医疗机构管理水平,加强医疗保险基金管理,从而提高劳务工医疗保险机构的服务水平和质量;注重劳务工医疗保险与新农合工作的衔接;建立农民工大病医疗救助制度、贫困医疗救助制度。以上政策建议可以保障深圳市劳务工医疗保险制度持续、稳定、健康的发展。
     研究创新
     ①深圳市率先进行大范围劳务工医疗保障研究与实践。②在适合农民工特点的筹资水平下,重点探索了劳务工卫生服务提供、需要、利用,并对卫生服务提供质量进行了评估。③社区卫生服务的提供与劳务工医疗保险结合,为解决农民工医疗保障的公平性问题提供了一个很好的思路。
Objective
     To know health service need, demand and utilization of migrant workers and thehealth service supply, and the performance of the Migrant Worker's Medical InsuranceSystem (MWMIS) in Shenzhen, and to provide basis for related departments to perfectthe policy of medical insurance and design health service system for migrant workersby summarizing the experience and discovering problems.
     Methods
     In this study, document analysis, the field observation, depth interview, caseexample research, and comparison research were performed to investigate and analyzehealth service of MWMIS in Shenzhen. By combining quantity and quality analyses,efforts were afford to give a systematic review on the project from health servicedemander, provider and manager sides. In details, the health service supply, need,utilization rate and the influencing factors in migrant workers were analyzed by thedescriptive method and chi-square test. Multiple factor analysis such as linearregression was adopted to study satisfaction and the response of the migrant workers tothe community health service.
     Results
     The study demonstrated that: (1) Health service supply of the migrant workers'medical insurance. There were 337 Community Health Centers (CHCs) totally.Average service radius and average service coverage of each CHC was 1.59 kilometersand 48.6 thousands people respectively. Totally the running condition of CHCs was bad,and 45.45%of them had a deficit; Among the migrant workers investigated, thosespending 10-19 min to walk to the nearest CHC accounted for 30.28%, and those spending 30 min or above for 37.32%; The constitution of the health human resourceswas not reasonable, and particularly there was a lack of the public health doctors. Thehealth human resources quantity of each CHC was 14. The ratio of doctors to nurseswas 1:0.76, which was higher than the whole nation's (1:0.61). Most professional titleswere junior, and the education background of the most migrant workers waspolytechnic.
     (2) Statue of migrant workers' health service need. The tow-week prevalence ratesof the insured and the un-insured were 22.24%and 25.52%, respectively, the chronicdisease prevalence rates of the insured and the un-insured were 21.06%and 16.68%,respectively, which were higher than the average levels in city areas in China in 2003(15.23%, and 17.73%, respectively).
     (3) Health service utilization of migrant workers. The two-week clinic rate of thesick insured and un-insured was 20.10%and 15.47%, respectively, and the two-weekno-clinic rate was 57.63%and 64.61%, respectively; The self-treatment percentage ofthe insured and the un-insured was 34.09%and 46.13%, respectively, and thepercentage of the insured and the un-insured who did not adopt any measure was23.54%and 20.07%, respectively. The major reasons of un-treatments included mildillness (more than 50.00%of patients) and economy difficulty (25.00%of patients).The clinic rate of the insured and the un-insured in CHCs was 42.44%, and 23.40%,respectively; The hospitalization rate of the insured and the un-insured was 3.56%and3.05%, which was both lower than that of the city population issued by the ThirdNational Health Service Investigation Report (4.2%); The hospitalization rate of theinsured and the un-insured in the township health centers was highest among the allmedical levels (42.86%, and 36.67%). The percentage of the insured and the un-insuredwho should stay in the hospital but did not stay in the hospital was 50.67%and 46.58%,respectively, and the major reason was economy difficulty, accounting for 74.36%and58.82%, respectively. There was no significant difference in the hospitalization rate andnot-hospitalization rate between the the insured and the un-insured (both P>0.05).
     (4) Health service response of MWMI. Among the elements of the response, theaverage score of keeping secret was the highest (3.65), and those of environment andthe accessibility were the lowest (3.07). 12.31%of the patients believed the healthservice of MWMI was "very bad" or "bad", and 53.08%"good" or "very good". Broadlinear regression model indicated that professions and the proportion of the healthhuman resource with master degree and above could significantly influence theresponse (P<0.05).
     (5) Health service satisfaction of MWMI. Among the factors, the average score ofthe satisfaction of service attitude was the highest (3.49), and that of the averageexpenses was the lowest (3.06). In overall evaluation of the satisfaction to medicalorganizations, 13.07%of the 399 patients were "very dissatisfied" or "not too satisfied".Broad linear regression model indicated that the medical expense every year, and theproportion of the health human resource with master degree and above couldsignificantly influence the health service satisfaction (P<0.05).
     Conclusions
     There are some achievements in health service of MWMIS: The health humanresource has already been put in place; Reasonable allocation of seeking medical adviseof migrant workers has been taken shape; The medical expenses of the insured migrantworkers have been controlled certainly; The level of health service utilization has beenraising; The space of the CHCs was broaden, such as the service quantity and itemshave been increasing and the level of the health service accessibility has been improved;The response and satisfaction of migrant workers to health service were good.
     There are some problems: The quantity of health provider including theinstitutions and the staff were inadequate. The personnel components and the allocationof institution were not reasonable. The service level and quality should be improved.Induced medical service still existed; The health service needs of in-patient andout-patient were much, while the health service utilization of hospital was little; Policyshould be adopted to the health service of MWMIS; About half of the CHCs were deficit; (5) The dynamics of broadcasting medical insurance policy publicly was notenough to influence the migrant workers to attend in health service of MWMIS.
     Policy Suggestions
     (1) We should recognize MWMIS rightly and definite that the dominant functionof government in MWMIS clearly; (2) We should increase the ability of the healthservice supply to increase the utilization level of health service continuously; (3) Weshould increase the service level and quality of health insurance institution byincreasing the efficacy of the health insurance cards dealing, simplifying the procedureof submitting the expense account and turning to next health institution, increasing themanagement level of the medical institution, and enhancing the management level ofmigrant workers' medical insurance fund; (5) We should make a joint between thehealth service of MWMI and the New Cooperative Medical Insurance System(NCMIS); (6) The big disease medical relief system should be established to poormigrant workers. All of above will guarantee MWMI to develop continuously, stablyand healthily.
     Innovation
     (1) The research about MWMI system and its practice were first done by a widemargin in Shenzhen.
     (2) Under the proper level of raising insurance premium, we explore the supply,need and utilization of the health service of MWMI, and evaluate the quality of thehealth service.
     (3) The idea of combining MWMI system and community health service offered agood solution to guarantee the fairness among migrant workers.
引文
1.国家统计局与劳动与社会保障部.中国劳动年鉴[M].北京:中国统计出版社,2005
    2.王保真,王斌.关于建立农民工社会保障制度的探讨[J].中国卫生经济,2004,21(8):39-42
    3.孙坚.农民工医疗保障机制探究[J].企业经济,2008,5:9-11
    4.徐拯.关于农民工医疗保障闻题的透析[J].商场现代化,2007,2:380-381
    5.李志新.农民工医疗保障制度探析[J].现代商业,2007,26:206-207
    6.2002年中国统计年鉴[Z].北京:中国统计出版社,2003:145.
    7.何平.访劳动和社会保障部社会保险研究所所长何平:农民工社保如何更“保险”.人民日报[N],2004-05-20
    8.卢海元.走进城市:农民工的社会保障[M].北京:经济管理出版社,2004
    9.李强.城市农民工的失业与社会保障问题[J].政策研究,2001,5:12
    10.罗桢婷.农民工健康靠什么保障[N].人民日报,2005-08-04(15)
    11.汪国华.断裂与弥补:农民工医疗保障的理性思考[J].医学与哲学,2006,27(11):31-32
    12.冯杰.完善农民工医疗保障制度的几点思考[J].西南交通大学学报(社会科学版),2007,8(3):153-157
    13.《国务院关于建立城镇职工基本医疗保险制度的决定》[Z].(国发[1998144号)
    14. Dong W: Can health care financing policy be emulated? The Singaporean medical savings accounts model and its Shanghai replica. J Public Health (Oxf) 2006, 28:209-214
    15. Wu M, Xin Y, Wang H, Yu W: Private and public cross-subsidization: financing Beijing's health-insurance reform. Health Policy 2005, 72:41-52
    16.杨艳,陈立坤,唐荣.农民工医疗保障问题探讨[J].北京市计划劳动管理干部学院学报,2005,3:14
    17. United Nations Development Programme (UNDP): China human development report 2005. New York, United Nations; 2005
    18. Li X: 40% migrant workers found with illness in Hubei.[http://english.gov.cn/2005-12/30/content_179211.htm].
    19. Guan Z: Economic transition and health insurance system reform in urban China. Beijing, National Institute for Social Insurance;2003
    20. Chinagate.com: National healthcare needs gradual reform.[http://www.chinagate.com.cn/english/medicare/50550.htm].
    21. Yusuf S, Nabeshima K: China's development priorities. Washington,DC, The World Bank; 2006
    22.中国农民工问题研究总报告起草组.中国农民工问题研究总报告[J].改革,2006,5:5-30
    23. Liu Y: What is wrong with China's health system? HarvardChina Rev (in print) 2006
    24. Ministry of Health Centre for Health Statistics and Information:Report on the results of the 1998 National Health ServicesSurvey. Beijing, Ministry of Health; 1999
    25. Liu Y, Rao K, Hsiao WC: Medical expenditure and rural impoverishmentin China. J Health Popul and Nutr 2003, 21:216-222
    26. van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A,Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, IbragimovaS, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, TisayaticomK, Trisnantoro L, Vasavid C, Zhao Y: Effect of payments for health care on poverty estimates in 11 countries in Asia: ananalysis of household survey data. Lancet 2006, 368:1357-1364
    27.任建萍,郭清,李显文,等.杭州市农民工医疗保障现况调查[J].中华医院管理,2006,22(11):775-777
    28.贾丽萍.构建农民工社会保障体系不能忽视该群体的复杂性[J].调研世界,2006,4:22-23
    29.李朝晖.我国农民工医疗保险方案存在的问题与完善思路[J].经济纵横,2008,5:25-28
    30.许小鹏.外来务工医疗保险的实践和探索[J].中国卫生经济,2002,21(6):35-36.
    31.孙方.上海、成都、北京、深圳四地农民工医疗保险制度比较[J].中国社会保障,2006,10:44-45
    32.胡建核.劳务工医疗保险制度在深圳[J].中国社会保障,2006,8:50-51
    33.张炎,纪颖,张帆,等.北京市建筑行业农民工就医意愿及影响因素调查[J].职业与健康,2008,24(1):1-4
    34.薛秦香,高建民.卫生服务提供的公平与效率评价[J].中国卫生经济,2002,21(4):29-32
    35.卫生部.2003年第三次全国卫生服务调查报告[M].北京:中国协和医科大学出版社,2004
    36. Calnan M, Almond S, Smith N.s. Ageing and public satisfaction with the health service: an analysis of recent trends. Soc Sci Med. 2003,57(4):757-762
    37. Roberts E.Consumer satisfaction in the Health Service: the role of the Community Health Council. The current role: its scope and limitations. R Soc Health J. 1978,98(4):173-176
    38. World Health Organization.the world health report 2000:health system:improving performance printed in france,2000:144-150
    39.江捍平,程锦泉,沈华亮,等.深圳市劳务工合作医疗的卫生服务现状与对策[J].中国卫生经济,2006,25(3):63
    40.深圳市医疗保险资料汇编(2006年,内部资料)
    41. Mitchell R, Carson R: A contingent valuation estimate of national freshwater benefits: technical report to the U.S.Environmental Protection Agency. Washington, DC, Resources for the Future;1984
    42. Bateman I, Langford I, Munro A, Starner C, Sugden R: Estimating four Hicksian welfare measures for a public good: a contingent valuation investigation, Land Econ 2000, 76:355-373
    43. Mas-Colell A, Whinston MD, Green J: Microeconomic Theory. Oxford, Oxford University Press; 1995
    44.胡务.农民工城镇医疗保险与新型农村合作医疗的衔接[J].财经科学,2006,5:93-99
    45.劳动和社会保障部信息统计中心.关于2007年上半年劳动保障事业发展计划执行情况的通报.劳社部函[2007]197号
    46.唐贵忠,钟晓妮,张苑,等.重庆市农民工医疗保险现况调查[J].中国公共卫生,2008,24(7):855-856
    47.余琳.重庆市主城区农民工医疗保险政策探析[D].重庆医科大学硕士学位论文,2007
    48.梁万年,郝模.卫生事业管理学[M].北京:人民卫生出版社,2003:275-282
    49. World health organization. The world health report 2000. Genera 2000
    50. United Kingdom Health Care Systems in Transition 1999,available on: http://www.euro.who.int/document/e68283.pdf,accessed Jua. 2nd, 2007
    51.蔡湛宇,陈平雁.病人满意度的概念与测量[J].中国医院统计,2002,9(4):236-238
    52.林良强,江捍平,程锦泉,等.深圳市劳务工医疗保险卫生服务满意度及影响因素研究[J]. 医学与社会,2007,20(3):1-3
    53.卢祖洵.社会医学[M].北京:科学出版社,2004
    54.张家放.医用多元统计学[M].武汉:华中科技大学出版社,2002
    55.肖远鸿,李宁秀,安燕波.四川省城市社区卫生服务人力资源现况调查[J].现代预防医学,2004,31(6):801-803
    56. Michael, L. P. The demand for health care in lower-income nations Theory, econometrics and empirical evidence from Indonesia. Dissertation of Ph. D. 2004. The University of North Carolina at Chapel Hill
    57. Jeffrey J. Rous, David R. Hotchkiss. Estimation of the determinants of household health care expenditures in Nepal with controls for endogenous illness and provider choice. Health Economics, 2003; 12:431-451
    58. Malthew Jowett, Anil Deolalikar, Peter Martinsson. Health insurance and treatment seeking behaviour:evidence from a low-income country .Health Economics, 2004; 13(9): 845-857
    59. Marisol Rodriguez, Mexandrina Stoyanova. The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain. HEALTH ECONOMICS, 2004; 13:689-703
    60. Sepehri A, Chemomas R. Are user charges efficiency- and equity-enhancing?A critical review of economic literature with particular reference to experience from developing countries. Journal of lntenational Development 2001; 13(2): 183-209
    61. Bolduc D, Lacroix Gand, Muller C. The choice of medical providers in rural Benin: A corrrparison ofdiscrete choice models. Journal of Health Economics, 1996; 15(4): 477-498
    62. Deb P, Holmes M. Substitution of physicians and other providers in out- patientmental health Care. Health Economics, 1998; 7(4): 347-361
    63. Sahn D, Younger S, GenicotG. The Demand for Health Care Services in Rural Tanzania. OXFORD BULLETIN OF ECONOMICS AND sTATISTICS, 2003; 65(2): 241-259
    64. Sisira K. Sarma. Demand for Outpatient Health Care in India: A Nested Multinomial logit Approach. Working Paper. 2003, The University of Manitoba. Canada
    65. Hanson K, Yip W, Hsiao W. The impact of quality on the demand for outpatient services in Cyprus. Health Economics, 2004; 13:1167-1180
    66. Habtom G, Ruys P. The choice of a health care provider in Eritrea. Health Policy, 2007; 80: 202-217
    67. Borah B. A mixed logit model of health provider choice: analysis of NSS data rurallndia. HealthEconomics, 2006; 15(9): 915-932
    68. Ellis RP, Mclnnes DK, Stephenson EH. Inpatient and outpatient health care demand in Cairo, Egypt. Health Econ, 1994; 3(3): 183-200
    69. Diane Dawson, Hugh Gravelle, Rowena Jacobs, et al. The efectsof expanding patient choice ofprovider on waiting times: evidence from a policy experiment. Health Econ. Published online in Wiley InterScience (www. interscience, wiley, corn). ⅨⅠ: 10. 1002 / hec. 1146
    70. Yip, Winnie, HongWang and Yuan li Liu(1998)"Determinants of patient choice of medical provider: a case study in rural China "Journal of Health Policy and Planningl3(3): 311-322
    71.姜文洁.青岛市居民就诊单位选择影响因素的多项式Logistic回归分析[J].青岛大学医学院学报,2002,38(2):161-163
    72.杨学来,徐凌中,孙胤羚,等.东营市城乡居民选择就诊单位的影响因素研究[J].中国卫生经济,2005,24(8):45-47
    73.钱东福,Raymond W.Pon,尹爱田.卫生服务提供者选择研究回顾与展望[J].中国卫生事业管理,2008,2:80-82
    74.杜静静.农民工大病统筹医疗保险政策分析--以济南市为例[J].甘肃联合大学学报(社会科学版),2007,23(5):32-36
    75.黄菊.济南农民工定点住院方便就诊费用优惠[N].人民日报,2006-11-16
    76.张炎,纪颖,张帆,等.北京市建筑行业农民工就医意愿及影响因素调查[J].职业与健康,2008,24(1):1-4
    77.梁万年.社区卫生服务管理.北京:人民卫生出版社,2001
    78.李士雪主编.全科医学概论.北京:人民卫生出版社,2002
    79.梁万年,李静,关静,等.全国社区卫生服务中心人力资源现状及地区间比较[J].中国全科医学,2005,3(4):1038-1040
    80.吴秀云,李曼春,马风云.宣武区、东城区社区卫生人力配备研究[J].中国全科医学,2003,3(4):285-286
    81.杨佳平,严非,王伟,等.西宁、银川两市社区卫生服务提供现状分析[J].中国初级卫生保健,2005,19(7):30-33
    82.姚岚,陈子敏,舒展,等.武汉市社区卫生服务提供公共卫生功能影响因素分析[J].中国全科医学,2004,7(21):1572-1575
    83.尹文强,严非,丁国伟,等.三城市社区卫生服务机构医疗服务提供效率评价[J].中华医院管理,2004,20(3):145-149
    84.辛梅,曲江斌,林静.济南市社区卫生服务人力资源现状调查与分析[J].中国全科医学,2004,7(21):1264-1265
    85.陈敏,张嵘.南京市卫生人力资源现状分析[J].中国初级卫生保健,2005,19(8):13-15
    86. Pascore,G.C. Patient Satisfaction in Primary Health care[J].Evaluation and Program Planning, 1993; 6:185-210
    87.李孜.城市贫弱人群健康问题及卫生服务利用研究[J].中国卫生事业管理,2003,6:34-35
    88.房莉杰.农村流动人口医疗保障制度的现状与建议[J].中国卫生经济,2006,25(12):52-55
    89.李路路.向城市移民:一个不可逆转的过程。见:李培林.农民工--中国进城农民工的经济社会分析[M].北京:社会科学文献出版社,2003:116-133
    90.陈金喜.深圳市流动人口社区卫生服务供给与保障研究[J].中国全科医学,2005,8(19):1637
    91.叩问中国民工的社会保障,半月谈,2004,7
    92.世界银行.2004年世界发展报告:让服务惠及穷人[M].北京:中国财政经济出版社,2004
    93.郝模,罗力,姜晓鹏,等.社区卫生服务的系列研究概述[J].中华医院管理,1999,15(8):454-458
    94.曾春燕,魏晋才.农民工医疗保障的困境与出路探究--浙江省农民工医疗保障现状的调查[J].中国卫生经济,2008,27(4):79-80
    95.冯杰.完善农民工医疗保障制度的几点思考[J].西南交通大学学报(社会科学版),2007,8(3):153-157
    96.唐贵忠,钟晓妮,张苑,等.重庆市农民工医疗保险现况调查[J]。中国公共卫生,2008,24(7):855-856
    97.赵峰,李丹.农民工也可参加医疗工伤保险一单位不办社保可举报[J].医药世界,2006, 11:23
    98.梁维萍,赵惠梅,贺鹭,等.太原市农民工医疗保障现况及影响因素研究[J].山西医科大学学报,2008,39(5):443-446
    99.汪国华.断裂与弥补:农民工医疗保障的理性思考[J].医学与哲学,2006,27(11):31-32
    100.陈晓鸿,王雷,夏杨,等.农民工医疗保障问题:农民工不怕穷就怕病[EB/OL].(2007-03-06)[2007-03-15].http://WWW.yew(?).com/ycwb2007-03/06/content-1403478.htm
    101.马亚娜,翁开源,宁雪佳.不同城市社区卫生服务人力资源的比较研究[J].中国卫生事业管理,2004,5:286-288
    102. Monheit AC: Persistence in health expenditures in the short run: prevalence and consequences. Med Care 2003, 41:Ⅲ53-Ⅲ64
    103. BENNETTM S, Mcpake B A. Private health providers in Developing Countries: serving the public interest?[M]. London.. London and New Jersey. 1997
    104. PREKER A.Innovations in Health service Delivery[M]. Woshington D.C: The World Bank.2003
    105.任苒.对不同所有制卫生服务提供者评价的国际导向[J].医学与哲学,2006,26(5):2-5
    106. Till Bamighausen, Yuanli Liu, Xinping Zhang, et al. Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study.BMC Health Services Research 2007, 7:114
    107.杜雯雯,曹乾.农民工医疗保障现有模式分析与制度创新[J].西华大学学报(哲学社会科学版),2008,27(3):82-84
    108.吴仁寿.医保卡全国通用令人期待[OL].光明网,2007-03-16
    109.谢敏.试论农民工医疗社会保障体系建设的途径[J].四川行政学院学报,2007,5:64-65
    110.朱胜进,李崇岩,王克春.关于城市贫困人口医疗救助的思考[J].中华医院管理杂志,2005,21(7):479-480
    111.粱维萍,贺鹭,郑建中.农民工的疾病风险与医疗保障分析[J].中国卫生资源,2007,10(6):293-294
    1.国家统计局与劳动与社会保障部.中国劳动年鉴[M].北凉:中国统计出版社,2005
    2.王保真,王斌.关于建立农民工社会保障制度的探讨[J].中国卫生经济,2004,23(8):39-42
    3.孙坚.农民工医疗保障机制探究[J].企业经济,2008,5:9-11
    4.徐拯.关于农民工医疗保障闻题的透析[J].商场现代化,2007,2:380-381
    5.李志新.农民工医疗保障制度探析[J].现代商业,2007,26:206-207
    6.杨艳,陈立坤,唐荣.农民工医疗保障问题探讨[J].北京市计划劳动管理干部学院学报,2005,3:14
    7.中国农民工问题研究总报告起草组.中国农民工问题研究总报告[J].改革,2006,5:5-30
    8.2002年中国统计年鉴[Z].北京:中国统计出版社,2003:145
    9.何平.访劳动和社会保障部社会保险研究所所长何平:农民工社保如何更“保险”[N].人民日报,2004-05-20
    10.卢海元.走进城市:农民工的社会保障[M].北京:经济管理出版社,2004
    11.李强.城市农民工的失业与社会保障问题[J].政策研究,2001,5:12
    12.罗桢婷.农民工健康靠什么保障[N].人民日报,2005-08-04(15)
    13.崔仕臣.农民工医疗保障模式探讨[J].理论界,2008,4:188-189
    14.梁维萍,赵惠梅,贺鹭,等.太原市农民工医疗保障现况及影响因素研究[J].山西医科大学学报,2008,39(5):443-446
    15.蒋远胜,申志伟.建立农民工医疗保障的两难困境与对策--基于四川省成都市五城区农民工的调查分析[J].农村经济,2008,1:78-81
    16.蒋长流.就业身份锁定下农民工健康风险冲击与管理[J].中国卫生经,2006,25(12):47-49
    17.任建萍,郭清,李显文,等.杭州市农民工医疗保障现况调查[J].中华医院管理,2006,22(11):775-777
    18.郑英隆.中国农民上弱信息能力初探[J].经济学家,2005,5:52-59
    19.邓良基.加强农业综合水产能力的技术经济问题研究[M].北京:中国农业科技出版社,2006
    20.蒋远胜,肖诗顺,宋青锋.家庭风险分担机制对农村医疗保险需求的影响一对四川省的初步调查报告[J].人口与经济,2003,1:74-80
    21.李孜.城市贫弱人群健康问题及卫生服务利用研究[J].中国卫生事业管理,2003,6:34-35
    22.陈晓鸿,王雷,夏杨,等.农民工医疗保障问题:农民工不怕穷就怕病[EB/OL].(2007-03-06)[2007-03.15].http://www.yewb.com/ycwb2007-03/06/content-1403478.htm
    23.房莉杰.农村流动人口医疗保障制度的现状与建议[J].中国卫生经济,2006,25(12):52-55
    24.李路路.向城市移民:一个不可逆转的过程.见:李培林.农民工一中国进城农民工的经济社会分析[M].北京:社会科学文献出版社,2003:116-133
    25. Liu GG, Zhao Z, Cai R, Yamada T, Yamada T: Equity in health care access to: assessing the urban health insurance reform in China. Soc Sci Med 2002, 55:1779-1794
    26. Anonymous: The State Council resolution on building a basic health insurance system for urban employees and workers. Chinese Journal of Health Care Quality Management 1998, 3:5-6
    27. Ducket J: State, collectivism and worker privilege: a study of urban health insurance reform. China Quart 2004, 177:155-173
    28.刘声.农民工将可以参加医疗保险[N].中国青年报,2004-06-29(7)
    29.冯杰.完善农民工医疗保障制度的几点思考[J].西南交通大学学报(社会科学版),2007,8(3):153-157
    30.《关于解决农民工问题的若干意见》[Z].(国发[2006]5号)
    31. Dong W: Can health care financing policy be emulated? The Singaporean medical savings accounts model and its Shanghai replica. J Public Health (Oxf) 2006, 28:209-214
    [32. Wu M, Xin Y, Wang H, Yu W: Private and public cross-subsidization: financing Beijing's health-insurance reform. Health Policy 2005, 72:41-52
    33. United Nations Development Programme (UNDP): China human development report 2005. New York, United Nations; 2005.
    34. Li X: 40% migrant workers found with illness in Flubei. [http://english.gov.cn/2005-12/30/content_179211.htm]
    35. Guan Z: Economic transition and health insurance system reform in urban China. Beijing, National Institute for Social Insurance;2003
    36. Chinagate.com: National healthcare needs gradual reform.[http://www.chinagate.com.cn/english/medicare/50550.htm]
    37. Yusuf S, Nabeshima K: China's development priorities. Washington,DC, The World Bank; 2006
    38 Liu Y: What is wrong with China's health system? HarvardChina Rev (in print) 2006
    39. Ministry of Health Centre for Health Statistics and Information:Report on the results of the 1998 National Health ServicesSurvey. Beijing, Ministry of Health; 1999
    40. Liu Y, Rao K, Hsiao WC: Medical expenditure and rural impoverishmentin China. J Health Popul and Nutr 2003, 21:216-222
    41. van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A,Adhikari SR, Oarg CC, Harbianto D, Herrin AN, Huq MN, IbragimovaS, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, TisayaticomK, Trisnantoro L, Vasavid C, Zhao Y: Effect of payments for health care on poverty estimates in 11 countries in Asia: ananalysis of household survey data. Lancet 2006, 368:1357-1364
    42.劳动和社会保障部信息统计中心.关于2007年上半年劳动保障事业发展计划执行情况的通报.劳社部函[2007]197号
    43.叩问中国民工的社会保障,半月谈,2004,7
    44.杜雯雯,曹乾.农民工医疗保障现有模式分析与制度创新[J].西华大学学报(哲学社会科学版),2008,27(3):82-84
    45.余琳.重庆市主城区农民工医疗保险政策探析[D].重庆医科大学硕士学位论文,2007
    46.唐贵忠,钟晓妮,张苑,等.重庆市农民工医疗保险现况调查[J].中国公共卫生,2008,24(7):855-856
    47. Mitchell R, Carson R: A contingent valuation estimate of national freshwater benefits: technical report to the U.S.Environmental Protection Agency. Washington, DC, Resources for the Future;1984
    48. Bateman I, Langford I, Munro A, Starner C, Sugden R: Estimating four Hicksian welfare measures for a public good: a contingent valuation investigation. Land Econ 2000, 76:355-373
    49. Mas-Colell A, Whinston MD, Green J: Microeconomic Theory. Oxford, Oxford University Press; 1995
    50. Jiang,Yuansheng. Health Insurance Demand and Health Risk M anagement in Rural China, Peter Lang Europaeischer Verlag der Wissenschaten, 2004
    51.张苗.“扩面”考验农民工医保含金量[J].中国社会保障,2006,10:41-42
    52.贾丽萍.构建农民工社会保障体系不能忽视该群体的复杂性.调研世界,2006,4:22-23
    53.李朝晖.我国农民工医疗保险方案存在的问题与完善思路[J].经济纵横,2008,5:25-28
    54.郑功成.社会保障与弱势群体保护[EB/OL].http//www.China.com.en.2003-1-20
    55.汪志宏.泰国的社区卫生筹资[J].医学与社会,2002,15(6):11-14
    56.李显文,毛正中.探索适合中国农村的健康保障制度之三:健康储蓄的可行性[J].中国卫生事业管理,2001,2:88
    57.《国务院关于建立城镇职工基本医疗保险制度的决定》[Z].(国发[1998]44号)
    58. Till Barnighausen, Yuanli Liu, Xinping Zhang, et al.Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study.BMC Health Services Research 2007, 7:114
    59.任天成,崔红志.建立农村社会保障制度的路径选择[J].中国青年政治学院学报,2004,6:120-125
    60.许小鹏.外来务工医疗保险的实践和探索[J].中国卫生经济,2002,21(6):35-36
    61. Li X: 40% migrant workers found with illness in Hubei.[http://english.gov.cn/2005-12/30/content_179211.htm]
    62. Dong W: Healthcare-financing reforms in transitional society: a Shanghai experience. J Health Popul Nutr 2003, 21:223-234
    63. Xiang B: Migration and health in China: problems, obstacles and solutions. In Asia Metacentre Research Paper Series 17 Singapore,Asian Meta centre for Population and Sustainable Development Analysis;2003
    64. Xinhua News Agency: Migrant workers to receive basic health care. [http://www.china.org.cn/english/China/166778.htm]
    65.胡务.农民工城镇医疗保险与新型农村合作医疗的衔接[J].财经科学,2006,5:93-99
    66.孙方.上海、成都、北京、深圳四地农民工医疗保险制度比较[J].中国社会保障,2006,10:44-45
    67.丛树海.论构建以大病保障为中心的医疗保障制度[J].上海财经大学学报(哲社版),2006, 1:22-23
    68.杜静静.农民工大病统筹医疗保险政策分析-以济南市为例[J].甘肃联合大学学报(社会科学版),2007,23(5):32-36
    69.王芳,刘娟,肖峥山,等.农民工医疗保险在统筹地区实施的可行性分析[J].中国卫生经济,2005,24(1):41-44
    70.曲雅萍.农民工医疗保险模式初探[J].卫生经济研究,2007,5:20-21
    71.胡建核.劳务工医疗保险制度在深圳[J].中国社会保障,2006,8:50-51
    72.万辟番,王莹.构建农民工医疗保障机制的思考[J].农业考量,2007,6:274-276
    73.赵峰,李丹.农民工也可参加医疗工伤保险一单位不办社保可举报[J].医药世界,2006,11:23
    74.汪国华.断裂与弥补:农民工医疗保障的理性思考[J].医学与哲学,2006,27(11):31-32
    75.曾春燕,魏晋才.农民工医疗保障的困境与出路探究--浙江省农民工医疗保障现状的调查[J].中国卫生经济,2008,27(4):79-80
    76.杨佳平,严非,王光荣.医保改革对医疗机构的影响[J].中国卫生资源,2005,8(4):173-174
    77.吴仁寿.医保卡全国通用令人期待[OL].光明网,2007-03-16
    78.谢敏.试论农民工医疗社会保障体系建设的途径[J].四川行政学院学报,2007,5:64-65
    79.陈红山.设置退休人员最低缴费年限确保医保基金安全运行[A].王东进.医疗保险优秀论文集[C].北京:中国劳动社会保障出版社,2006:98-102
    80.赵英杰,谭士伟,辛旭东,等.黑龙江省农民工医疗保险问题研究[J].佳木斯大学社会科学学报,2007,25(6):35-36
    81.朱胜进,李崇岩,王克春.关于城市贫困人口医疗救助的思考[J].中华医院管理,2005,21(7):479-480
    82.粱维萍,贺鹭,郑建中.农民工的疾病风险与医疗保障分析[J].中国卫生资源,2007,10(6):293-294
    83. Monheit AC: Persistence in health expenditures in the short run: prevalence and consequences. Med Care 2003, 41:Ⅲ53-Ⅲ64
    84. Michael, L. P. The demand for health care in lower-income nations Theory, econometrics and empirical evidence from Indonesia. Dissertation of Ph. D. 2004. The University of North Carolina at Chapel IIil1
    85. Jeffrey J. Rous, David R. Hotchkiss. Estimation of the determinants of household health care expenditures in Nepal with controls for endogenous illness and provider choice. Health Economics, 2003; 12: 431-451
    86. Malthew Jowett, Anil Deolalikar, Peter Martinsson. Health insurance and treatment seeking behaviounevidence from a low-income country .Health Economics, 2004; 13(9): 845-857
    87. Marisol Rodriguez, Mexandrina Stoyanova. The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain. HEALTH ECONOMICS, 2004; 13:689-703
    88. Sepehri A. , Chemomas R. Are user charges efficiency- and equity-enhancing?A critical review of economic literature with particular reference to experience from developing countries. Journal of Intenational Development 2001; 13(2): 183-209
    89. Bolduc D, Lacroix Gand, Muller C. The choice of medical providers in rural Benin: A comparison ofdiscrete choice models. Journal of Health Economics, 1996; 15(4): 477-498
    90. Deb P, Holmes M. Substitution of physicians and other providers in out- patientmental health Care. Health Economics, 1998; 7(4): 347-361
    91. Sahn D, Younger S, GenicotG. The Demand for Health Care Services in Rural Tanzania. OXFORD BULLETIN OF ECONOMICS AND STATISTICS, 2003; 65(2): 241-259
    92. Sisira K. Sarma. Demand for Outpatient Health Care in India: A Nested Multinomial logit Approach. Working Paper. 2003, The University of Manitoba. Canada
    93. Hanson K, Yip W, Hsiao W. The impact of quality on the demand for outpatient services in Cyprus. Health Economics, 2004; 13:1167-1180
    94. Habtom G, Ruys P. The choice of a health care provider in Eritrea. Health Policy, 2007; 80: 202-217
    95. Borah B . A mixed logit model of health provider choice : analysis of NSS data ruralIndia. HealthEconomics, 2006; 15(9): 915-32
    96. Ellis RP, MclnnesDK, Stephenson EH. Inpatient and outpatient health care demand in Cairo, Egypt. Health Econ, 1994; 3(3): 183-200
    97. Diane Dawson, Hugh Gravelle, Rowena Jacobs, et al. The efectsof expanding patient choice ofprovider on waiting times: evidence from a policy experiment. Health Econ. Published online in Wiley InterScience(www.interscience.wiley.corn). ⅠⅪ: 10. 1002/hec. 1146
    98. Yip, Winnie, HongWang and Yuan li Liu(1998)"Determinants of patient choice of medical provider: a case study in rural China "Journal of Health Policy and Planning13(3): 311-322
    99.姜文洁.青岛市居民就诊单位选择影响因素的多项式Logistic回归分析[J].青岛大学医学院学报,2002,38(2):161-163
    100.杨学来,徐凌中,孙胤羚,等.东营市城乡居民选择就诊单位的影响因素研究[J].中国卫生经济,2005,24(8):45-47
    101.钱东福,Raymond W.Pon,尹爱田.卫生服务提供者选择研究回顾与展望[J].中国卫生事业管理,2008,2:80-82
    102.黄菊.济南农民工定点住院方便就诊费用优惠[N].人民日报,2006-11-16
    103.张炎,纪颖,张帆,等.北京市建筑行业农民工就医意愿及影响因素调查[J].职业与健康,2008,24(1):1-4
    104.杨佳平,严非,王伟,等.西宁、银川两市社区卫生服务提供现状分析[J].中国初级卫生保健,2005,19(7):30-33
    105.姚岚,陈子敏,舒展,等.武汉市社区卫生服务提供公共卫生功能影响因素分析[J].中国全科医学,2004,7(21):1572-1575
    106.尹文强,严非,丁国伟,等.三城市社区卫生服务机构医疗服务提供效率评价[J].中华医院管理,2004,20(3):145-149
    107.世界银行.2004年世界发展报告:让服务惠及穷人[M].北京:中国财政经济出版社,2004
    108.郝模,罗力,姜晓鹏,等.社区卫生服务的系列研究概述[J].中华医院管理,1999,15(8):454-458
    109. Department of Health.Delivering health and Social care.http://www.dh.gov.uk
    110. Highlights on health in the United Kingdom 2004, available On: http://www.euro.who.int/document/e88530.pdf.accessed Jua. 2nd, 2007
    111.潘志刚.英国医疗服务体系简介及启示[J].中华全科医师杂志,2004,3(4):265
    112. United Kingdom Health Care Systems in Transition 1999, available on: http: //www.euro.who.int/document/e68283.pdf,accessed Jua. 2nd, 2007
    113. Department of Health.Modernizing health and social :services:national priorities guidance 2000/01-2002/03.http://www.dh.gov.uk
    114. Department of Health Improvement,expansion and reform:the next three years priorities and planning framework 2003-2006. http://www.dh.gov.uk
    115. Department of Health. Reforming NHS financial flows: introducing payment by results.http://www.dh.gov.uk
    116. NHS Gateway. History of the NHS,http://www.nhs.uk
    117. Department of Health. Departmental Report 2004. http://www.dh.gov.uk
    118. WHO. The World Heahh Report 2004. http://www.who.org
    119.张莹.中外社区卫生服务模式的比较与借鉴[J].中国卫生事业管理,2003,7:419
    120.刘利群.澳大利亚社区卫生服务的提供体系及启示[J].中国全科医学,2002,5(1):40
    121.于保荣,王维夫,李友卫,英国、澳大利亚和德国的基本卫生服务提供及管理体制研究[J].中国卫生事业管理,2007,9:641-644
    122.李勤.德国瑞典的社区卫生服务[J].全科医学临床与教育杂志,2005,3(4):196
    123. PREKER A.Innovations in Health service Delivery[M]. Woshington D.C: The World Bank.2003
    124. BENNETTM S, Mcpake B A. Private health providers in Developing Countries: serving the public interest?[M]. London: London and New Jersey. 1997
    125.任苒.对不同所有制卫生服务提供者评价的国际导向[J].医学与哲学,2006,26(5):2-5

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700