高质量发展视角下灵活就业人员参加职工医疗保险的三重维度  

Three Dimensions of Flexible Employees Participating in Employee Medical Insurance from the Perspective of High-Quality Development

作　　者：王素芬[1] 付浩然 Wang Sufen;Fu Haoran(School of law,Liaoning University,Shenyang,Liaoning 110036)

机构地区：[1]辽宁大学法学院,辽宁沈阳110036

出　　处：《河南财经政法大学学报》2025年第1期74-87,共14页Journal of Henan University of Economics and Law

基　　金：2021年国家社会科学基金一般项目“社会救助法中积极就业的法律实现机制研究”(项目编号:21BFX127)的阶段性成果。

摘　　要：灵活就业人员参加职工医疗保险是推动社会保险制度高质量发展的内在要求。从纳保维度来看,灵活就业人员参加职工医疗保险既是基于团体性社会保险“领薪就业”参保逻辑的法理考量,也是基本医疗保险参保扩面、保障灵活就业人员医保待遇权的必要之举。从缴费维度来看,职工医疗保险对灵活就业人员财产权的限制须置于比例原则框架内进行审查,未来在实现短期“各保其保”的基础上可通过降低缴费基数下限、确立灵活的缴费方式、强化保费补助以减轻灵活就业人员的缴费负担。从给付维度来看,应基于职工医疗保险法律关系的法定之债属性逐步取消医保待遇等待期,统一累计最低缴费年限以保障灵活就业人员的退休医保待遇,构建职工医疗保险疾病津贴制度填补灵活就业人员的因病收入损失。The participation of flexible employees in employee medical insurance is an inherent requirement for promoting the high-quality development of the social insurance system.From the perspective of insurance coverage,the participation of flexible employees in employee medical insurance is not only a legal consideration based on the logic of“paid employment”participation in group social insurance,but also a necessary measure to expand the coverage of basic medical insurance and protect the right to medical insurance benefits for flexible employees.From the perspective of premium payment,the restrictions on the property rights of flexible employees under employee medical insurance should be reviewed within the framework of the proportionality principle.In the future,on the basis of achieving short-term“each insured has its own insurance”,the payment burden of flexible employees can be reduced by lowering the lower limit of the payment base,establishing flexible payment methods,and strengthening premium subsidies.From the perspective of benifit payment,the waiting period for medical insurance benefits should be gradually eliminated based on the statutory debt attribute of the legal relationship of employee medical insurance,the minimum cumulative premium payment years should be unified to ensure the retirement medical insurance benefits payment of flexible employees,and a medical insurance disease allowance system for employees should be established to fill the income loss caused by illness for flexible employees.

关 键 词：灵活就业人员 职工医疗保险 高质量发展 比例原则 医保疾病津贴 

分 类 号：D922.55[政治法律—民商法学]