灵活就业人员基本医保参保的政策实践、关键议题与战略选择  

The policy practice,key issues and strategic choices of participating in basic medical insurance for flexible employees

作　　者：胡宏伟 张泽 黄春柳 HU Hongwei;ZHANG Ze;HUANG Chunliu

机构地区：[1]中国人民大学公共管理学院/中国人民大学健康保障研究中心,北京100872

出　　处：《社会保障研究》2024年第6期66-77,共12页Social Security Studies

基　　金：国家社会科学基金项目“社区整合照护对我国老年失能轨迹的影响效应与治理体系研究”(22BRK045)的阶段性成果。

摘　　要：在劳动力市场弹性化和高质量就业诉求转向的背景下,灵活就业人员基本医保特别是职工医保参保覆盖面偏低、参保长效性不足的问题凸显。借鉴吉尔伯特社会福利政策分析思路,基于资格条件、资金筹集、待遇给付和公共服务四个基本维度,考察我国灵活就业人员基本医保参保的政策实践,研究发现:我国灵活就业人员基本医保参保政策实践具有参保资格户籍条件化、个人自愿性供款、医保待遇给付差异化、医保公共服务优化等基本特征。在此基础上,深入探讨去劳动关系化、责任主体认定、个人账户设置、经办服务等关键议题,进而结合中国实际,从价值选择、时间选择、模式选择三个方面提出持续推进灵活就业人员基本医保参保扩面提质的战略选择:以“公平、可负担、充足”为价值基础,借助《医疗保障法》立法契机将“强制参保”纳入法律规定,推行“个账可选、分档参保、分类设置等待期”政策模式。In the context of the flexibility of the labor market and the shift of high-quality employment demands,the problems of low coverage and insufficient long-term effectiveness of basic medical insurance for flexible employees,especially employee medical insurance,are highlighted.Drawing on Gilbert's social welfare policy analysis approach,this paper examines the policy practice of basic medical insurance for flexible employees in China from the four basic dimensions of qualification,fund raising,benefit payment and public service.It is found that the policy practice of basic medical insurance for flexible employees in China has the basic characteristics of qualified household registration,individual voluntary fundraising,differentiated medical insurance benefit payment and optimized medical insurance public service.Based on these findings,this study delves into key issues such as de-labor relationship,identification of responsible entities,individual account settings,and administrative services.Furthermore,combining the actual situation in China,strategic choices for continuously promoting the expansion and quality improvement of basic medical insurance participation for flexible employment personnel are proposed from three aspects:value choice,time choice,and model choice.These choices are based on the values of"fairness,affordability,and adequacy,"and it is suggested to use the legislative opportunity of the"Medical Security Law"to incorporate"mandatory participation"into legal provisions,and to implement policy models such as"optional individual accounts,tiered participation,and categorized waiting periods."

关 键 词：灵活就业人员 医保参保 政策实践 关键议题 战略选择 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理] F249.2[医药卫生—公共卫生与预防医学]