农村人口医疗保障实证分析--以山东省为例

基于山东省450份问卷调查资料,本文分析了农村人口的医疗保障状况,对新型农村合作医疗在试点进程中遇到的问题和发展障碍进行了审视和总结。结果表明,政府在农村医疗保障中的作为远远不够;农村人口的健康和医疗保障水平较低;新型农村合作医疗在制度设计上存在一些缺陷,宣传力度、满意程度、收入、文化程度、地区经济发展水平是影响农民参加新型农村合作医疗的重要因素,应将他们作为今后稳步推进新型农村合作医疗的切入点。     

新型农村合作医疗制度分析

目前中国政府下大力气推动新型农村合作医疗制度的试点工作,政府成为农村初级医疗保障制度创新的外在推动力,但以法律为基础的制度建设滞后,建立新型农村合作医疗的制度保障没有确立;还缺乏推行合作医疗政策和合作医疗立法的原动力,即承担新型农村合作医疗制度主体角色的农民,多数缺乏参加合作医疗的能力、主观积极性;作为主体的农民更多的时候是被动地接受各种规定,缺乏农民参与决策、管理和监督的机会;新型农村合作医疗制度存在内在缺陷。     

农民社会保障的制度实践与发展困境——基于北京市三区县的实证研究

通过对北京市三个区县农民社会保障的运行诊断及农民自身对制度的整体判断,双向互动地呈现了现行制度的存在逻辑。农民对城乡社会保障的衔接需求很高,尤其是新型农村养老保险、新型农村合作医疗和农村低保三大项目。然而,现行制度却与理想模型还存在较大落差。     

改革前后三十年农村合作医疗的制度变迁

农村合作医疗制度六十年的发展,经历了两个大的阶段：旧农村合作医疗阶段和新型农村合作医疗阶段。两个阶段农村合作医疗制度的发展速度都非常快,但旧农村合作医疗制度在经历了顶峰之后,迅速衰退;而新型农村合作医疗制度虽然没有走旧农村合作医疗制度的老路,但保障水平比较低。新旧农村合作医疗制度有相似的起点,但是结果却大不一样。旧农村合作医疗制度的衰退源于农村经济体制改革,新型农村合作医疗制度的发展源于政府的推动。农村合作医疗制度的可持续发展需要稳定的财力支持。     

论建立多层次农村医疗保障体系

随着医疗卫生体制的市场化改革和农村合作医疗的解体 ,农民失去了最基本的医疗保健 ,农民健康问题日益突出。合作医疗并不具有普遍适用性 ,不可能再成为新时期农村医疗保障制度的主要形式。应因地制宜 ,根据当地的经济发展水平灵活选择医疗保障模式 ,不能拘泥于千篇一律的模式 ,徒劳地寻求一劳永逸的模式 ,应该建立多层次的农村医疗保障体系。应特别强调国家在解决农民医疗保障问题上的重大责任 ,国家需要在农民医疗保障的制度设计和财政投入方面 ,采取更加积极的态度和措施     

人口健康与农村合作医疗制度

增进人口健康对于经济和社会发展有着重大意义,而当前我国农村医疗保障制度的缺失使农村人口的健康无从保障。以人口健康为切入点,分析农村人口医疗保健的现状与需求,依据当前国情,提出从"合作"和"新型"两方面重建农村合作医疗保障制度,并指出该制度在农村医疗保障体系中居于基础地位。     

新型农村合作医疗和特困人口医疗救助相结合的制度建设

农村医疗救助制度的覆盖面是占农村5%的特困人口,归属民政部门管理;新型农村合作医疗制度的参合率一般都在85%左右,归属卫生部门管理。这两个制度在运作过程中的结合模式,既要有效地降低制度结合后的运行成本,让特困人口能够享受到更多的住院补偿;还要有利于两个政府部门的工作协调。经过3年试点的探索,已经产生了较好的结合模式。     

新型农村合作医疗制度可持续性因素分析基本框架

新型农村合作医疗制度是提供农民医疗保障、构建农村卫生体系的重要载体,对于其可持续性从以下三方面来分析;以筹资为中心的医疗制度系统构成角度理论性分析;保险制度设计方案分析和不同地区的制度可持续性要点分析结合医疗制度的其他评价指标进行拓展型分析,如制度的公平和效率等。     

农村新型合作医疗与农民的医疗保障

文章运用2004年中国营养与健康调查数据,分析了农村新型合作医疗是否解决了农民的医疗保障问题,试图从微观层面探讨中国农村合作医疗步履艰难的原因。该研究建立了农民参加合作医疗及医疗支出的选择行为两个决策模型,结果表明,自评健康状况非常好及差的农民均不愿意参加合作医疗,即农村合作医疗组织不仅存在逆向选择,分散农民医疗风险的能力也较弱。从医疗支出模型来看,农村居民是否有医疗支出及医疗支出的多少主要取决于疾病的严重程度,而农民参加合作医疗对此无显著性影响,可见,中国目前推行的新型合作医疗制度并没有为农村居民提供足够的医疗保障。     

新型农村合作医疗参合率影响因素探析—以青岛为个案

较高的参合率是新型农村合作医疗制度持续运行的基础。从制度设计上看,新型农村合作医疗制度有利于农民的参与。但是在运行过程中,新型农村合作医疗制度对农民的吸引力并不强,农民的参合积极性并不高,个别地区还出现了退保现象,这对新型农村合作医疗制度持续发展产生了消极影响。通过对青岛市的研究发现,制度是否稳定、农民从中获益程度、政府资金到住情况以及筹资标准、方式等因素对参合率有着重要影响。     

风险社会中的人口安全与和谐社会的构建

本文论述了风险社会、人口安全与构建和谐社会之间的内在联系,认为风险社会的来临和人口风险的增加引发了人们对人口安全问题的关注。人口安全问题在风险社会的视域中具备了全新的理论内涵,作为风险社会的有机构成,它包括了人口规模、人口结构、人口素质与人口健康、人口分布与人口迁移等多个方面的内容。在风险社会中规避人口风险、维护人口安全,对构建社会主义和谐社会有着至关重要的意义。     

Insights from longitudinal data on the earnings growth of U.S. foreign-born men

Does the growth in earnings of foreign-born men exceed that of U.S. natives? We use longitudinal data on earnings from a Social Security Administration (SSA) database matched to the 1994 March Current Population Survey to shed new light on this important issue. We also examine the trend over time in the foreign-born men's earnings growth and illuminate the various ways that SSA data can be used to explore the earnings patterns of immigrants.     

SHORT REVIEWS

Books reviewed in this article: Neil J. Diamant, Revolutionizing the Family: Politics, Love, and Divorce in Urban and Rural China, 1949–1968 International Federation of Red Cross and Red Crescent Societies, World Disasters Report 2000: Focus on Public Health Christian Joppke, Immigration and the Nation‐State: The United States, Germany, and Great Britain Peng Xizhe with Guo Zhigang (eds.), The Changing Population of China Sebastiao Salgado, Migrations: Humanity in Transition United Nations Development Programme, Human Development Report 2000 United Nations Population Division, The World at Six Billion United Nations Population Division, World Population Monitoring 1998. Health and Mortality: Selected Aspects World Bank, Can Africa Claim the 21st Century?     

Internal Migration and Mental Health: An Examination of the Healthy Migration Phenomenon in China

Population Research and Policy Review - Using the 2008 and 2009 Rural–Urban Migration in China (RUMiC) survey data, two waves of a nationally representative survey dataset, this study...     

Measuring socioeconomic mortality differentials over time

Using 1973 Current Population Survey data matched to 1973-1978 Social Security mortality records, this study measures the relationship between the income and education of men and their subsequent mortality. The estimated relationships are compared with socioeconomic mortality differentials found by Kitagawa and Hauser in their study of 1960 census-death certificate matched data. The comparison suggests that there has been no improvement in the relative mortality experience of low socioeconomic status men. More generally, the article discusses how Social Security data could be used to monitor, on a continual basis, our progress toward eradicating significant mortality differentials in the United States.     

4th International Population Conference: drawing the community into population programs

Summarizes the deliberations and recommendations of the (1978) 4th International Population Conference: "Expanding Rural and Urban Community Participation in Population Programs," sponsored by the World Population Society and the Population Center Foundation, and held in the Philippines. The 2 main concerns were finding ways of involving people in rural villages and urban communities in population programs, and fostering the sharing of ideas and experiences for the benefit of program administrators. Topics covered by the conference and reviewed here were organization and action for community participation; relating population and family planning to other services and the relevant personnel; role of women and women's organizations; involvement of youth; distribution of family planning information, techniques, and supplies; and new ideas and approaches. The resolutions of the delegates and other recommendations are also reviewed.     

Research on Health Status and Health Care of the Elderly in China

The issue of health status and care for the elderly in urban and rural areas is becoming increasingly serious in the rapid context of population aging in China.The paper analyzed the health status of urban and rural elderly in China in the two-week morbidity rate,prevalence rate of chronic diseases, disability status,self-rated health and healthy life expectancy of the elderly using the data from the 2006 Sampling Survey on the Status of Urban/ Rural Aged Population in China,the Fourth National Health Service Survey and the 2006 Second China National Sample Survey on Disability,to explore the current provision of sources of care for the elderly and try to make some policy recommendations about to improve the health and care for the elderly population facing the crisis of population aging.     

基于“服务链”理论的居家养老服务需求、供给与利用研究

本文利用中国老龄科学研究中心2000年"中国城乡老年人口状况一次性抽样调查"和2006年"中国城乡老年人口状况追踪调查"数据,深入分析中国老年人的居家养老意愿及其对居家养老服务的需求、供给与利用情况,并利用"服务链"的理论进一步探讨目前我国在发展居家养老服务过程中存在的主要问题,提出相应的对策建议。     

Social Security in China: Government White Paper

The largest financial problem faced by many aging societies is how to support their older, retired members. That support was once wholly a matter for individual families, with perhaps a minimal safety net offered by charitable institutions. Increasingly, in the usual course of economic development, the requisite transfers become a responsibility of the state—financed either through tax revenues or by pensions offered by (or required of) employers. The combination of lengthening life expectancy at later ages and falling fertility, however, makes those transfers ever more onerous as fewer workers are expected to support greater numbers of retirees. The situation is often likened to the approaching collapse of a Ponzi scheme. Not surprisingly, governments see an attractive solution in what is in effect a reprivatization of responsibility—not back to the family but right to the individual, through a system of individual retirement accounts (albeit with considerable state supervision). The financial trans‐fers—savings and later dissavings—then take place over each person's life cycle. Establishing a social security system—through pay‐as‐you‐go transfers, individual retirement accounts, or some combination of the two—is a major institution‐building and administrative task for a developing country, the more so in the context of rapid population aging. China is certainly a case of rapid aging, with the proportion of the population over age 60 projected to rise from 10 percent in 2000 to 20 percent by 2025 and 30 percent by 2050. The document excerpted below, a 2004 White Paper issued by the government of China, describes China's current social insurance provisions and the proposed expansion of coverage (beyond government employees and the urban formal sector) over coming years. In urban areas, it envisages pension coverage of “all eligible employees,” with an increasing emphasis on personal accounts. (Not mentioned is the situation of the large “floating population” of informal rural‐to‐urban migrants.) In rural areas, reliance on family support perforce continues: in 2003, only 2 million farmers are reported as drawing old‐age pensions. A safety‐net provision for the destitute elderly with no family provides for another 2.5 million. The document mentions various experimental schemes in rural areas. One, for medical insurance, covers 95 million residents; another offers an annual “reward” to those over 60 who have only one child (or two girls). The excerpts comprise sections I (Old‐age Insurance) and X (Social Security in Rural Areas) and the Conclusion of the White Paper, China's Social Security and Its Policy, issued by the Information Office of the State Council, Beijing, September 2004.     

我国社区居家养老服务均等化研究

当前,国家对建立居家养老服务体系越来越重视,城乡社区居家养老服务得到较快发展。但是,在各地社区居家养老服务的发展过程中,还存在服务不均等、不均衡的现象。利用中国老龄科学研究中心2006年"中国城乡老年人口状况追踪调查"的数据,详细分析目前我国社区居家养老服务的需求、供给与利用状况,着重分析城市与农村,东部、中部与西部在社区居家养老服务的供给、需求与利用之间的差异。认为我国目前的社区居家养老服务存在着明显的不均等现象,需要针对城乡和不同地区社区居家养老服务的实际情况与老年人的需求状况分别制定相应的措施。