建立和完善上海外来灵活就业人员医疗保险制度分析-analysis of establishing and perfecting the medical insurance system for foreign flexible employment in shanghai.docx

摘要经济体制改革和产业结构的调整使上海就业结构呈现多元化发展，灵活就 业已成为一种重要的就业形式。上海外来灵活就业人员数量已逾 200 万，这一群 体在参加社会医疗保险时，由于其收入较低、工作流动大等特点导致参保和转移 接续困难，医保供需矛盾凸显。解决好这一群体的基本医保需求，关系到社会公 平与效率，有利于上海社会医疗保险制度的进一步完善。上海市已先后出台一系列办法保障自由职业者、个体经济组织业主以及外来 从业人员的医疗需求，但是现行的政策还未能很好覆盖上海外来灵活就业人员。 论文在深刻把握我国经济社会发展水平基础上，结合时代背景，对上海社会医疗 保险改革进行政策效应分析，肯定其成绩的同时也发现其需要进一步完善。本文 对上海市外来灵活就业人员医疗保险进行抽样调查，发现其参保率和参保意愿均 较低的现象，运用 Spss、Excel 等工具进行数据分析，发现上海现行社会医疗保 险制度并不非常适合外来灵活就业人员，其参保机制、缴费机制与管理工作有待 完善。为深入探究外来灵活就业人员医保供需现状，采用 logistic 多元回归方法 分析了上海外来灵活就业人员医疗保险需求影响因素和上海市政府的医疗保险 供给能力。在此基础上构建上海外来灵活就业人员医疗保险模式，采用 Monte Carlo 法对上海外来灵活就业人员关注的大病医疗保险进行制度设计，确定其缴 费层次，并进行可行性分析。最终提出建立和完善上海外来灵活就业人员医疗保 险制度的建议，包括制度运行环境优化和筹资渠道拓展等几个方面。论文在广泛搜集国内外灵活就业人员医疗保障文献的基础上，针对上海地区 进行实地调研分析，选题紧随新医改深化大背景，切入准确。采用定性研究与定 量研究相结合，国内分析与国际比较相统一的方式，用 Monte Carlo 法对上海外 来灵活就业人员的大病医疗进行方案设计并仿真预测，有较强的可行性，希望为 上海市外来灵活就业人员的医疗保险制度提供切实可行的政策建议。关键词：外来灵活就业，医疗保险，供需矛盾，大病医疗保险STUDY ON THE ESYABLISHMENT AND IMPROVEMENT OF MEDICAL INSURANCE SYSTEM FOR ALIEN FLEXIBLE EMPLOYMENT IN SHANG HAIABSTRACTThe economic reform and the transformation of industrial structure caused a diversified employment structure in Shanghai. Alien flexible employment has become one of the important forms of employment. Alien flexible employment from out of Shanghai has reached more than 2million. Because of their low income and flexibility when they take the social medical insurance, the transformation of account became a issue, there are supply and demand imbalance between them. The solution to this difficult is a matter of social fairness and efficient, and it do good to the further improvement of Shanghai social medical care insurance system.Shanghai has launched a series of measures to ensure freelancers, self-employme nt and workers from out of Shanghai, meeting their medical needs. But the system cur rently is not very well cover the Alien Flexible Employment.Paper on the basis of und erstanding Chinas economic and social development level, combined with times back ground, analysis of Shanghai social medical insurance refo