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1.
我国基本医疗保障制度卫生服务可及性实证研究   总被引:6,自引:1,他引:5  
"看病难、看病贵"是当前社会反映强烈的热点问题,而其本质反应了卫生服务的可及性及其公平性较差。文章以陕西省眉县为实证研究现场,通过入户调查,采用集中指数和卫生服务可及性标准化等方法,对城镇职工、城镇居民和新型农村合作医疗等3种基本医疗保障制度参保人群卫生服务可及性及其公平性进行比较分析,探讨了3种基本医疗保障制度卫生服务可及性及其公平性的现状和差别,为完善我国基本医疗保障制度提供了科学依据。  相似文献   

2.
全民医疗保障制度是指我国政府为保障国民基本健康权益,保障城乡全体居民能够公平获得基本卫生保健所做出的制度安排,是为了在基本卫生保健方面为国民提供筹资保护与风险分担、改善卫生筹资公平性的政策选择。依据WHO对全民覆盖医疗保障的定义,我们将全民医疗保障制度覆盖范围界定为,“是全体国民在需要保健服务时,能够以可支付的费用获得适当的健康促进、预防,  相似文献   

3.
文章提出中国多层次医疗保障体系基本框架和三个发展阶段和目标,通过"全覆盖、保基本、多层次、多类型"制度设计,构建满足城乡居民多层次、多样化医疗保障需求的保障体系。认为现阶段多层次医疗保障体系应以全民医疗保障制度为基础、基本医疗保险制度为主体、补充医疗保险制度为延伸、医疗救助制度为托底的"四位一体"的医疗保障体系。  相似文献   

4.
全民医保目标下医疗保障制度的底线公平问题初探   总被引:2,自引:0,他引:2  
全民医保目标提出之前,我国医疗保障体系的公平性问题主要集中于制度在不同人群中的缺失.全民医保不仅需要实现医疗保障制度的全民覆盖,同时还提出了全民公平受益这一深层次要求.因此,多种医疗保障制度的建立与并存扩展了医疗保障语境下的公平视角,底线公平因而成为一种适宜的理念.底线的提出,基于人们健康权利的平等与一致性.底线公平的理念强调政府的基本责任在人群中的普惠性,同时将公平与效率统一起来,承认一种有差异的公平.底线公平理念有着制度建设中的现实性和前瞻性双重意义:在当前多种医保制度差异较大,公平性不足的情况下,用此理念均衡不同的制度发展,未来用此理念对责任进行明确,则可以减少由福利刚性给政府和社会带来的压力.  相似文献   

5.
利用中央和各级政府的财政转移,西藏自治区建立了覆盖全部农牧人口的基本医疗保障制度。然而,西藏周边地区居民尚未享受类似的基本医疗保障,因而产生了医疗补助的公平性问题。消除这一现象的关键。首先在于根据居民健康脆弱性指标,制定地区级差补助标准,然后以建立医疗救济制度为起点。逐步推广合作医疗制度,循序渐进地扩大社会基本医疗保障覆盖面。  相似文献   

6.
中国长江三角洲全民基本医疗保障可行性实验研究   总被引:2,自引:0,他引:2  
该简述了世界经济、农业劳动力比例与医疗保障制度发展规律,上中等收入国家医疗保障制度概况,新加坡模式特点、经济与社会效果,及中国医疗保障制度现状。对珠江三角洲模式(全民住院商业医疗保险)和长江三角洲模式(全民基本医疗保障模式)分别作了介绍,提出“门诊家庭账户.住院社会统筹(借贷制),大病风险救助”全民基本医疗保障模式实验方案,以保障城乡各种人群健康和控制医疗卫生总费用占GDP比例的增长幅度,迎接中国加入世贸组织后.国际商业医疗保险公司的挑战。  相似文献   

7.
作为医疗保障制度较为健全的国家和地区,英国、新加坡和中国香港三地的全民医疗保障体系经常成为学术界的研究对象。英国是全民免费医疗的典范,新加坡是政府主导的混合型医疗保障模式的代表,香港则凭借着质优价廉的公立医院服务享誉全球。本文将从卫生筹资的公平性、个人的可负担能力、医疗保障的覆盖模式、卫生筹资的可持续性以及个人责任的承担这五个核心维度来评估三地医疗保障系统的优越性和局限性,以期为我国新时期医疗改革的深化提供借鉴与参考。  相似文献   

8.
杨昱  赵文光 《卫生软科学》2011,25(11):759-760,768
我国的医疗保障制度自建国以来逐步建立和发展,然而城乡分离的格局,使城乡居民在享受医疗卫生服务时缺少公平性,在新的发展阶段,如何缩小城乡医保水平的差距,保障占人口大多数的农村居民的健康权益,是医改在新时期的首要任务。新医改在方案设计中,以“低水平,广覆盖”为目标来扩大可享受医疗保障的人群,在提高医疗卫生服务的可及性的同时,也存在一些问题,文章就此提出了相关的建议。  相似文献   

9.
新一轮医药卫生体制改革强调了对公平性的关注,通过加大政府卫生投入、推进基本医疗保障制度建设、建立国家基本药物制度、促进基本公共卫生服  相似文献   

10.
建立统筹城乡发展的医疗保障体系,逐步改变目前存在的城乡二元医疗保障制度,实现全体城乡居民病有所医,是我国医疗保障制度发展完善的重要目标。浙江省慈溪市结合当地的经济和社会发展实际,积极探索整合城乡医疗保障制度的途径和模式,并取得了一定的成效。本文就浙江省慈溪市城乡居民基本医疗保险制度实施现状和存在的问题进行分析,并提出完善城乡基本医疗保障制度的政策建议。  相似文献   

11.
This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.  相似文献   

12.
中国卫生改革与发展蓝图的构想   总被引:2,自引:0,他引:2  
解决当前“看病难、看病贵”问题涉及到卫生服务的可及性、公平性和成本问题,但这并不是卫生改革和发展要达到的最终目的,“看病难”和“看病贵”体现了中国卫生系统的“制度性疾病”。提出了中国卫生改革与发展蓝图框架结构,即:实现1个目标(普及基本卫生服务)、健全3个制度(基本医疗保险制度、基本卫生服务制度和基本药物制度)及实施6个政策策略。在未来的15年内,中国将在“以人为本,科学发展观”的思想指引下,建设一个和谐的、社会主义的小康社会。构建和谐社会,普及基本卫生服务是全国人民的愿景。为强化政府对基本卫生服务的保障责任,促进卫生服务的公平性,设想能否将“普及基本卫生服务”与“普及九年义务教育”共同构成中国最主要的2个社会政策。实现“普及基本卫生服务”是一个长期的过程,体现卫生事业发展要与经济发展水平相适应,需要动员全社会共同参与。  相似文献   

13.

Introduction  

Equity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made.  相似文献   

14.
健康公平——建设健康城市的公共政策基石   总被引:1,自引:0,他引:1  
文章透过我国健康公平性现状,分析了影响健康公平性的制度因素,进而提出建设健康城市中实现健康公平的公共政策建议:加大卫生投入,实施"低水平、广覆盖、高效率、可持续"的卫生发展模式,以建立健全城乡一体化的社区卫生服务体系为切入点,建立资金来源多渠道、保障方法多形式、保障水平多层次的全民健康保障制度,实现全民基本卫生服务均等化。  相似文献   

15.
Unless the concept is clearly understood, “universal coverage” (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization’s World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these.All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability.The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.  相似文献   

16.
A desire to enhance protection against health care costs and improve equity of access to health care lies at the core of many health sector financing initiatives. Until recently, international debates about financing and health equity have focused primarily on mechanisms to promote equity in relation to very specific elements of health systems. However, in recent years there has been growing interest in considering these equity challenges from a more systemic perspective. In this context, universal health coverage is becoming a rallying call, with a focus on how best universal coverage can be financed. This paper is the first in a special issue which presents a body of research whose overall aim was to critically evaluate existing inequities in health care financing and provision in Ghana, South Africa and Tanzania, and the extent to which health insurance mechanisms (broadly defined) could address financial protection and equity of access challenges. In this first paper we introduce the countries' health systems, with a special emphasis on existing mechanisms for financial protection. We also identify in broad terms the key challenges for universal coverage, setting the scene for the subsequent papers.  相似文献   

17.
Sri Lanka has been lauded for providing good health coverage at a low cost despite having a modest per capita income. This article identifies the unique historical factors that enabled Sri Lanka to achieve near universal coverage, but it also discusses how this achievement is now being undermined by inadequate government investment in health services, the burdens of non-communicable diseases, and the growing privatisation of health services. In doing so, the article highlights the challenges of achieving and maintaining universal health coverage in a relatively low income country with a health system designed to treat infectious diseases and provide child and maternal health services as the country undergoes an epidemiological transition from infectious to non-communicable diseases. Using updated information on developments in the Sri Lankan health system, this article argues, in contrast with earlier publications, that Sri Lanka is no longer providing good health at a low cost. It shows that Sri Lanka’s low investment in health is detrimental and not an asset to achieving good health. The article also questions the possibilities of providing coverage for noncommunicable diseases at a low cost. The article has four main sections. The first details Sri Lanka’s accomplishments in moving toward universal health coverage. The second identifies the factors enabling Sri Lanka to do so. The third describes the equity and access challenges the health system now confronts. The fourth assesses what the Sri Lankan experience suggests about the requirements for universal health coverage when providing health services for treating non-communicable diseases becomes an important consideration.  相似文献   

18.
The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the government's commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.  相似文献   

19.
2009年以来,我国医疗保障制度建设步伐明显加快,统筹城乡发展,实现全民医保,成为医疗保障政策研究的热点。同时,理论界也开始更多地关注城乡医疗保障的公平性、科学性以及有效性等制度发展的深层次问题。本文从医疗卫生改革与医疗保障、城镇医疗保障、农村医疗保障、城乡医疗救助四个方面综述了2009年以来的相关研究,并地进行了简要评价。  相似文献   

20.
South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.  相似文献   

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