卫生体系分类方法的创新

本文研究的是卫生体系分类问题,希望得到比以往分析的卫生组织模式更深入的成果。从卫生服务的筹资方式看,可在标准三分法(据此可将卫生体系分为三类:自愿保险、社会医保和全民医保)基础上增加两种类型:强制国民医保和特殊人群医保计划。从保险方和服务提供方之间的服务提供和关系来看,有必要对垂直整合和独立的体系加以区分。本文与以往大部分研究的不同之处在于其潜在的逻辑。本文假设所有体系均为混合体系,主张抛开传统的卫生体系分类逻辑(即根据现行体系将各个国家分入不同类别),转而采用拼图逻辑。细分卫生服务或人口的概念,被证明对这一目标非常有用。

Innovation on classification of healthcare systems

This article addresses the issue of the classification of healthcare systems, with the intent to take a step further than the previously analysed models of healthcare organisation. As concerns the financing of healthcare services, the standard tripartite classification (according to which healthcare systems are divided into three groups:voluntary insurance, social health insurance and universal coverage)is enriched with two additionaltypes:compulsory national health insurance and residual programs. With respect to the provision of services and the relationship between insurers and providers, it is important to distinguish between vertically integrated and separated systems. What differentiates this analysis from the majority of previous studies is its underlying logic. Assuming that all systems are hybrid,the article proposes to put aside the classic logic for classifying healthcare systems (according to which individual countries are pigeonholed into different classes depending on the prevailing system) in favour of the identikit logic. The concept of segmentation (of healthcare services or population) proves to be remarkably useful to this purpose.