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1.
South Korea introduced mandatory social health insurance forindustrial workers in large corporations in 1977, and extendedit incrementally to the self-employed until it covered the entirepopulation in 1989. Thirty years of national health insurancein Korea can provide valuable lessons on key issues in healthcare financing policy which now face many low- and middle-incomecountries aiming to achieve universal health care coverage,such as: tax versus social health insurance; population andbenefit coverage; single scheme versus multiple schemes; purchasingand provider payment method; and the role of politics and politicalcommitment. National health insurance in Korea has been successfulin mobilizing resources for health care, rapidly extending populationcoverage, effectively pooling public and private resources topurchase health care for the entire population, and containinghealth care expenditure. However, there are also challengesposed by the dominance of private providers paid by fee-for-service,the rapid aging of the population, and the public-private mixrelated to private health insurance. 相似文献
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China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China's current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China's particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform. 相似文献
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South Korea proactively introduced public long-term care insurance (LTCI) in 2008 when older people were only about one-tenth of the total population. At that time, Korea switched from a tax-based, local-government-operated LTC program targeting low-income older people to the current universal public LTCI run by the National Health Insurance Service, the single public insurer. The LTCI program provides a comprehensive package of home- and institution-based care mainly targeting older people who need assistance in daily living. Over the past decade, the program has continued to expand its population and service coverage: older people in high need have been covered, and an infrastructure for service provision has been established. Future agendas include financial sustainability, care coordination, and the role of local governments. Korea’s experiences suggest having an LTCI separate from the NHI has the benefit of potential de-medicalization of LTC, which, in turn, creates challenges for the coordination of health care and LTC. A centralized LTCI system with a single payer has the benefit of bigger risk-pooling, but this may become a barrier to designing integrated community care systems at the local level. There is a tradeoff between population coverage, benefits/cost coverage, and fiscal sustainability. 相似文献
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Laurell AC 《Ciência & saúde coletiva》2011,16(6):2795-2806
The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of neoliberal reorganization of society. Unlike other Latin American countries, this process did not include a new Constitution. The study is based on official documents and a systematic review of the process of the implementation of the System of Social Health Protection and its impact on coverage and access to health services. The analysis concludes that it is unlikely that universal population coverage will be accomplished much less universal access to services. However, reforms are leading to the commodification of the health system even in the context of a weak private sector. 相似文献
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Mooney G 《Australian and New Zealand journal of public health》2004,28(6):559-560
OBJECTIVE: To draw historical parallels between inequalities in South Africa and Australia and their implications for public health, and especially Aboriginal health, in the latter. METHODS: To use the work of Terreblanche in South Africa and Houston in Australia to demonstrate the relevance of past inequalities to some of today's health problems. RESULTS: Economic structural issues remain crucial to the development of and the future health of these two countries. There are more grounds for hope for a more equal society in South Africa than there are in Australia. CONCLUSIONS: South Africa has made some attempt to face its past while Australia has not. Attempts to kill off Aboriginal culture continue. Aboriginal health will only improve when white Australia is prepared to face its 'black' past and move beyond the racism and indifference that surround Aboriginal affairs. The neo liberalism of both countries serves their disadvantaged populations ill. 相似文献
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Alok Gupta Stephen T. Parente Pallab Sanyal 《International journal of health care finance and economics》2012,12(4):303-322
Healthcare is an important social and economic component of modern society, and the effective use of information technology in this industry is critical to its success. As health insurance premiums continue to rise, competitive bidding may be useful in generating stronger price competition and lower premium costs for employers and possibly, government agencies. In this paper, we assess an endeavor by several Fortune 500 companies to reduce healthcare procurement costs for their employees by having HMOs compete in open electronic auctions. Although the auctions were successful in generating significant cost savings for the companies in the first year, i.e., 1999, they failed to replicate the success and were eventually discontinued after two more years. Over the past decade since the failed auction experiment, effective utilization of information technologies have led to significant advances in the design of complex electronic markets. Using this knowledge, and data from the auctions, we point out several shortcomings of the auction design that, we believe, led to the discontinuation of the market after three years. Based on our analysis, we propose several actionable recommendations that policy makers can use to design a sustainable electronic market for procuring health insurance. 相似文献
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Bodenheimer T 《American journal of public health》2003,93(1):112-115
Before 1971, all proposals for universal health insurance were based on private sector financing and administration. After 1971, universal health insurance plans relying on the private sector complicated efforts of the universal health insurance movement. To forge as broad a movement for universal health insurance as possible, it may be worthwhile for universal health insurance advocates of different persuasions to seek common ground on the basis of a set of goals for a new health care system. The goals can serve as a measuring stick to determine which health insurance plans are worthy of support. 相似文献
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《Health policy (Amsterdam, Netherlands)》2022,126(9):925-932
Despite mandatory social health insurance in Korea, the fraction of total healthcare spending paid out-of-pocket has been considerably high. In 2013, the Korean government expanded benefits coverage of social insurance for patients diagnosed with the costliest disease groups (cardiovascular and cerebrovascular diseases, cancer, and intractable diseases). We analyze individual longitudinal information from the 2010 to 2016 Korea Health Panel to estimate the impact of the policy change on healthcare spending, utilization, and enrollment in private supplemental health insurance. Impacts on other health-related and financial measures are additionally assessed to evaluate the effects in multiple dimensions. Our difference-in-differences approach with entropy balancing weights shows that the expansion of benefits coverage of public health insurance reduced out-of-pocket spending on health by 30% without accompanying increases in healthcare utilization. The impact was smaller for the individuals with high socioeconomic characteristics, who are more likely to use other costly services that remained unaffected by the policy. We do not find evidence that expanding social insurance benefits coverage changed the demand for supplemental private health insurance. 相似文献
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In South Africa, the challenges of economic growth, job creation and effective service delivery are regarded as key to the long-term development of the country. The provision of basic environmental health services is acknowledged as an important factor impacting on the quality of living environments and the health of communities. This paper outlines the environmental health challenges faced by local authorities in the context of national policy, the wider local government development framework and the backlog in the provision of basic services. Using South African examples, the paper concludes with a synopsis of the gaps in policy and delivery drawing on the policy framework of the World Health Organisation, Health for All in the 21st Century. Many of the insights highlighted are likely to parallel the experiences in other developing countries. 相似文献
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The government-initiated Annual Workers Health Examination Program and the Industrial Accident Compensation Program both of which are delivered from outside the workplace mainly by a handful of service agents have remained the cornerstones of occupational health and safety (OHS) policy in South Korea since the 1960s. Initially, policies centered on the technical dimensions of OHS problems. This acultural approach is no longer efficient, and the scope of problems that can be dealt with is limited. The injury rate has gone down from 6 to less than 1 injury per 100 insured workers, but since the 1980s there has been no sign of improvement in the death rate from industrial accidents, and future improvement in the injury rate is not expected. As South Korea is facing major economic and social changes, review of current OHS policy is also underway. International collaborations and comparisons will surely add thoughtful perspectives to this discussion. 相似文献
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Social health insurance in Nepal: A health system departure toward the universal health coverage
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Rajani Pokharel Pushkar Raj Silwal 《The International journal of health planning and management》2018,33(3):573-580
The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health‐care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health‐care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI. 相似文献
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Ye Li Qunhong Wu Ling Xu David Legge Yanhua Hao Lijun Gao Ning Ning Gang Wan 《Bulletin of the World Health Organization》2012,90(9):664-671
Objective
To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes.Methods
Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure.Findings
The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure.Conclusion
Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies. 相似文献17.
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Abel-Smith B 《Health policy and planning》1992,7(3):215-226
Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches. 相似文献
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