墨西哥全民健康覆盖发展历程及对我国的启示

2003年墨西哥启动卫生改革,建立了覆盖非正式就业人群的大众健康保险,实现全民健康覆盖。为了保证不同健康保障制度的一致性,墨西哥政府为非正式就业人员提供补助,保证他们与正式就业人员健康保障筹资水平相同,进而享有同样的卫生服务。尽管改革取得了很大成效,但依然存在一些问题:卫生系统碎片化、缺少激励提供者改进服务的机制、不同健康保障制度间及不同州之间依然存在不公平、患者自付费用仍然很高、州政府资金未能及时到位。墨西哥卫生改革经验对我国有一定的借鉴意义:医疗保险制度与卫生服务体系改革应同步推进,尽快实现不同医疗保险制度之间的一致性,加强不同部门之间的协调,明确各级政府的筹资责任。

Evolution of universal health coverage in Mexico and its implications for China

In 2003, Mexico started health system reform and established Seguro Popular, which covers the unemployed and underemployed and ensures universal health coverage. To ensure solidarity among different health seaurity schemes, the government subsided informal employees so that the financing standard was the same as the formal employees and then ensures the same service for them. Although the reform has had many effects, there are still some problems: The health system is still broken; the incentive mechanism for providers to improve service is lacking; there is inequity between different health insurance systems and states; the out-of-pocket expense of patients is still high; and funding from the state government is not provided in a timely manner. The experience of Mexico is helpful for China: The health insurance and healthcare systems should be developed synchronously; solidarity among different health insurance systems should be ensured as soon as possible; various departments must cooperate; and the funding responsibilities of governments at all levels must be defined.