医疗保险设计如何影响卫生服务的成本和可及性——根据11个国家不同收入人群的调查

2010年的调查研究了澳大利亚、加拿大、法国、德国、荷兰、新西兰、挪威、瑞典、瑞士、美国和英国成人的医保相关经历。这些国家的医保有不同的覆盖范围,体现在既有公共的又有公私合营的保险体系,并且具有不同的费用报销比例。总的来说,本次研究发现医疗保险设计导致不同保险的可及性、成本分担和问题等方面存在显著差异。即使在有保险的情况下,美国的成年人承担的医疗费用最高,需要花费大量时间填写保险书面材料和处理争议并且有可能被拒绝支付。德国人和美国人在填写书面材料上花费的时间差不多,但是不需要自付费用;瑞士人的自付费用虽然很高,但是在获得医保或者费用支付上没有任何障碍。对于美国成年人,全面的医疗改革可以在很多方面改进,包括减少本次研究中发现的因收入不同而产生的差别。

How health insurance design affects access to care and costs, by income, in eleven countries

This 2010 survey examines the insurance-related experiences of adults in Australia,Canada,France,Germany,the Netherlands,New Zealand,Norway,Sweden,Switzerland,the United States,and the United Kingdom.The countries all have different systems of coverage,ranging from public systems to hybrid systems of public and private insurance,and with varying levels of cost sharing.Overall,the study found significant differences in access,cost burdens,and problems with health insurance that are associated with insurance design.US adults were the most likely to incur high medical expenses,even when insured,and to spend time on insurance paperwork and disputes or to have payments denied.Germans reported spending time on paperwork at rates similar to US rates but were well protected against out-of-pocket spending.Swiss out-of-pocket spending was high,yet few Swiss had access concerns or problems paying bills.For US adults,comprehensive health reforms could lead to improvements in many of these areas,including reducing differences by income observed in the study.