Busse R, Schwartz F W
Dept. of Epidemiology & Social Medicine, Medizinische Hochschule Hannover, Germany.
Int J Health Plann Manage. 1997 Apr-Jun;12(2):131-48. doi: 10.1002/(SICI)1099-1751(199704)12:2<131::AID-HPM464>3.0.CO;2-#.
Through the recent National Health Insurance Act (NHIA), the Philippines have committed themselves to introducing a social health insurance with universal coverage within 15 years. Germany was the first country to introduce a social health insurance system more than 100 years ago. Its system is based on the principles of corporatism, federalism and a mandate for equity. Based on a long-term German experience with equity, quality, cost and efficiency issues, the Philippines' NHIA is analysed concerning the entitlement to benefits and the benefit package, the organization of the health insurance programme, health insurance financing, and provider payment mechanisms. It is suggested that the Philippines could profit from including preventive and promotive services as well as pharmaceuticals in the benefits package. The organization of the health insurance system could be decentralized using the 13 regions as its principal units. To achieve financial equity between regions and health funds, a contribution compensation scheme is proposed. To prevent over-utilization in over-served areas and to promote utilization in under-served areas, a relative value scale for fee-for-service payments seem advisable.
通过最近的《国家健康保险法》（NHIA），菲律宾承诺在15年内引入全民覆盖的社会健康保险。德国是100多年前首个引入社会健康保险制度的国家。其制度基于社团主义、联邦制和平等原则。基于德国在公平、质量、成本和效率问题上的长期经验，对菲律宾的《国家健康保险法》在福利权益和福利套餐、健康保险计划的组织、健康保险融资以及提供者支付机制方面进行了分析。建议菲律宾可从将预防和促进服务以及药品纳入福利套餐中获益。健康保险系统的组织可利用13个地区作为主要单位进行分权。为实现地区与健康基金之间的财务公平，提议采用缴费补偿计划。为防止服务过度地区的过度利用并促进服务不足地区的利用，按服务收费支付的相对价值尺度似乎是可取的。
