Ros C C, Groenewegen P P, Delnoij D M
Netherlands Institute of Primary Health Care NIVEL, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
Health Policy. 2000 May;52(1):1-13. doi: 10.1016/s0168-8510(00)00065-8.
In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing. We found that some combinations are more present: different payment systems for primary care physicians go together with different forms of cost sharing, different services have different forms of cost sharing. In countries with a GP as gatekeeper no charges are in use for the GP. No distinct relationship could be found between the financing system (tax-based or insurance-based) and the form of cost sharing or the exclusion of vulnerable populations. It is concluded that there are two ways of filtering 'unnecessary' demand. One is by introducing cost sharing for directly accessible services such as GPs. The second way is by having GPs act as gatekeepers to more specialized, and more costly care.
在大多数欧洲国家，为了减少医疗需求，已经引入了费用分担机制。费用分担有不同的形式，但由于历史形成的系统特征和主流价值观，各国在特定形式的应用上存在差异。本综述聚焦于18个欧洲国家，以及卫生系统特征与当前费用分担形式的组合。我们发现某些组合更为常见：针对初级保健医生的不同支付系统与不同形式的费用分担并存，不同的服务有不同形式的费用分担。在以全科医生作为守门人的国家，对全科医生不收取费用。在筹资系统（基于税收或基于保险）与费用分担形式或弱势群体的排除之间，未发现明显的关系。得出的结论是，有两种过滤“不必要”需求的方式。一种是通过对直接可及的服务（如全科医生服务）引入费用分担。第二种方式是让全科医生作为更专科、更昂贵医疗服务的守门人。
