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医疗保险、按服务收费补贴与市场结果:对澳大利亚医疗保健融资迷宫的部分描述

Medicare, fee-for-service subsidies, and market outcomes: a partial description of Australia's health care financing labyrinth.

作者信息

Connelly L B, Doessel D P

机构信息

Brisbane Graduate School of Business, Queensland University of Technology, Australia.

出版信息

J Health Care Finance. 2000 Winter;27(2):66-82.

Abstract

In Australia, both in-hospital and out-of-hospital services are subsidized via a national, social health insurance scheme, referred to as "Medicare." Revenue for the scheme is raised via general taxation and an earmarked "tax," which is presently 1.5 percent of taxable income. Members are entitled to the subsidized consumption of a broad range of medical practitioner services provided on both an in-hospital and an out-of-hospital basis, in both private and public facilities. Moreover, the range of services subsidized by the Australian scheme is broad, and includes the types of medical care that are available only to those U.S. Medicare patients who have opted for the Supplementary Medical Insurance Program. The purpose of this article is to provide a descriptive account of the Australian Medicare arrangements, particularly those that pertain to private, fee-for-service, medical practice. This article emphasizes the fact that, although the provisions are nationally uniform in application, these arrangements do not give rise to homogeneity of consumer payments and medical practitioner revenue. The article's theme is that, just as the simple terms "Medicare" and "Medicaid" belie the complexity of U.S. social health insurance, the Australian application of the term "Medicare" also describes a health care financing labyrinth.

摘要

在澳大利亚,住院和院外服务均通过一项名为“医疗保险”的全国性社会医疗保险计划获得补贴。该计划的资金通过一般税收和一项专项“税”筹集,目前该税为应税收入的1.5%。会员有权在私立和公立机构享受住院和院外提供的广泛医疗服务的补贴消费。此外,澳大利亚该计划补贴的服务范围很广,包括只有那些选择了补充医疗保险计划的美国医疗保险患者才能享受到的医疗服务类型。本文旨在对澳大利亚医疗保险安排进行描述,特别是那些与私立、按服务收费的医疗实践相关的安排。本文强调,尽管这些规定在全国范围内统一适用,但这些安排并未导致消费者支付和医生收入的同质化。本文的主题是,正如简单的术语“医疗保险”和“医疗补助”掩盖了美国社会医疗保险的复杂性一样,澳大利亚对“医疗保险”一词的应用也描述了一个医疗保健融资迷宫。

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