Kutzin J
Health Policy Manas Analysis Project, World Health Organization, Regional Office for Europe, Bishkek, Kirgiziya Republic.
Health Policy. 2001 Jun;56(3):171-204. doi: 10.1016/s0168-8510(00)00149-4.
Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. The framework is proposed as a tool for descriptive analysis of the key functions, policies, and interactions within an existing health care system, and equally as a tool to assist the identification and preliminary assessment of policy options. The aim is to help to clarify the policy levers that are available to enhance the insurance function for the population as efficiently as possible, given the 'starting point' of a country's existing institutional and organizational arrangements. Analysis of health care financing systems using this framework highlights the interactions of various policies and the need for a coherent package of coordinated reforms, rather than a focus on particular organizational forms of 'health insurance'. The content of each main health care system function (revenue collection, pooling of funds, purchasing of services, provision of services) and the market structure with which the implementation of each is organized are found to be particularly important, as are policies with respect to the benefit package and user fees.
卫生筹资政策的特点是政策工具与政策目标之间存在混淆，在低收入和中等收入国家尤为如此。本文试图通过提供一个概念框架来解决这一问题，该框架以增强卫生保健系统的 “保险功能”（在不导致经济贫困的情况下获得所需护理）这一规范性目标为驱动。该框架被提议作为一种工具，用于对现有卫生保健系统内的关键功能、政策及相互作用进行描述性分析，同时也作为一种有助于识别和初步评估政策选项的工具。目的是在一个国家现有制度和组织安排的 “起点” 基础上，帮助阐明可用于尽可能高效地增强人群保险功能的政策杠杆。使用该框架对卫生保健筹资系统进行分析，突出了各项政策之间的相互作用以及进行一整套协调一致的改革的必要性，而不是关注 “医疗保险” 的特定组织形式。结果发现，每个主要卫生保健系统功能（收入筹集、资金统筹、服务购买、服务提供）的内容以及组织实施每项功能的市场结构，与福利包和使用者付费政策一样，都尤为重要。
