Hussey P, Anderson G F
Health Policy and Management, John Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA.
Health Policy. 2003 Dec;66(3):215-28. doi: 10.1016/s0168-8510(03)00050-2.
A major choice confronting many countries is between single-payer and multi-payer health insurance systems. This paper compares single-payer models in the areas of revenue collection, risk pooling, purchasing, and social solidarity. Single-payer and multi-payer systems each have advantages which may meet countries' priorities for their health insurance system. Single-payer systems are usually financed more progressively, and rely on existing taxation systems; they effectively distribute risks throughout one large risk pool; and they offer governments a high degree of control over the total expenditure on health. Multi-payer systems sacrifice this control for a greater ability to meet the diverse preferences of beneficiaries. Several major reforms of single-payer insurance systems--expansion of the role of private insurance and transformation to a multi-payer system--are then described and illustrated using specific country examples. These reforms have been implemented with some success in several countries but face several important challenges.
许多国家面临的一个主要选择是在单一支付者和多支付者医疗保险体系之间。本文在收入筹集、风险共担、购买和社会团结等方面对单一支付者模式进行了比较。单一支付者和多支付者体系各有优势，这些优势可能符合各国医疗保险体系的优先事项。单一支付者体系通常在资金筹集上更具累进性，并依赖现有的税收体系；它们能在一个大的风险池中有效分散风险；并且它们使政府对卫生总支出有高度控制权。多支付者体系为了更有能力满足受益人的不同偏好而牺牲了这种控制权。接着描述并举例说明了单一支付者保险体系的几项重大改革——扩大私人保险的作用以及向多支付者体系转变。这些改革在几个国家已取得一定成功，但也面临一些重要挑战。
