Lu Jui-fen R, Leung Gabriel M, Kwon Soonman, Tin Keith Y K, Van Doorslaer Eddy, O'Donnell Owen
Department of Health Care Management, Chang Gung University, Taiwan.
Soc Sci Med. 2007 Jan;64(1):199-212. doi: 10.1016/j.socscimed.2006.08.033. Epub 2006 Oct 2.
This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.
本文比较了香港、韩国和台湾的医疗保健提供系统中“同等需求同等对待”（ETEN）原则的维持程度。医疗保健根据需求分配的程度偏差通过横向不公平指数来衡量。利用方面与收入相关的不平等分为四个主要来源：（i）收入的直接影响；（ii）需求指标（自我评估的健康状况、活动受限情况以及年龄和性别交互项）；（iii）非需求变量（教育程度、工作状况、私人医疗保险覆盖情况、雇主提供的医疗福利、医疗补助状况（低收入医疗援助）、地理区域以及城乡居住情况）以及（iv）一个残差项。所研究的服务类型包括西医、持牌传统中医师（LTMP）、牙科和急诊室就诊，以及住院治疗。在香港，医师和牙科服务存在违反ETEN原则的情况。看西医存在有利于富人的不公平现象。不同寻常的是，这种不公平在全科医生服务中存在，而专科医疗服务中不存在。相比之下，韩国似乎几乎全面维持了ETEN原则，尽管富裕人群在获得更高水平门诊护理方面享有优惠待遇。台湾的结果处于中间水平，即富人使用门诊服务的可能性略高，但西医和牙科就诊次数分布均匀，而在持牌传统中医师诊疗次数方面存在轻微的有利于富人的偏差。台湾的急诊室就诊和住院治疗要么成比例，要么略微有利于穷人。未来的工作应侧重于评估旨在减少所观察到的不平等分布的政策干预措施。
