Damrongplasit Kannika, Melnick Glenn A
School of Public Health, University of California, Los Angeles, USA.
Health Aff (Millwood). 2009 May-Jun;28(3):w457-66. doi: 10.1377/hlthaff.28.3.w457. Epub 2009 Mar 31.
Efforts by countries to attain universal coverage are often hampered by supply constraints that can reduce access to care for those already in the system and, in many Asian and developing countries, by the emergence of informal payment systems that extract under-the-table payments from patients. In 2001, Thailand extended government-financed coverage to all uninsured people with little or no cost sharing. We found that Thailand has added nearly fourteen million people to the system and achieved near-universal coverage without compromising access for those with prior coverage; we also found that, to date, no informal payment system has emerged.
各国为实现全民覆盖所做的努力往往受到供应限制的阻碍，这些限制可能会减少已纳入医保体系人群获得医疗服务的机会，在许多亚洲国家和发展中国家，还受到非正式支付系统出现的影响，这些系统向患者收取暗箱操作的费用。2001年，泰国将政府资助的医保覆盖范围扩大到所有未参保人群，且几乎没有成本分担。我们发现，泰国已将近1400万人纳入医保体系，并实现了近乎全民覆盖，同时没有影响此前已参保人群获得医疗服务的机会；我们还发现，迄今为止，尚未出现非正式支付系统。
