Voluntary Health Insurance Board/Institute of Public Administration, Dublin, Ireland.
Health Policy. 2010 Nov;98(1):39-49. doi: 10.1016/j.healthpol.2010.06.009. Epub 2010 Jul 24.
The paper summarises the conclusions for health policy from the experience of three countries who have introduced risk equalisation subsidies, in their voluntary health insurance (VHI) markets. The countries chosen are Australia, Ireland and South Africa. All of these countries have developed VHI markets and have progressed towards introducing risk equalisation. The objective of such subsidies is primarily to make VHI affordable while encouraging efficiency in health care production. The paper presents a conceptual framework to understand and compare risk equalisation subsidies in VHI markets. The paper outlines how such subsidies are organised in each of the countries and identifies problems that arise in their implementation. We conclude that the objectives of risk equalisation, in VHI markets are no different to those in countries with mandatory insurance systems. We find that the introduction of risk equalisation subsidies is complex and that countries seeking to introduce risk equalisation in VHI markets must carefully consider how such subsidies advance their overall health policy goals. Furthermore, we conclude that such subsidies must be structured correctly as otherwise incentives exist for risk selection which may threaten affordability and efficiency. Our overall conclusion is that also in voluntary health insurance markets risk equalisation has a role in meeting the related public policy objectives of risk solidarity and affordability, and without it these objectives are severely undermined.
本文总结了三个国家在其自愿医疗保险（VHI）市场引入风险均衡补贴的经验对健康政策的结论。选择的国家是澳大利亚、爱尔兰和南非。所有这些国家都开发了 VHI 市场，并朝着引入风险均衡的方向发展。这种补贴的目的主要是使 VHI 负担得起，同时鼓励医疗保健生产的效率。本文提出了一个概念框架来理解和比较 VHI 市场中的风险均衡补贴。本文概述了这些补贴在每个国家是如何组织的，并确定了在实施过程中出现的问题。我们的结论是，VHI 市场中的风险均衡补贴的目标与强制性保险制度国家的目标没有什么不同。我们发现，引入风险均衡补贴是复杂的，那些试图在 VHI 市场引入风险均衡的国家必须仔细考虑这些补贴如何推进其整体健康政策目标。此外，我们的结论是，这些补贴必须正确构建，否则存在风险选择的激励，这可能威胁到负担能力和效率。我们的总体结论是，在自愿医疗保险市场中，风险均衡也在满足风险团结和负担能力的相关公共政策目标方面发挥作用，如果没有风险均衡，这些目标将受到严重损害。
