Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK.
Health Policy. 2011 May;100(2-3):256-63. doi: 10.1016/j.healthpol.2010.10.018. Epub 2010 Dec 3.
This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI).
The Kakwani's progressivity index was used to assess the equity consequences of the new NHI system (with flat rate NHI scheme) compared to the current tax financed system. It was also used to model a proposed system (with a progressive NHI scheme) that can generate the same amount of funding more equitably.
The new NHI system would be less equitable than the current tax financed system, as evident from the reduction of Kakwani's index to 0.168 from 0.217. The new flat rate NHI scheme, if implemented, would reduce the progressivity of the health finance system because it is a less progressive finance source than that of general government revenue. We proposed a system with a progressive NHI scheme that generates the same amount of funding whilst preserving the equity at the Kakwani's progressivity index of 0.213.
A NHI system with a progressive NHI scheme is proposed to be implemented to raise health funding whilst preserving the equity in health care financing.
本文评估了马来西亚计划改革现行税收融资制度以建立国民健康保险（NHI）对公平性的潜在影响。
使用 Kakwani 累进指数来评估新的 NHI 系统（采用统一费率 NHI 计划）与现行税收融资制度相比的公平性后果。它还被用于模拟一个可以更公平地筹集相同数量资金的拟议系统（采用累进 NHI 计划）。
新的 NHI 系统将不如现行税收融资制度公平，从 Kakwani 指数从 0.217 降至 0.168 可以明显看出。新的统一费率 NHI 计划如果实施，将降低卫生金融系统的累进性，因为它是比一般政府收入更缺乏累进性的资金来源。我们提出了一个采用累进 NHI 计划的系统，该系统可以筹集相同数量的资金，同时保持 Kakwani 指数为 0.213 的公平性。
建议实施具有累进性的 NHI 计划的 NHI 系统，以提高卫生资金筹集水平，同时保持卫生保健融资的公平性。
