Flynn M L, Chung Y S
J Public Health Policy. 1990 Summer;11(2):238-53.
Health insurance in developing nations has tended to widen rather than reduce the gulf between privileged and underprivileged and between urban and rural dwellers. Beneficiaries are typically urban industrial workers with regular jobs and adequate incomes. The case of health insurance implementation and health policy planning in Korea is of particular interest. It illustrates the dilemmas which arise out of a privatized model with decentralized administration and fragmented governmental responsibility in a rapidly industralizing economy. In this respect, Korean health care institutions and financing patterns reflect major influences from Japan, the United States, and Germany. Since 1976, when national health insurance was first implemented in Korea, problems in cost inflation, overspecialization of physicians, underutilization of hospital facilities, and maldistribution of health care resources have emerged. The consequences of waste and poor allocation in a developing nation are more severe than in developed nations and raise questions about the appropriate role of the public sector where conflicts between social welfare and economic objectives arise.
发展中国家的医疗保险往往会扩大而非缩小特权阶层与弱势群体之间以及城乡居民之间的差距。受益者通常是有固定工作和足够收入的城市产业工人。韩国医疗保险的实施情况和卫生政策规划尤其值得关注。它说明了在快速工业化的经济中，由分散管理和政府责任碎片化的私有化模式所引发的困境。在这方面，韩国的医疗保健机构和融资模式体现了来自日本、美国和德国的重大影响。自1976年韩国首次实施国民健康保险以来，出现了成本通胀、医生过度专业化、医院设施利用不足以及医疗资源分配不均等问题。在发展中国家，浪费和分配不当的后果比发达国家更为严重，这也引发了关于在社会福利和经济目标出现冲突时公共部门应扮演何种适当角色的问题。
