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经合组织的五种医疗体系类型:演绎分类的实证结果

Five types of OECD healthcare systems: empirical results of a deductive classification.

作者信息

Böhm Katharina, Schmid Achim, Götze Ralf, Landwehr Claudia, Rothgang Heinz

机构信息

University of Mainz, Germany.

出版信息

Health Policy. 2013 Dec;113(3):258-69. doi: 10.1016/j.healthpol.2013.09.003. Epub 2013 Sep 13.

Abstract

This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history.

摘要

本文根据罗斯冈和温特[1]演绎生成的类型学对30个经合组织国家的医疗体系进行了分类。这种类型学区分了医疗体系的三个核心维度:监管、融资和服务提供,以及三种行为主体类型:国家行为主体、社会行为主体和私人行为主体。我们认为,这三个维度之间存在一种等级关系,以监管为先导,其次是融资,最后是服务提供,其中上级维度限制下级维度的性质。这一等级规则将理论上合理的类型数量限制为十种。为了验证我们的观点,我们主要利用经合组织卫生数据和世界卫生组织国家报告对30个经合组织国家的医疗体系进行了分类。分类结果产生了五种体系类型:国民医疗服务体系、国民医疗保险、社会医疗保险、国家主义社会医疗保险和私人医疗体系。所有这五种类型都属于理论上合理的医疗体系类型组。仅斯洛文尼亚由于其独特的转型历史,不符合我们关于维度和典型行为主体之间等级关系的假设。

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