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低成本政策工具,助力以色列投保人在医疗体系中维护自身权益。

Low-budget policy tool to empower Israeli insureds to demand their rights in the healthcare system.

作者信息

Brammli-Greenberg Shuli, Waitzberg Ruth, Medina-Artom Tamar, Adijes-Toren Ariella

机构信息

School of Public Health at the University of Haifa, Israel; Smokler Center for Health Policy Research at Myers-JDC-Brookdale Institute, JDC Hill, POB 3886, Jerusalem 91037, Israel.

Smokler Center for Health Policy Research at Myers-JDC-Brookdale Institute, JDC Hill, POB 3886, Jerusalem 91037, Israel.

出版信息

Health Policy. 2014 Dec;118(3):279-84. doi: 10.1016/j.healthpol.2014.11.005. Epub 2014 Nov 18.

Abstract

Since 1995 universal healthcare coverage has been provided in Israel through National Health Insurance (NHI). Although the country has lower rates of health spending than most OECD countries, the NHI Law stipulates that a broad benefits package will be provided by four competing Health Plans (HPs). These third-party payers manage healthcare utilization and cost through mechanisms that affect both provider and consumer behavior. Cost Containment is one of their main organizational objectives. The Ministry of Health (MoH) supervises HPs to ensure that they provide their members with adequate healthcare of high quality in accordance with the NHI Law and uphold the principles of efficiency and equity. In this paper we report on a policy instrument recently introduced by the MoH which enables it to share some of its responsibility for supervision with the insureds. This policy instrument is a website launched in 2014 that gives access to transparent information about the coverage of the NHI and voluntary health insurance (VHI) benefits packages. The idea is to empower insureds with knowledge and awareness of their rights and eligibility to benefits, so they can demand them from the HPs and/or private insurers; if refused, they can refer the case to the supervisor (the MoH). This policy instrument addresses market failures related to information asymmetry and can potentially improve competition among the HPs and within the VHI market.

摘要

自1995年以来,以色列通过国民健康保险(NHI)提供全民医保覆盖。尽管该国的医疗支出率低于大多数经合组织国家,但NHI法规定,四个相互竞争的健康计划(HPs)将提供广泛的福利套餐。这些第三方支付者通过影响提供者和消费者行为的机制来管理医疗保健的利用和成本。成本控制是他们的主要组织目标之一。卫生部(MoH)监督健康计划,以确保它们根据NHI法为其成员提供高质量的充足医疗保健,并坚持效率和公平原则。在本文中,我们报告了卫生部最近推出的一项政策工具,该工具使卫生部能够与被保险人分担部分监督责任。这一政策工具是一个于2014年推出的网站,可提供有关NHI和自愿健康保险(VHI)福利套餐覆盖范围的透明信息。其目的是使被保险人了解自身权利以及享受福利的资格,从而能够向健康计划和/或私人保险公司提出要求;若遭拒绝,他们可将此事提交给监管机构(卫生部)。这一政策工具解决了与信息不对称相关的市场失灵问题,并有可能改善健康计划之间以及VHI市场内部的竞争。

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