He Alex Jingwei
Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.
BMC Health Serv Res. 2017 Aug 25;17(1):603. doi: 10.1186/s12913-017-2559-7.
Struggling to correct the public-private imbalance in its health care system, the Hong Kong SAR Government seeks to introduce a government-regulated voluntary health insurance scheme, or VHIS, a distinctive financing instrument that combines the characteristics of private insurance with strong government regulation. This study examines citizens' responses to the new scheme and their willingness to subscribe.
First-hand data were collected from a telephone survey that randomly sampled 1793 Hong Kong adults from September 2014 to February 2015. Univariate and multivariate methods were employed in data analysis.
More than one third of the respondents explicitly stated intention of subscribing to the VHIS, a fairly high figure considering the scheme's voluntary nature. Multivariate analysis revealed moderate evidence of adverse selection, defined as individuals' opportunistic behaviors when making insurance purchasing decision based on their own assessment of risks or likelihood of making a claim.
The excellent performance of Hong Kong's public medical system has had two parallel impacts. On the one hand, high-risk residents, particularly the uninsured, do not face a pressing need to switch out of the overloaded public system despite its inadequacies; this, in turn, may reduce the impact of adverse selection that may lead to detrimental effects to the insurance market. On the other hand, high satisfaction reinforces the interests of those who have both the need for better services and the ability to pay for supplementary insurance. Furthermore, the high-risk population demonstrates a moderate interest in the insurance despite the availability of government subsidies. This may offset the intended effect of the reform to some extent.
香港特别行政区政府努力纠正其医疗体系中的公私失衡问题，试图引入一项政府监管的自愿医疗保险计划（VHIS），这是一种独特的融资工具，兼具私人保险的特点和强有力的政府监管。本研究考察了公民对新计划的反应及其参保意愿。
2014年9月至2015年2月，通过电话调查从1793名香港成年人中随机抽样收集一手数据。数据分析采用单变量和多变量方法。
超过三分之一的受访者明确表示有参保VHIS的意愿，考虑到该计划的自愿性质，这一数字相当高。多变量分析显示存在适度的逆向选择证据，逆向选择定义为个人在基于自身对风险或索赔可能性的评估做出保险购买决策时的机会主义行为。
香港公共医疗系统的出色表现产生了两个并行的影响。一方面，高风险居民，尤其是未参保者，尽管公共系统存在不足，但他们并不迫切需要转出负担过重的公共系统；这反过来可能会减少逆向选择的影响，而逆向选择可能会对保险市场产生不利影响。另一方面，高满意度强化了那些既需要更好服务又有能力支付补充保险费用的人的利益。此外，尽管有政府补贴，高风险人群对该保险仍表现出适度的兴趣。这可能在一定程度上抵消改革的预期效果。
