Glied Sherry, Black Morgan, Lauerman Wiley, Snowden Sara
Robert F. Wagner Graduate School of Public Service, New York University.
Mount Sinai Health System.
Issue Brief (Commonw Fund). 2019 Apr 1;2019:1-10.
When discussing universal health insurance coverage in the United States, policymakers often draw a contrast between the U.S. and high-income nations that have achieved universal coverage. Some will refer to these countries having "single payer" systems, often implying they are all alike. Yet such a label can be misleading, as considerable differences exist among universal health care systems.
To compare universal coverage systems across three areas: distribution of responsibilities and resources between levels of government; breadth of benefits covered and extent of cost-sharing in public insurance; and role of private insurance.
Data from the Organisation for Economic Co-operation and Development, the Commonwealth Fund, and other sources are used to compare 12 high-income countries.
Countries differ in the extent to which financial and regulatory control over the system rests with the national government or is devolved to regional or local government. They also differ in scope of benefits and degree of cost-sharing required at the point of service. Finally, while virtually all systems incorporate private insurance, its importance varies considerably from country to country. A more nuanced understanding of the variations in other countries' systems could provide U.S. policymakers with more options for moving forward.
在美国讨论全民医疗保险覆盖范围时，政策制定者常常将美国与已实现全民覆盖的高收入国家进行对比。一些人会提及这些国家拥有“单一支付者”体系，常常暗示它们都是一样的。然而，这样的标签可能会产生误导，因为全民医疗保健体系之间存在相当大的差异。
在三个方面比较全民覆盖体系：各级政府之间责任和资源的分配；公共保险涵盖的福利广度和成本分担程度；以及私人保险的作用。
使用经济合作与发展组织、英联邦基金会及其他来源的数据，对12个高收入国家进行比较。
各国在对该体系的财政和监管控制权归属于国家政府还是下放给地区或地方政府的程度上存在差异。它们在福利范围和服务点所需的成本分担程度上也存在差异。最后，虽然几乎所有体系都包含私人保险，但其重要性在不同国家之间差异很大。对其他国家体系差异的更细致理解可为美国政策制定者提供更多前进的选择。
