Programa de Políticas, Sistemas y Gestión en Salud, School of Public Health, University of Chile, Chile.
Programa de Políticas, Sistemas y Gestión en Salud, School of Public Health, University of Chile, Chile.
Health Policy. 2019 Jul;123(7):621-629. doi: 10.1016/j.healthpol.2019.05.013. Epub 2019 May 18.
In the path to universal health coverage, policymakers discuss different alternative health system's financing schemes. Classical typologies have been posited, including models such as National Health Service, Social Health Insurance and Private Health Insurance. More recently, National Health Insurance (NHI) has been suggested as a separate model. Nevertheless, there are discrepancies regarding what defines an NHI model. The purpose of this article is to propose a comprehensive definition of an NHI model, aimed to disentangle the current discrepancies in the conceptualization and the scope of this type of arrangement. Based on the previous literature we identified some common characteristics across NHI definitions, namely universal coverage, pooling in a single fund and a purchasing function based on a single-payer financing mechanism. Areas of controversy were also identified. While some authors emphasized the importance of an effective separation between the purchaser and provider functions, others highlighted the relative importance of privately-owned provision to define a system like NHI-type. Based on empirical data, we suggest that the ownership is not a critical variable to distinguish an NHI from other models, and instead, suggest that a pivotal characteristic of the NHI is the single payer mechanism that is not integrated with the health providers.
在实现全民健康覆盖的道路上，政策制定者讨论了不同的医疗体系融资方案。已经提出了经典的分类法，包括国民健康服务、社会健康保险和私人健康保险等模式。最近，有人提议将国家健康保险（NHI）作为一种单独的模式。然而，对于什么是 NHI 模式，存在着定义上的差异。本文旨在提出一个全面的 NHI 模式定义，旨在厘清这种安排在概念化和范围方面的当前差异。基于先前的文献，我们确定了 NHI 定义中的一些共同特征，即全民覆盖、在单一基金中汇集资金以及基于单一支付方融资机制的购买功能。还确定了存在争议的领域。虽然一些作者强调了在购买者和提供者职能之间进行有效分离的重要性，但另一些作者则强调了私营部门提供服务对定义 NHI 类型系统的相对重要性。基于经验数据，我们认为所有权不是将 NHI 与其他模式区分开来的关键变量，而是建议 NHI 的一个关键特征是单一支付方机制，该机制与卫生提供者没有整合。
