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韩国公众参与国家健康保险福利覆盖范围的决策制定。

Participation of the Lay Public in Decision-Making for Benefit Coverage of National Health Insurance in South Korea.

作者信息

Oh Juhwan, Ko Young, Baer Alley Allison, Kwon Soonman

机构信息

International Health and Health Policy and Management; LEE Jong-wook Center for Global Medicine; Seoul National University College of Medicine ; Seoul , Republic of Korea.

Office for Benefit Coverage ; Korea National Health Insurance Services ; Seoul , Republic of Korea.

出版信息

Health Syst Reform. 2015 Jan 2;1(1):62-71. doi: 10.4161/23288604.2014.991218.

DOI:10.4161/23288604.2014.991218
PMID:31519081
Abstract

-Although South Korea successfully established national health insurance (NHI) in 1977, and has maintained universal coverage since 1989, it has long been criticized for insufficient benefit coverage. Korea has been under public pressure to increase its NHI benefit coverage, while also facing controversies over the appropriateness of items that were newly added to the benefit package. Pressured by the controversies and difficulties regarding national policy decisions on the benefits package, the Korea National Health Insurance Services eventually decided to establish a lay citizen's council, named the Citizen Committee for Participation, to help incorporate social value judgments in benefit coverage priority setting in 2012. The experience of the citizen council in Korea shows that unlike common myth, people may be willing to increase their premium contribution to expand benefits once a deliberative, democratic decision-making process exists. The general public does not necessarily demand ever-increasing benefits; rather they wish to keep benefits at a reasonable level once they understand the nature of public funding, financial sustainability, and cost effectiveness. If these experiences are common among all people in the world, not only in the unique context of Korea, this public participation approach to deliberative democracy may help reduce policy failure in other cultural settings.

摘要

尽管韩国于1977年成功建立了国家健康保险(NHI),并自1989年以来一直保持全民覆盖,但长期以来一直因福利覆盖不足而受到批评。韩国面临着来自公众的增加国民健康保险福利覆盖范围的压力,同时也面临着福利套餐中新增加项目是否合适的争议。在关于福利套餐的国家政策决策的争议和困难的压力下,韩国国民健康保险服务机构最终决定在2012年成立一个外行公民委员会,即参与公民委员会,以帮助将社会价值判断纳入福利覆盖优先级的设定中。韩国公民委员会的经验表明,与普遍的误解不同,一旦存在协商性的民主决策过程,人们可能愿意增加保费以扩大福利。公众不一定要求不断增加福利;相反,一旦他们了解公共资金的性质、财务可持续性和成本效益,他们希望将福利保持在合理水平。如果这些经验在世界上所有人中都很常见,而不仅仅是在韩国这种独特的背景下,这种协商民主中的公众参与方法可能有助于减少其他文化背景下的政策失败情况。

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