韩国、土耳其、泰国和印度尼西亚医疗保险基金合并经验：跨国比较研究。
The experiences of merging health insurance funds in South Korea, Turkey, Thailand, and Indonesia: a cross-country comparative study.
机构信息
Department of Health Promotion, Faculty of health, Ilam University of Medical Sciences, Ilam, Iran.
National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran.
出版信息
Int J Equity Health. 2021 Feb 26;20(1):66. doi: 10.1186/s12939-021-01382-w.
BACKGROUND
Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds.
METHODS
This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged.
RESULTS
The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds.
CONCLUSIONS
Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.
背景
医疗保险制度碎片化可能导致医疗服务获取和利用方面的财务公平性受损。克服这一挑战的一种可能选择是将现有的医疗保险基金合并。本文旨在回顾和比较韩国、土耳其、泰国和印度尼西亚在合并其医疗保险基金方面的经验。
方法
这是一项跨国比较研究。根据获取数据的情况，有目的地选择了研究国家，以审查其关于合并医疗保险基金的经验。为了找到与主题最相关的文献，研究了包括书籍、科学论文、学位论文、报告和政策文件在内的不同信息来源。使用 PubMed、Scopus、Google Scholar、Science Direct 和 ProQuest 等研究数据库查找相关文章。还分析了世界卫生组织和世界银行等国际组织发布的文件。使用数据驱动的常规内容分析方法分析文件的内容，并提取所有相关主题的详细信息。作者多次审查提取的信息，出现了 9 个主题。
结果
研究结果表明，提高不同人群的卫生筹资公平性和获得卫生服务的机会是合并医疗保险基金的主要触发因素之一。合并医疗保险基金面临的挑战包括享受更好福利待遇群体的抵制以及工人和雇主对提高缴费率的担忧。合并医疗保险基金的主要优势包括改善卫生保健筹资公平性、减少卫生保健服务获取和利用方面的不平等、增强风险共担、降低行政成本、更有机会控制总卫生保健支出以及增强战略采购。这些国家的经验还强调，需要政治承诺和经历可靠的经济增长，以增强福利套餐并在合并后从财务上支持单一国家保险计划，以促进合并医疗保险基金的实施。
结论
如果合并是实现全民健康覆盖的途径，那么应该同时或先后在卫生系统的供应方和需求方实施其他促进健康的改革。
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