School of Economics, University of the Philippines Diliman, Quezon City, Philippines.
Erasmus School of Economics, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Health Syst Reform. 2021 Jul 1;7(2):e1911473. doi: 10.1080/23288604.2021.1911473.
The fraction of health-care costs financed from prepayment sources is a critical indicator of progress toward Universal Health Coverage. But it does not tell how prepayment varies with the level of health-care costs and between poorer and richer patients. This paper used survey data from the Philippines to estimate inpatient costs paid by the National Health Insurance Program (aka PhilHealth) in 2013-2017 when attempts were made to extend population, service and financial coverage. The mean fraction of the inpatient bill paid by PhilHealth increased by 21 percentage points. Expansions of population coverage do not appear to have been primarily responsible for this increase. Despite the introduction of a catastrophic cover benefit package, the fraction of inpatient costs that were prepaid increased more at lower costs than at higher costs. PhilHealth payments for inpatient care were pro-rich but became substantially less so, possibly because hospitals were no longer permitted to charge poor patients in excess of reimbursement ceilings. Overall, prepayment of inpatient costs increased and became more pro-poor, reflecting gains in insurance and equity.
预付款来源在医疗费用中所占的比例是全民健康覆盖进展的一个关键指标。但是，它并没有说明预付款随医疗费用水平的变化以及在较贫穷和较富裕患者之间的差异。本文利用菲律宾的调查数据，估算了 2013-2017 年国家健康保险计划（又名 PhilHealth）在扩大人口、服务和财务覆盖范围时支付的住院费用。由 PhilHealth 支付的住院费用账单的平均份额增加了 21 个百分点。人口覆盖范围的扩大似乎并不是这一增长的主要原因。尽管引入了灾难性保险福利套餐，但在较低费用下，预付款在住院费用中所占的比例增加得更多，而在较高费用下则增加得更少。PhilHealth 对住院治疗的支付是偏向富人的，但这种情况有了很大改善，这可能是因为医院不再被允许向贫困患者收取超过报销上限的费用。总的来说，住院费用的预付款增加了，而且更有利于穷人，这反映了保险和公平性的提高。
