Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan, Taiwan.
Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan.
Health Syst Reform. 2022 Jan 1;8(1):2114648. doi: 10.1080/23288604.2022.2114648.
Universal Health Coverage (UHC) is a widespread policy goal in the 21st century. The aim is to protect people from financial risk while promoting their access to good-quality care. This study examined the social insurance systems of South Korea and Taiwan to explore the critical challenges of achieving effective UHC. By assessing the impact of UHC on financial risk protection (measured by out-of-pocket payment share and catastrophic payment headcount), we found that when South Korea inaugurated its National Health Insurance (NHI) program with a limited benefits package and high cost sharing, it did not reduce the financial burden. Meanwhile, we observed a drop of 5 to 6 percentage points in the catastrophic payment headcount in Taiwan, which offered a universal and rather comprehensive benefits package with a modest cost-sharing design under its single-payer NHI system. The political-economic context of the UHC policy evolution was further explored through an in-depth discussion. We conclude that to provide sufficient financial risk protection against unexpected medical expenses, the design of the insurance scheme, in particular the risk-sharing mechanism, not only matters but is also the key to success.
全民健康覆盖（UHC）是 21 世纪广泛存在的政策目标。其目的是保护人们免受财务风险，并促进他们获得高质量的医疗服务。本研究考察了韩国和中国台湾地区的社会保险制度，以探讨实现有效 UHC 的关键挑战。通过评估 UHC 对财务风险保护的影响（通过自付费用份额和灾难性支付人数来衡量），我们发现，当韩国推出其国家健康保险（NHI）计划，提供有限的福利套餐和高自付比例时，并没有减轻财务负担。与此同时，我们观察到，在台湾，提供全民和相当全面的福利套餐，采用单一支付者 NHI 系统和适度自付比例的情况下，灾难性支付人数下降了 5 到 6 个百分点。通过深入讨论，进一步探讨了 UHC 政策演变的政治经济背景。我们得出的结论是，为了提供充分的财务风险保护，以应对意外的医疗费用，保险计划的设计，特别是风险分担机制，不仅重要，而且是成功的关键。
