مطالعه تطبیقی عدالت در تامین مالی در مدل‌های بیمه سلامت
محورهای موضوعی : -مدارک پزشکیمحمد سعادتی 1 , رامین رضاپور 2 , ناصر درخشانی 3 , مریم نقشی 4
1 - دانشجوی دکتری تخصصی مدیریت خدمات بهداشتی درمانی، مرکز تحقیقات پیشگیری از آسیب حوادث جاده‌ای، دانشگاه علوم پزشکی تبریز،آذربایجان شرقی، ایران
2 - دانشجوی کارشناسی‌ارشد مدیریت خدمات بهداشتی درمانی، قطب علمی آموزشی مدیریت سلامت ایران، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی تبریز، آذربایجان شرقی، ایران
3 - دانشجوی کارشناسی‌ارشد مدیریت خدمات بهداشتی درمانی، قطب علمی آموزشی مدیریت سلامت ایران، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی تبریز، آذربایجان شرقی، ایران
4 - دانشجوی کارشناسی‌ارشد مدیریت خدمات بهداشتی درمانی، قطب علمی آموزشی مدیریت سلامت ایران، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی تبریز، آذربایجان شرقی، ایران
کلید واژه: عدالت, بیمه سلامت, تامین مالی, مشارکت عادلانه,
چکیده مقاله :
مقدمه:مشارکت عادلانه در تامین مالی یکی از اهداف اصلی نظام‌های بهداشتی درمانی در جهان می‌باشد. برقراری سیستم بیمه‌ای یکی از رایج‌ترین روش‌ها برای محافظت مالی مردم در برابر هزینه‌های سلامتی به شمار میرود. لذا مطالعه حاضر با هدف بررسی تطبیقی نظام‌های بیمه‌ای در کشورهای مختلف جهان صورت گرفت. روش پژوهش:این پژوهش به صورت تطبیقی در سال 1395 انجام گرفت. ابتدا بررسی متون جامعی برای استخراج شواهد علمی با استفاده از پایگاههای داده و وبسایت‌های مرتبط و معتبر انجام پذیرفت. پس از غربالگری متون یافته شده، داده‌های مربوط به شاخص‌های عدالت در تامین مالی استخراج گردید. جهت تطبیق داده‌های شاخص‌های عدالت در تامین مالی با مدل‌های بیمه سلامت از چارچوب تقسیم‌بندی گاردن استفاده شد. یافته‌ها:درکشورهای مورد مطالعه از چهار مدل تامین مالی و بیمه‌ای که شامل بیمه درمان ملی (NHI)، سیستم طب ملی (NHS)، بیمه درمان اجتماعی (SHI) و بیمه خصوصی استفاده می‌شد. فرانسه و استرالیا کشورهایی بودند که از دو مدل به طور همزمان استفاده می‌کنند. کشورهای انگلیس، دانمارک، کانادا و آلمان به ترتیب دارای بالاترین میزان شاخص مشارکت عادلانه در تامین مالی بودند. نتیجه‌گیری:یافته‌های مطالعه نشان داد سیستم‌های بیمه‌ای اجتماعی، بیمه‌های ملی و سیستم ملی بهداشتی می‌توانند عملکرد مناسبی در محافظت مالی افراد جامعه نشان دهند، بنابراین می‌توان گفت برقراری سیستم بیمه‌ای نقش بسزایی در محافظت مالی مردم در برابر هزینه‌ای سلامت داشته است. البته قابل ذکر است انتخاب مدل بیمه‌ای در کشورها باید براساس منابع و زیر ساخت‌های موجود هر کشور صورت پذیرد تا بتواند بخوبی نقش خود را ایفا کند. مقدمه:برقراری سیستم بیمه ای یکی از رایج ترین روش ها برای محافظت مالی مردم در برابر هزینه های سلامتی به شمار میرود. لذا مطالعه حاضر با هدف بررسی تطبیقی نظام های بیمه ای در کشورهای مختلف جهان صورت گرفت .روش پژوهش:این پژوهش به صورت تطبیقی در سال 1395 انجام گرفت. ابتدا بررسی متون جامعی برای استخراج شواهد علمی با استفاده از پایگاههای داده و وبسایت های مرتبط و معبر انجام پذیرفت. پس از غریالگری متون یافته شده، داده های مربوط به شاخص های عدالت در تامین مالی استخراج گردید. جهت تطبیق داده های شاخص های عدالت در تامین مالی با مدل های بیمه سلامت از چارچوب تقسیم بندی گاردن استفاده شد. یافته ها:درکشورهای مورد مطالعه از چهار مدل تامین مالی و بیمه ای که شامل بیمه درمان ملی (NHI)، سیستم طب ملی (NHS)، بیمه درمان اجتماعی (SHI) و بیمه خصوصی استفاده می شد.کشورهای انگلیس، دانمارک، کانادا و آلمان به ترتیب دارای بالاترین میزان شاخص مشارکت عادلانه در تامین مالی بودند.نتیجه گیری:یافته های مطالعه نشان داد سیستم های بیمه ای اجتماعی، بیمه های ملی و سیستم ملی بهداشتی می توانند عملکرد مناسبی در محافظت مالی افراد جامعه نشان دهند، بنابراین می توان گفت برقراری سیستم بیمه ای نقش بسزایی در محافظت مالی مردم در برابر هزینه ای سلامت داشته است. البته قابل ذکر است انتخاب مدل بیمه ای در کشورها باید براساس منابع و زیر ساخت های موجود هر کشور صورت پذیرد تا بتواند بخوبی نقش خود را ایفا کند.
Introduction: Fair financing contribution is one of the main objectives the healthcare systems in the world. Insurance system is one of the most common methods of financial protection against the cost of healthy people is considered. This study aimed to evaluate the comparative insurance system in different countries were performed. Methods: This comparative study was conducted in 2017. First, a comprehensive literature search was conducted through relevant and valid databases and websites to extract scientific evidence. After the screening of findings, Data related to the fairness financing, including the out of pocket, catastrophic payment and fair financing contribution was extracted. Garden classification framework used to match the indicators with models of health insurance. Results: In countries studied, four model finance and insurance including: national health insurance (NHI), national medical system (NHS), social health insurance (SHI) and private insurance was used. France and Australia are the countries where the two models are used simultaneously. The lowest rate of pay out of pocket and catastrophic health expenditure for households in France (6 and 0.01 percent), which uses public and private health insurance model. Britain, Denmark, Canada and Germany, respectively, have the highest indices were fair participation in financing. Conclusion: According to the study it can be concluded that social insurance, national insurance and national health systems can have a good performance in financial protection of the population, So can say insurance system establishing a significant role in financial protection against the cost of people's health. Of course is to be mentioned for choose the model insurance countries should be based on infrastructure and resources available in every country so well able to play its role. Introduction: Fair financing contribution is one of the main objectives the healthcare systems in the world. Insurance system is one of the most common methods of financial protection against the cost of healthy people is considered. This study aimed to evaluate the comparative insurance system in different countries were performed.Method: This comparative study was conducted in 2017. First, a comprehensive literature search was conducted through relevant and valid databases and websites to extract scientific evidence. After the screening of findings, Data related to the fairness financing was extracted. Garden classification framework used to match the indicators with models of health insurance.Result:In countries studied, four model finance and insurance including: national health insurance (NHI), national medical system (NHS), social health insurance (SHI) and private insurance was used. The lowest rate of pay out of pocket and catastrophic health expenditure for households in France (6 and 0.01 percent), which uses public and private health insurance model. Britain, Denmark, Canada and Germany, respectively, have the highest indices were fair participation in financing.Conclusion: According to the study it can be concluded that social insurance, national insurance and national health systems can have a good performance in financial protection of the population, So can say insurance system establishing a significant role in financial protection against the cost of people's health. Of course is to be mentioned for choose the model insurance countries should be based on infrastructure and resources available in every country so well able to play its role.
1- Dror DM, Jacquier C. Micro‐insurance: Extending Health Insurance to the Excluded. International social security review, 1999; 52(1): 71-97.
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4- Organization WH. The world health report 2000: health systems: improving performance: World Health Organization; 2000.
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6- Van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact. Erasmus University, Rotterdam and IPS, Colombo; 2005.
7- Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health policy, 2007; 83(2): 304-13.
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9- Spaan E, Mathijssen J, Tromp N, McBain F, Have At, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bulletin of the World Health Organization, 2012; 90(9): 685-92.
10- Berkhout E, Ostingh H. Health Insurance in Low Income Countries: Where is the evidence that it works?; 2008.
11- Carrin G, Waelkens MP, Criel B. Community‐based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Tropical medicine & international health, 2005; 10(8): 799-811.
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14- Noland & Esmith. Ecinomic of health and health care. Garden; 2003: 532.
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16- Rodin J, de Ferranti D. Universal health coverage: the third global health transition? The Lancet, 2012; 380(9845): 861-2.
17- Act C. An Overview of US Health Care Delivery.9781284037753_CH01_PASS03.indd 20-1.
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22- Carrin G, Desmet M, Basaza R. Social health insurance development in low-income developing countries: new roles for government and non-profit health insurance organizations. Building social security: The challenge of privatization; 2001.
23- WHO. Regional overview of social health insurance in South-East Asia. SEA-HSD-274 Regional Office for South-East Asia, New Delhi; 2004: 12-4.
24- Santerre RE, Neun SP. Health Economics: Theories, Insights, andIndustry Studies. Chicago: Irwin; 1996.
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26- McPake B, Kumaranayake L, Normand CE. Health economics: An international perspective. New York, NY: Routledge; 2002.
27- Graig L. A. Health of nations: an international perspective on U.S. health care reform (3rd ed.). Washington, DC: Congressional Quarterly; 1999.
28- Saltman RB, Figueras J. European health care reform: analysis of current strategies. WHO regional publications European series, 1997: 72.
29- Flood CM, Haugan A. Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Economics, Policy and Law, 2010; 5(3): 219-341.
30- Murray CJ, Xu K, Klavus J, Kawabata K, Hanvoravongchai P, Zeramdini R, et al. Assessing the distribution of household financial contributions to the health system: concepts and empirical application. Health systems performance assessment: debates, methods and empiricism Geneva: World Health Organization, 2003; 12.
31- Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The lancet, 2003; 362(9378): 111-7.
32- WHO. Out-of-pocket expenditure on health as a percentage of private expenditure on health (US$) Last update: April 12, 2016 http://apps.who.int/nha/database/Select/Indicators/en.
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1- Dror DM, Jacquier C. Micro‐insurance: Extending Health Insurance to the Excluded. International social security review, 1999; 52(1): 71-97.
2- King M. Community health worker extra hands for a doctor. Trans Mohammadloo S, Pashapoor N) Urmia: Takvin; 2000.
3- Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Hafizur Rahman M. Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 2008; 1136(1): 161-71.
4- Organization WH. The world health report 2000: health systems: improving performance: World Health Organization; 2000.
5- Orszag PR, Emanuel EJ. Health care reform and cost control. New England Journal of Medicine, 2010; 363(7): 601-3.
6- Van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact. Erasmus University, Rotterdam and IPS, Colombo; 2005.
7- Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health policy, 2007; 83(2): 304-13.
8- Wade RH. Making the world development report 2000: attacking poverty. World Development, 2001; 29(8): 1435-41.
9- Spaan E, Mathijssen J, Tromp N, McBain F, Have At, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bulletin of the World Health Organization, 2012; 90(9): 685-92.
10- Berkhout E, Ostingh H. Health Insurance in Low Income Countries: Where is the evidence that it works?; 2008.
11- Carrin G, Waelkens MP, Criel B. Community‐based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Tropical medicine & international health, 2005; 10(8): 799-811.
12- Churchill CD. What is insurance for the poor? Protecting the poor: A microinsurance compendium. 11: International Labour Organization (ILO) in association with GSE Research; 2006: 11-24.
13- Zare H. Basic Health Insurance: Principles, Structure, Coverage and Regulation. Tehran: Medical Services Insurance Organization Publication; 2006: 37-45.
14- Flood C. International health care reform: a legal, economic and political analysis: Psychology Press; 2003.
14- Noland & Esmith. Ecinomic of health and health care. Garden; 2003: 532.
15- Karimi S, Ziari NB. Equity in Financial Indicators of the Health in Iran during the Third and Fourth Development Programs. Director General, 2013; 9(7).
16- Rodin J, de Ferranti D. Universal health coverage: the third global health transition? The Lancet, 2012; 380(9845): 861-2.
17- Act C. An Overview of US Health Care Delivery.9781284037753_CH01_PASS03.indd 20-1.
18- Reid TR. The healing of America: A global quest for better, cheaper, and fairer health care: Penguin; 2010.
19- World Health Organization , Europe ROf, Copenhagen. Health Care Systems in Transition Canada; 1996.
20- Marchildon GP, Mossialos E, Allin S. Health systems in transition: Canada. European Observatory on Health Systems and Policies Copenhagen; 2005.
21- Boyle S. Health Systems in Transition: United Kingdom (England): Health System Review: European Observatory on Health Systems and Policies; 2011.
22- Carrin G, Desmet M, Basaza R. Social health insurance development in low-income developing countries: new roles for government and non-profit health insurance organizations. Building social security: The challenge of privatization; 2001.
23- WHO. Regional overview of social health insurance in South-East Asia. SEA-HSD-274 Regional Office for South-East Asia, New Delhi; 2004: 12-4.
24- Santerre RE, Neun SP. Health Economics: Theories, Insights, andIndustry Studies. Chicago: Irwin; 1996.
25- Kulesher RR, Forrestal EE. International models of health systems financing. Journal of Hospital Administration, 2014; 3(4): 127.
26- McPake B, Kumaranayake L, Normand CE. Health economics: An international perspective. New York, NY: Routledge; 2002.
27- Graig L. A. Health of nations: an international perspective on U.S. health care reform (3rd ed.). Washington, DC: Congressional Quarterly; 1999.
28- Saltman RB, Figueras J. European health care reform: analysis of current strategies. WHO regional publications European series, 1997: 72.
29- Flood CM, Haugan A. Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Economics, Policy and Law, 2010; 5(3): 219-341.
30- Murray CJ, Xu K, Klavus J, Kawabata K, Hanvoravongchai P, Zeramdini R, et al. Assessing the distribution of household financial contributions to the health system: concepts and empirical application. Health systems performance assessment: debates, methods and empiricism Geneva: World Health Organization, 2003; 12.
31- Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The lancet, 2003; 362(9378): 111-7.
32- WHO. Out-of-pocket expenditure on health as a percentage of private expenditure on health (US$) Last update: April 12, 2016 http://apps.who.int/nha/database/Select/Indicators/en.