健康保险改革和健康保险计划的发展:以阿联酋阿布扎比酋长国为例。

Q4 Medicine Journal of Health Care Finance Pub Date : 2014-01-01
Samer Hamidi, Sami Shaban, Ashraf A Mahate, Mustafa Z Younis
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引用次数: 0

摘要

导言:阿布扎比酋长国已采取具体步骤,通过改善获得保健提供者的机会和选择自由,改革医疗保险。保健费用的增加和全球金融危机的影响意味着各国不再能够单独承担费用。因此,许多国家已寻求彻底改革其医疗保健系统,以便与私营部门(无论是医疗保健计划提供者还是雇主)分担提供服务的负担。目的:本文探讨和讨论阿布扎比酋长国如何处理私人保健计划中固有的政策问题。方法:2013年初从政府来源收集阿布扎比医疗保健计划的数据。结果:阿布扎比模式有私营部门参与,但政府设定价格和收益。阿布扎比模式通过将保险纳入强制性要求,充分处理了逆向选择问题。还有道德风险问题,这是个人和医生行为的结合,可能会影响系统的效率。随着时间的推移,使用医疗服务的人数普遍增加,这可能反映出人们对该政策及其好处以及生活方式的改变有了更大的认识。结论:虽然目前的卫生保健系统的使用水平是足够的,但随着使用水平的提高,政府可能面临财政负担。因此,政府需要采取保障措施,以限制其风险敞口。医疗市场需要加强竞争,减少垄断行为。政府需要让个人意识到更健康的生活方式,并鼓励采取预防措施。
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Health insurance reform and the development of health insurance plans: the case of the Emirate of Abu Dhabi, UAE.

Introduction: The Emirate of Abu Dhabi has taken concrete steps to reform health insurance by improving the access to health providers as well as freedom of choice. The growing cost of health care and the impact of the global financial crisis have meant that countries are no longer able to solely bear the cost. As a result many countries have sought to overhaul their health care system so as to share the burden of provision with the private sector whether it is health care plan providers or employers.

Objectives: This article explores and discusses how the policy issues inherent in private health care schemes have been dealt with by the Emirate of Abu Dhabi.

Methods: Data was collected in early 2013 on health care plans in Abu Dhabi from government sources.

Results: The Abu Dhabi model has private sector involvement but the government sets prices and benefits. The Abu Dhabi model adequately deals with the problem of adverse selection through making insurance coverage a mandatory requirement. There are issues with moral hazards, which are a combination of individual and medical practitioner behavior that might affect the efficiency of the system. Over time there is a general increase in the usage of medical services, which may be reflective of greater awareness of the policy and its benefits as well as lifestyle change.

Conclusion: Although the current health care system level of usage is adequate for the current population, as the level of usage increases, the government may face a financial burden. Therefore, the government needs to place safeguards in order to limit its exposure. The market for medical treatment needs to be made more competitive to reduce monopolistic behavior. The government needs to make individuals aware of a healthier lifestyle and encourage precautionary actions.

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来源期刊
Journal of Health Care Finance
Journal of Health Care Finance Medicine-Health Policy
CiteScore
1.70
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0.00%
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0
期刊介绍: The Journal of Health Care Finance is the only quarterly journal devoted solely to helping you meet your facility"s financial goals. Each issue targets a key area of health care finance. Stay alert to new trends, opportunities, and threats. Make easier, better decisions, with advice from industry experts. Learn from the experiences of other health care organizations. Experts in the field share their experiences on successful programs, proven strategies, practical management tools, and innovative alternatives. The Journal covers today"s most complex dollars-and-cents issues, including hospital/physician contracts, alternative delivery systems, generating maximum margins under PPS.
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