韩国和台湾两种社会保险制度的故事:金融风险保护的视角。

Jui-Fen Rachel Lu, Ji-Tian Sheu, Tae-Jin Lee
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摘要

全民健康覆盖(UHC)是21世纪一项广泛的政策目标。其目的是保护人们免受财务风险,同时促进他们获得高质量的护理。本研究考察了韩国和台湾的社会保险制度,以探讨实现有效全民健康覆盖的关键挑战。通过评估全民健康覆盖对财务风险保护的影响(通过自付份额和灾难性支付人数来衡量),我们发现,当韩国启动具有有限福利和高成本分担的国民健康保险(NHI)计划时,它并没有减轻财务负担。与此同时,我们观察到台湾灾难性的支付人数下降了5到6个百分点,台湾提供了一个普遍而相当全面的福利方案,在其单一付款人的全民健康保险制度下,有适度的成本分担设计。通过深入讨论,进一步探讨了全民健康覆盖政策演变的政治经济背景。我们的结论是,要为意外医疗费用提供足够的财务风险保护,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。
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A Tale of Two Social Insurance Systems in South Korea and Taiwan: A Financial Risk Protection Perspective.

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.

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