Progressive segmented health insurance: Colombian health reform and access to health services
Progressive segmented health insurance: Colombian health reform and access to health services
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DOI：
10.1002/hec.1147
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发表时间：
2007-01-01
期刊：
影响因子：
2.1
通讯作者：
Venegas, Stella
中科院分区：
文献类型：
--
作者：
Ruiz, Fernando;Amaya, Liliana;Venegas, Stella
让贫困人口平等获得卫生服务是任何卫生改革的一个全面目标。哥伦比亚医疗改革通过分段累进的社会医疗保险办法解决了这一问题。该战略是确保全民覆盖，通过工资挂钩保险扩大覆盖范围，并为最贫困人口实施补贴保险计划，这些人与正规就业无关。采用队列设计，对卫生服务利用和自付费用进行了前瞻性研究。它代表了哥伦比亚的四个城市(Cendex卫生服务使用和支出研究，2001年)。应用了四部分计量经济模型。该模型将医疗服务利用和用药与不同的社会经济、地理和风险相关变量联系起来。结果表明，与未参保的人相比，有补贴的医疗保险提高了卫生服务的利用率，减轻了最贫穷者的经济负担。其他社会健康保险计划通过可变的自付支出保持了较高的利用率。家庭和年龄因素对医疗服务利用有显著影响。地理变量对医院住院服务利用有显著影响。地理和收入变量对自付费用也有重大影响。预计使用率和模拟有利于两个州的收入分配保险的双重政策，以向全民保险目标迈进。版权所有(C)2006 John Wiley&Sons，Ltd.
Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study 2001). A four part econometric model was applied. The model related medical service utilization and medication With different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-state income seumented insurance to progress towards the universal insurance goal. Copyright (c) 2006 John Wiley & Sons, Ltd.