哥伦比亚医疗保障制度设计与改革成效

Colombia health security designing and reform effect

哥伦比亚是一个发展中国家,在《2000年世界卫生报告》的卫生系统绩效评估中,卫生筹资公平性的排位为第一位。1993年改革前,医疗保障覆盖低,卫生服务提供效率低且不公平,只有20%的人口得到筹资保护。1993年卫生改革后,针对不同的人群建立了两种医疗保障筹资模式:缴费型制度和补助型制度,采取雇主-雇员缴费和总税收的混合方式进行卫生筹资。改革不仅扩大了覆盖面,改善了卫生服务的可及性,而且通过按照健康需要和支付能力筹资的方式,改善了卫生筹资的公平性。哥伦比亚医疗保障制度设计特征和改革成效对我国目前医疗保障制度设计和改革具有重要的启示。

Colombia is a developing country which was at the first position on fairness of financial contribution measured by 2000 World Health Report. Before the 1993 health reform, Colombia health system was inefficient, low coverage and inequity, only around 20 percent of the Colombian population were financially protected against the risk of health shocks. After health sector reform two regimes were introduced ： the Contributory Regime （ RC ） and the Subsidized Regime （ RS）, and the system are financed by a mix of employer-employee contributions and general taxes. It showed the main positive results of the social security reform; not only expanded the coverage and access of health care, but also improved equity in health finance based on health need and ability to pay. It is necessary to learn some experiences gained from Colombia for the design and reform of Chinese health care reform currently.