??????/???????????????????????????????????????????????????????????????? (UC)

1
??????/???????????????????????????????????????????
?????????????????????(UC)
2
??????????????????????

• ?????????????????????? ??????????????????????????
  ?????????? ???????????????????????????????????????
  ??????????????????
• ??????????????? Exclusion list ????
  ???????????????????????? ?????????????????????????
  ?????????? ???????????????????????

3
??????????????????????????????

• ?????????????????????????????????????????? UC
  ?????????????????????????? ?????????????????????
  ?????? ?????? UC
• ?????????????????????????????????????????
  ?????????????????????? ??????????????????
• ???????????????????????????????????? ?????????
  ?????????????????????????????????????
  ????????????????????????????

4
???????????????????????????

• ??????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ?????????????????
• ???????????????????????????? (Cost
  sharing)????????-???????
• ?????????????? ??????????????????????

5
??????????????????????????????????????????????

• Equity
• Financial equity (Vertical equity)
• Access equity (Essential health care)
• Efficiency
• Rational use of resources (Provider)
• Moral hazard (Patient)
• System administration
• Quality
• Optimal (technical or medical) standard
• Reasonable humanized services
• Consumer right and empowerment
• Choice
• Damage protection

6
?????????????????????????????????????????????????
??????????????????

• System Financing
• Additional source of fund (limited or inadequate
  system budget)
• Rational use of resources
• Moral hazard
• Choices
• Optional (non-essential) services
• Provider Customer relationship
• Sense of commitment
• Sense of value
• Administrative benefits

7
????????????????????????????(Cost sharing)
????????-???????

• ??????????????????????????????
• ???????????????????????????(Optional
  supplemental insurance, ??? ?)
• ?????????????????????????????????
• ???????????? (Co-payment)
• ?????????????? (Co-insurance)
• ???????????????????????????????????????
  (Deductible)
• ?????????????????????????????????? (Ceiling)
• ????????????????????????????????? (Exclusion list)

8
???????????????????????(Optional supplemental
insurance, ??? ?)

• ??????????????????????????????????????????????????
  ?????????????
• ???????????????????????
• ??????????????????????????????????

???
Equity -/-- Financial Access to Essential but expensive??
Efficiency 0/- Optional non-essential
Quality /0/- Essential or not?
Consumer right and empowerment Choice available Role of local authorities
Financing Distribution depends on availability of services ???
9
???????????? (Co-payment)

• ??????????????????????????????????????? (?????)
  ????????????????
• ?????????????????? ????????????????
• ????????????????????????????????? ????
  ???????????
• ????????????????????????????????????????? ???

Equity --/-/0 Depends ?
Efficiency 0/ Reduce moral hazard?
Quality /0/- May delay access
Consumer right and empowerment 0
Financing 0/ Depend ???, and may not benefit UHOSNET
10
?????????????? (Co-insurance)

• ????????????????????????????????????
  ????????????? (??????) ?????????????????????
• ????????????????????????????????????????????????
• ?????????? ????????????????????? ???
  ?????????????????????????????? (????????)

Equity 0/- May adversely affect the middle-class
Efficiency Reduce moral hazard
Quality 0/- Reduce satisfaction?
Consumer right and empowerment 0/ Optional coverage by local authorities, or private insurance
Financing Distribution depends on availability of services ???
11
?????????????????????????????? ???????????????????
?? ??????? Medisave ??????????????????????????????
???????
???????????????????? ?????????????? ???????????
?????????????? ??.?????? Class C( ???????????? ) 20 80
??.?????? Class B2(????????? 6 ?????) 35 65
??.?????? Class B1(????????? 3-4 ?????) 80 20
??.?????? Class A(????????? 1-2 ?????) 100 0
??.????? 100 0
???????????????????? ?????????????? ???????????
?????????????? ??.?????? Class C( ???????????? ) 20 80
??.?????? Class B2(????????? 6 ?????) 35 65
??.?????? Class B1(????????? 3-4 ?????) 80 20
??.?????? Class A(????????? 1-2 ?????) 100 0
??.????? 100 0
????? ?????????? Singapore Ministry of Health
(Hsiao, 1995)
12
???????????????????????????????????????
(Deductible)

• ??????????????????????????????????????????????????
  ????????????? ????????????????????????????????????
  ????????
• ???? Catastrophic illness

Equity -/-- May against primary care access
Efficiency /- Delay access leads more serious situation
Quality 0/- May compromise some essential care
Consumer right and empowerment 0 Role of local authorities or private insurance
Financing Distribution depends, but not benefit UHOSNET
13
?????????????????????????????????? (Ceiling)

• ??????????????????????????????????????????????????
  ???????????????????????
• ???????????????????????????????????????
• ???????????? ??????? ???????? ???????????????

Equity - Problematic in case of catastrophic illness
Efficiency 0/- Optional non-essential
Quality 0/- May compromise high-cost care
Consumer right and empowerment 0 Role of local authorities orl private insurance
Financing ? May result in bad debt for high-cost care
14
?????????????????????????????????(Exclusion list)

• ??????????????????????????????????????
  ?????????????????????????????????????????????????
• ?????????? ??????????????????????
  ??????????????????????? ??????????????????????????
  ???????
• ?????? Quality-based purchasing arrangement

Equity 0/- Depends on exclusion list (Essential or not)
Efficiency /0/- Optional and luxury
Quality 0/- May compromise quality in the long-run
Consumer right and empowerment 0/- Role of local authorities or private insurance
Financing Expensive equipments, tests, procedures May result in bad debt
15
????? ??????????????????????????????????????? ?
Cost Sharing Equity Efficiency Quality Consumer right and empowerment Financing
??????????? -/-- 0/- /0/-
Co-payment --/-/0 0/ /0/- 0 0/
Co-insurance 0/- 0/- 0/
Deductible -/-- /- 0/- 0
Ceiling - 0/- 0/- 0 ?
Exclusion list 0/- /0/- 0/- 0/-
16
?????????????? ??????????????????????

• ??????????????????????????? ??????????????
• ????????????????
• ???? FinancinggtMoral hazard
• ??? Equity Quality ???????????? Consumer right
  ??? Efficiency ???
• ????????????????????????????????????????????????
• ????????????????????????????
• ?????????????? ?????????????????????????
• ??????? ???????????????????????????
• ??????????????????????????????
• ???????????????????????????????
• ?????????????????????????
• ??????????? ??????????? ??????????????????????

17
?????????????? ?????????????????????????
IPD Condition Total charge claimed(1) 20 Co-insurance by patient Reimbursed by DRG from NHSO(2) Total payment ( of TC)
Uhosnet case study Hospital 1 (Status quo) 439.5 mil. 0 278.7 mil. 278.7 mil. (63.4)
Uhosnet case study Hospital 1 (With Co-I) 439.5 mil. 87.9 mil. 222.9 mil. (80DRG) 310.8 mil. (70.7)
2548 National data 35.5 bill. 7.1 bill. 26.3 bill. (74.1TC) 33.4 bill. (94.1)

• ???????? (1) ???????????????????
• (2) ??????????? Global budget ????????????
  ??? ???/1 RW ?????

18
?????????????????????????????????????????????????
?????????
???????????????????? ?????????????? ???????????
???????????? (?????) 0 100
???? 2-4 ????? 0-10 90-100
??????????????? 0-20 80-100
???????????????????? ????? 2 25 75
???????????????????? ????? 1 50 50
???????? ?????????????????? ????????????????????
?
19
?????????????? Co-insurance?????????????????????
?????
??????? ????????? ?????????????? ???????????
????? 0 ??? charge 100 ??? DRG
???????? 20 ??? charge 80 ??? DRG
??????????? 40 ??? charge 60 ??? DRG
???????? ?????????????????? ????????????????????
?
20
???????????????????

• ??????????????????????????????????????????????????
  ??
• ??????????????????????????????????????????????????
  ????????
• ??????????? ????????????????????
  ???????????????????????????? ?????????????????????
  ???????
• ?????????????????????????????????????????
• ???????????????????????????????????????
• ?????????????????????????????? ???????????????????
  ??????????????

21
????? - ?????????????????????????????

• ????? ? ??????????????????????????
• ? ???????????????????????????
• ? ??????????????????? ?????????????? ?????????
  ?????? (????.??????????? ????????????????????????
  ??????)
• ??????? ? ???????????????????????
  ?????? ???????????????????????????????????? ???
  ?????
• ? ???????????????????????????????????

22

• ??????

23
???????????????????????????????? UC

• ??????????????????????????????????????????????????
  ??????????????????
• ??? Equity Quality ???????????? Consumer right
  ??? Efficiency ???
• ???? FinancinggtMoral hazard
• ????????????????????????????????????????????????