Abstract：
Health systems\' insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public-private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.
摘要：
卫生系统保险/资金可以通过多种方式组织。一些国家采用了公私混合参与的制度(如澳大利亚、智利,爱尔兰,南非,新西兰)创建了两级卫生系统，允许消费者(群体)优先获得基本护理标准(例如跳过等待时间)。在这些类型的系统中实现效率和公平的程度受到质疑。在本文中,我们考虑通过管理竞争模型来整合这两个层次，这是社会健康保险(SHI)系统的基础。我们阐述了一个由两部分组成的概念框架，where,首先,我们审查和更新管理竞争模式的现有先决条件，以适应更广泛的卫生系统定义，第二,我们根据保险功能键入实现该模型的可能路线图，并专注于对提供者和治理/管理的后果。
