Professional Documents
Culture Documents
kesehatan: Sebuah
perspektif internasional
Who Pays? Who Benefits?
What values are reflected?
Common developments
a. Hampir semua negara-negara industri
menjamin sebagian besar biaya rawat inap
untuk sebagian besar warganya
b. Universalisme berkurang saat Anda
bergerak menjauh dari rumah sakit untuk
perawatan rawat jalan, barang medis, dll
c. Belanja publik mendominasi strategi
pendanaan
Sumber daya terkonsentrasi pada rumah
saki
Taxes
Australia
France
Germany
Japan
U.K.
U.S.
Social
insurance
contributions
Private
insurance
premiums
Example: Germany
Archetypal social insurance system1st
in the world (Bismarck 1880s)
Compulsory health insurance--paid 1/2
employer, 1/2 employee
750 sickness funds
each is independent, self-governing unit
Sponsorship range from: local, company,
occupation
More on Germany
Benefits include income maintenance
Sickness funds contract directly with
providers
Hospital capital investment regionally
planned
Australia
Universal entitlement based on
citizenship/residency
General tax funding
Delivery system is public/private hybrid
Private insurance encouraged
Access
Equity
Cost control (global)
Income protection (individual)
Efficiency (at macro and micro levels)
Including target efficiency (benefits flow to the
most financially or medically needy)
Freedom of choice
Innovation
Adequacy of access:
the right to health care
Access to health care as necessary to
general welfare of country
Along with education, police/fire protection
Solidarity
In contrast to the individualistic (market)
notions of a right to health care and
individual freedoms and self-sufficient
Solidarityvery important notion in
European health care schemes
The mutual responsibility of citizens for the
health care of each other
Income protection
Without universal coverage, some
must bear the cost of care entirely
out of pocket
Remember: average per capita
spending ranges from $2249 - 6102, the
range is great
Equity
The ways in which health care is paid
for have a significant bearing on
questions of equity or fairness
Equity issues reflected in whether
payment is progressive, regressive,
proportional
Cost control
2 ideas here:
First, controlling total HC spending
public funding = public control
Second, controlling HC spending
relative to other national spending
priorities (education, safety)
General tax funding makes this
explicit
Choice
The essence of economic and social
freedom!
Made up of all of the following
The choice of doctor
The choice by a doctor about how she
wants to practice medicine
The choice of a health care system
The personal choice of how much to pay
for health care
Innovation
The market has been potent force
behind innovation and medical progress
Commercial creation of medical goods of
all kinds---drugs and devices
(medical progress has increased peoples
expectations and costs)
Resources
Medicine and the Market: Equity v.
Choice by Daniel Callahan and Angela
Wasunna (2006)
The Politics of Health in Europe by
Richard Freedman (2000)
www.oecd.org