|Implemented in this survey?|
The exisiting ceiling on the cumulative out-of-pocket payments has had a limitation because the ceiling is not linked to the ability to pay of patients. To make the ceiling effective in reducing the financial burden of patients and in minimizing the catastroophic effects of illness on the poor, government decided to differentiate the ceiling into three levels depending on the income of the insured, namely top 20%, middle 30%, and bottom 50%
To reduce the financial burden on patients, in 2004 the government introduced a ceiling on the cumulative out-of-pocket payments made within half a year. However, the measure has had a limitation because the ceiling is not linked to the ability to pay of patients. To make the ceiling effective in ensuring financial protection and minimizing the catastrophic effects of illness on the poor, the government (on January 1, 2009) decided to differentiate the ceiling into three levels depending on the income of the insured: top 20%, middle 30%, and bottom 50% of the insured. The greater the income, the higher the ceiling on the cumulative out-of-pocket payment per year, leading to increased risk protection for the worse off.
To reduce the burden of health expenditure and increase financial risk protection
Patients, the worse off
|Medienpräsenz||sehr gering||sehr hoch|
|Implemented in this survey?|
The financial burden of out-of-pocket payment for health care is heavier for the poor than for the better off. The existing system of a uniform ceiling on cumulative out-of-pocket payments, namely 2,000 USD for six months, has been criticized to have a limited effect on reducing the financial burden of the worse off.
Differentiated ceilings for different income groups
After research by the National Health Insurance Corporation (NHIC), the Ministry of Health and Welfare differentiated the ceiling into three levels. The ceiling was set at 4,000 USD in one year for top 20% of the insured in terms of income, 3,000 USD for middle 30% of the insured, and 2,000 USD for bottom 50% of the insured.
The approach of the idea is described as:
renewed: A (uniform) ceiling on cumulative out-of-pocket payments was introduced in 2004.
The upper 50% of the insured, for whom the ceiling has increased from the previous level, can be opposed to the policy change, but there was no active opposition to the new policy. The overall support for the policy is grounded in the legitimacy of the policy change toward increased financial risk protection and the consensus on the limitations of the previous uniform ceiling on out-of-pocket payments.
|Ministry of Health and Welfare||sehr unterstützend||stark dagegen|
|Health Services Researchers||sehr unterstützend||stark dagegen|
|progressive civic groups||sehr unterstützend||stark dagegen|
|Better off||sehr unterstützend||stark dagegen|
|Ministry of Health and Welfare||sehr groß||kein|
|Health Services Researchers||sehr groß||kein|
|progressive civic groups||sehr groß||kein|
|Better off||sehr groß||kein|
The ceiling is differentiated on the basis of the ability to pay (or income) of the insured, which is measured by the insurance contribution that they pay. Income assessment of the self employed is not as transparent as that of employees, and there may be some issues in the future on how to measure the ability to pay of the insured and set the ceiling accurately.
A ceiling on out-of-pocket payments is a crucial mechanism for financial protection. With differentiated ceilings based on the income level of the insured, the new policy is expected to reduce the financial burden or catastrophic effects of illness on the worse off.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|