I 

   
ø ø  

%& 2002 ).+.

!"#$"

1.


 
 ,- I 

./ 01
2 3/  456 7- 489:; A3 5= >? 4@ @A #16 4 B A%C; E 4 +E; F2 GG
1997 K ) LM NL BL5 8N/ O3P
 >Q R /National Health Account/ NL . A3 5=
T./ >Q U1 >41 7.14
AWXY Z A[ U/GG  9 7\+ ]^ )- 8.+ 1992 ).+ 4U L/ 5.6
AWXY Z Aa - E3 Abc GG de+ ).+
 f NL-P
 A3 5= .9 2 %

8A= 4838/ 34 Z
U1 >41 >Q Aa

- h+ AU8i U/GG ./ 01
/./ >Q AU8i 4dj+ 8kBX 7\+ 

897@/

 NL . E
>h ./ >Q +l - 45 (31%) A%C; (37%)o 7- 489:; A3 5= >? 442 7X/ 2% \5p 

k+C

4R=;
5

+E;

4 B

#1 (30%) E

U/GG 4q

.L!

E\+;./ A3 5= >? 489:; 442./ #1
F2U/ >Q 418i

r

./

dj

89:;

8.+

d;




8.


s

.b
 A3 5= 1tP dU  u .B!L +v A\.+GG 
    O3;
 A3 5= A97+  A^-P 8wEe 4\y +#$z A{ d q R=z +#$z
 A3 5= A97+ 9 A,j >? ) U1 >41 0.36 A[ U/GG  |?8i
dU
 A3 5= A97+ AL8@}
U ,-  8wEe
\5 dj
O3z  U#
B 5~; A2a+  8wEe Bb\€ E U/GG .q
O3;
 5~; .+-
   -; AL8@];
 A3 5= .97+ 3 ;

 u ‚ A. GG

1

2.


  .+ A2.3 A2.3? .3?

2.1


  AKB

ƒ" 8.„ O3C;
-„
  )$; A, z/ ?… .| >\ 700

)-

2K

†\

/

E!.‡

-X#

>b GG

q

†\

/

A\LMK-z/ 48 -8j 2\ˆU  8NL‰
BŠ L@A L!M B  >\ O3 A71 BE4P 5‹ Š5
8\3‡ 8ŒB 8F%5LT GG R  u+ z/ 4/Ž
AL8@A #1

>\ ,^ A71  80T/

A

O3C;+ E
80T>L 3i G 0P At!P
B‘ P  
8KL/ [. O$“ &B#
8@‚/
K [. E.”.A. 1883 ).+ ]>h/ 5 K A3 U GG  5 >?‰ K A3
U €
8 -8j 2\ˆU 
8NL‰
 B  .K –— >\ 87Ko BE4P 5
\˜+
 E™,+ 5š- NL >\ A\L3 ‹) E™.> A› GG [. &B#
q )U‰
  .B94 UbŽ +#$; >?‰ U L/
œr XE 8 ).+ ABf
>ƒ\  
U L/ %o 9Y Iže 
8NL8
K 5‹ .BŒŒ+
U L/ yy .q+ ] EŽ
[.  
8NL8 (Occupation Based)
  2 BŒŒ+ @8i/ .BUbb %‡ .B5‚ A2– dj Bj U GG
q Š5 /h .K A[ bd ./ ).+ ƒ"
+
/
B P



 NL Ÿ GG R=;
A/C  O3+
8 -8j
B L@A L!M B  7\+ A./ 7b7Ž
U € d
K 2 84./ At!P
  4B>Mz/ ¡
8.„ 1 NL \Ly (Commercial insurance)o o
˜ A˜ NL \Ly ¢ 885ALT GG

B L@A
€
 e; 8 -8U  u

EUq+ AAƒi/ A] U 2\ˆU  NL \Ly U €GG


A:v+ >?‰
AAƒi/ AL8@A 1˜ BY A.[ o
AL8@} E 2

EŽ


8b@A

\%31

(Solidarity) ]

! 

E


5-




A3 5= ./ AL8@A .B!L (Universal Coverage) £9/ Ub .B P    +#$; E\dj 3- GG q, NL 4K 79

OX E.”.A. 1887/8o šB# E.”.A. 1892o

¤ f
+ 1894 8bb BE4P 5 ˜;
8\3‡ .  ˜B
27{ ˜; A/8/ 85  K+LT GG 8bb ,- E5|
  5 1899 A/- 85]P A%.;GG  ,- 4A\i/
).+ ¥U ¦+ 7= 2Lb E.”.A. 1920 5š- NL \L3
  5 ->h 0
kLrT
  5 A/Q
@W A/C  A3 d 1941 ). +. y A….;GG EUq A/C  O3C;
>§
  ˜; .N8i/ #1

A[
>§

A3!f ˜; dz/ E.”.A. 41945 ).+ ¦ j ,^ A71 (Universal Coverage)
d  ,- B[z K€GG


\}A A/C  O3C; +.4  –—
A3 A71
  5  ,. +#$; E\03
30A [ GG

+ AAƒi:v
I{X/ AA  05$


84@8  Ižez/ .L¨+ –— 5A  8$
£
dj d E\E©

v%

]^

O3C;

\5p

A+]3U

5-P

)



£
-z/
8Ub U/GG 42i/
).+ ¥U ¦ AAƒi:v
A/C  A3 4E3-z/ % 8ªo
  ) -# @L >\ A\L3 ) ./9T GG
q ./ 85]X
KX O3C;+ (E.”.A. 41948 E4 1986) E5|ošB# E ¡ dj 84- O3C; \5p (E.”.A.1978 E4 1986) ho 5X#o © v%

U €GG

¦+ 2Lb 4-# >\ 
«\/ 30A 418i \LM
kL; do 3

1992
^#+ 5 5
 e; ^ ^ -# ) E™8u A› GG

+

de

ƒ"+

&d


B P





)

7\+U

8>.\]z/ E\ K ¤ f
+
B P
  ) ^ ^ .7? ,- - GG R=; O3C; +  –— 5š- NL \L3o At!P BE4P 5‹
\31
B P   M  E.”.A. 1922
8 d 79 +  AWXYo( ¬6AKo ž-XY Aq

>08) W™X AY]& E

R=; -!– O3C; 8@lc GG A,j >? A
+?
+EA A1XY O3C; 4?ˆ 50 U­ E\>§ 48^
U L/
 A3 5= U­
9 ) Iže !4+ +# 79 ].[z/ ¦+
A3 5= #1 B42


 A3 5= 1OPU

.B!L E? dj .83U0}
8.„
  )U$; 85]P BL5 

z/GG

q

L3

497Ž

%6X6-ƒ6®% 6E

€T!


B P   85]P E\Ly d R®$ Tq@ \5p ?-5   BY«  z/GG °+ A, Y
d±-

 2 (E.”.A 1966

).+.

.B71


8KL)

8kBX

,^+


AL8@A

#1

8bb



š4>U; U/GG šUq O3C; 85]P E
8\L3 .²
B P   4% 87 5š- @L BL5 \ i/ #1. Iže
8@B/ @8i ¤8@~; A[ Y88 U/GG % 5 ,^+
AL8@A #1

72 5š- @L

\L3 O3 A71
 I³ E.”.A 42004 K+C85]P E\L3; U/GG 4B P
  ´ .´ 39€ 48B/ \ i ] dU #1.-Iže
8@B/
AL8@A #1 

72 2\i 
8@L8
B L@A A71


(Community Based Health Insurance) E.”.A

41990

K+C

€T!6

®% 6B6U%!6-ƒ6% 85]P d¶ GG EUq
B L@A A71


4

e; ABYˆU €T! E.”.A 2007 49.5 „ |· / 5.7  
dU/ BL@A A71
  BY8 418i / A|5].;GG

E\ A/C / A£h9 4A™Ž 
+ 5& K+C \5p
8.„
 )U$; (
B P
B L@A A71) BTO 5š- @L \L3 ,^+
AL8@A #1 97b.;GG

72
  85]P E
dU U/GG q L3 % E\ +bR

R=;

O3C;+

(.+bR

°)



85]P

.BL5

E?®

E\L3; U/GG AAƒi/
A1XY O3C;  
-72/
AL8@A #1

AU8i \LM 

(410 $ -;) d 8>@j O3C; €T! (80.9 $)6 % (32 $) 6 ° (25 $)6 ®%

(18.1 $)6 pX- (13.5 $) E B (12.1

$) 8r. \LM  3i GG

2.2


  I  .+ A2.3? A2.3?


/ 01 E3‚ ./  /Ž djG  9 Bb\5
 A3 5=‰ B 83& U/GG
/ 01
 +l 4dj / A{
dU/ 5 A,j >? . 01 4/./ 9? >Q -#  # 4@  / 3& A ¸8i
dU/ E
F2U U/GG 5 ]./ /Ž
-# 3&
@A@A A?+ A­P \5p
 >Q k +# 4q r/ .9 . A3 5=
/./ >Q .F2 !58T GG 8kBX+ 5 4-# 3&/ .R=; #1. Iže:; A3 5= Bh9 \ \

. 

dj . 01
2 3/ >Q ^ A
;  ,- /Ž U/GG 45 8kBX E\ A
  +l
-„ 89:; z/GG A,j >? 89:; E\ 5 ,^ 4 9? >Q A ¸8i
dU/ A3 5= >? 41^ #1 E
F2j U/GG 
A42 5

‹)

41OPU A­ 
/
Ž
dU ;5 .  U/GG ¹/+ OA-+ dU O/ .
41^ #1
3& 9z/ 30 bd Eu

dj U/GG

4q+ 8kBX 89:; . A3 5=‰ #1
2w
 A3 5=‰ @  –— dj 89:;  s Bb\ A3 5=‰ 497+
5!z/ d A3 5=‰ .97+ 4>@j+ 8. AU8i 3&
8!\€
AL8@A #1=;o z/ 30A 8º¥ >\ U ALŒ
3}  ,2 GG 4 4897Ž ,.
  +E; 8kBX  B  ]^ O3C; E\-
/ ,^
B A%C; ./ ®#8
@§ 30A O3;+ ¸8i/
  +l U/GG de+ 4 B A%C;
3‚/  8 

A8BBˆU‰ .BL%3 .z5 0.»- ./
 

+l 8\˜ >@ A; +GG 4
897Ž ;5C; .?L1
  E\ A  +l 97+ A2– U/GG
  4q -;
8.4‰ ?p; E\@ - 6 1.

89:;
 A3 5= #1
41^ A3 5= 2.5  >? bd 7\+ A= 88U †bA NL
–—/ dj
#1 s 7 6

2.

  ‹)
42./ #1 .+ 8%lU NL BL5 bd 3& NL BL5 dj OA- O/ Ui/ AaP \LM -B/ E™\52/ B[

3.


#2


 >Q s 7b 6

A?+ NL b\5 ,^+ E\ 1˜-z/
 A3 5=

.97+ ; 6 4.


 A3 5= 3¼/ E A3 5= @Q/ (
 8ŒB) .
 4A3 5= @Q:; % \\ 7 h6 >Q £h&
8r.  ./
 A3 5= .B5‚ ; 6

5.

8kBX+ 89½U+ ˜.A- 6

6

6.

AL8@} -#  # 49
?  ? . A3 5=   ‹) E™41

9
?
].¤U 2
2 dj 30} .BTh


.9 2\iU 2 ; GG 8kBX+ . A3 5=
/./  k 418i A8TwO .\5 E\ I 

]^

-# .@A@A

/Ž

A7+

z/ O3

8lU ./   U/GG .q 5 -#  # @A@A . A3 5= 4/./  ˜ .˜
  ‹) 85]P BL5 .
/./  4k Aa 418i ?+ ./ d
.y+ dU
-!– O3C;

++
b
/ j U/GG

 +l B Y 8[.

45 K A[
9 ? 4dU E\3
h/
 >Q F2 A!%; d GG 8.+
 >Q E3 4Iže E3  d  –—
5 3&+  >Q .F2 /Ž .d A!%;U‰
4 \3T GG EUq ?p; +# O3;  ^ ^ -#  8$  4BL5  ? 4-# )‰ % Bhh+
  85]P BL5
8r. E\dU - GG






8b@A


˜.A


 E™d

 BL5

A42 


1tP67 h A3 5=



A8BBˆ E™

89U k
O3X‰ —˜;
U ,- >\8r. \LM .BF%3 E\;

3- GG

3.
  NL-P w@ w@ Ob~;6
R=; O3 8p#C O3;
eL/
5  A?hs 3.1.


  A] U ,-

B P
  ) 89
dj A O3 / \ i/ #1. Iže 5+ dU 5^ 01 87L/
N€ Œ N8¾; §L
83.^ 5.@~; z²GG
B‘ P     T^ O3C;
 j
A] U ,- 8>@j
AL8@A #1=; BK 7 7 ,^+ \ i #1. Iže 87L²
@€

—˜;




j

89

BL5 7

;.T GG




A] U

l

E\
¿3Cv B Po .4P E IžeP ,- 5 01 8K+C >\ 5^ 01 >+ 8² 5^ 01 8K+C >\ 5 @8i²  ; GG , A:v A3C;
A] U l ?
5 @8¾; B71
8KL d 7 7 >\ 5

87hX:; 81c GG
8.„ O3C;

+
b
/ E/U-+ j U/GG .+bR žX XÀA#
5 N8¾;o +  ?
5 
5
I{X/

01


@€

N8¾;


B P



.BK

5

? A] U Y8-z/ z/GG de+
 j ]03 / 2h E3
8Ub
A] 8bÁ O^+ 5+ dU 5^ 01 87L²
@€ —˜; 4F2 A Á
A] U ABŽ >\ 5. 7hX:; (Self Employed) B A,j >? A3X‰ Azi ,^ A71
dU A«P
  8Œ+ d¶ GG 8bb -T ,^+
A3X‰ —˜; Y88 A«P
  . d —˜; 8.„ +~; 841./ A]

d^GG [ uŸ B P
 

8Œº \K;² 48p; .eL²
\ i/ #1. Iže 87hX B.+ .5 N8¾;o .5
B f @8¾;o .5

f @8¾;

§L8¾; U/GG X XÁ XÁ


B P   ƒ   E
T. d
A] U ,-²


8.„
AL8@A #1=; 8.„ +~; 42
B P   A]

—˜; E\
 +]z²

d^GG €T!+ 4A3X‰
44 O

87

R=;
5 N8¾;o ].‹ ho
 A]o +o E™,+
5^ 01 \ i N8¾;
?1
B P   . d .44 @P A] Ž
[.
  AŒÌB.;GG
B P    AWX4 O3C;+    E
T. d q L3 W#ž A3 5=‰ K 47!:v AÍ U;GG W#ž
B P   A3 5= ,. 8ŒB @9  3i GG
KX² 8Œ+ B.+

IMSS

Instituto Mexicano del Seguro Social)
8].² 8Œ+ A] U 7z² \ i/ 01

5

f$; 87L/
@€ N8¾; d A@L+ ?/ ƒ GG 8

,.8i² 8ŒU \5p 5 |A f$; 87L/
@€ @8¾; A] U 72² ISSTE (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado)
8].² 8Œ+ U/GG 4
8.4‰
O3C; 8p#C NL BL5 O3; 

A]


9

444 d

B|3A
[

NP

NL-P

87
¤8@A

\ i/ A]





B P


#1.-Iže 


8NB€

89

E™dj

d EUq+
! A% EWz/ 418 ) -;
dj

Î; Y- GG 3.2


F2j
 A3 5=  °Î; (Benefit Packages)) (

  8Œ A3 5= @Q:; Y4

2/
ž ++U

NL
  8Œ @  / TE
3ƒz/ 8.8/
->Ì
 A3 5=$;



j


F2j


?+

°f

(Benefit Packages)

]

->^GG B P
 j
F2j A3 5=$;
  8Œ
 A?+ E!!4+ 5+ / B3] TUi ]^
AL8@}
 ;5C;  uL \Ly d e]zT GG q L3 uL 4@hz/ y! ; Y4


 

A]
2 ›z/
A3 5= )U$; E™3Ï BL5
3] dj U/GG R A3.w A]
2 ›z/ A3 5=$; A[ E™3Ï BL5 EÐ 41˜-z/ -;+ dU  BL5 OA A97+  s
2 4dj+   8Œ+ dU A] 0 87]U ./ AN Ad+GG
    ]T^ O3C; / 49?
#+ >Q:; >@ R=; 9Ui

„U$; @87
7}
#+ )U$; AƒÏ 8bb z/GG

EUq+
8 #+o 8ˆ8/ .-4
#+ E 8¨ >Q:;o
~$X

A3 5=o


t

5¨o

9  GG

9


>

A3 5=

E


b@^

E\
O3C; U]P ,-
8>@j
#+ AU$; j
BF2j d .+bR KXo %o €T!o žX E [
A U…o @/ @  B84 o @L-P
O$; || /  848‰ O$;o 5 U­
7} A3 5=$;o Ef5 /
dj #+:; E .-4/ > .e

A@2–

 dj

R=;

#+:;

B P





 848‰ z²GG A O3C;
”;A¢ #+ E /
dj
AY



/

Bƒ> 7Z

#+:;
BF2j d -T 5
 j A] EUq #+:;
B5‚ E

Az/GG

O3;
\LM/ 43Ï
 8ŒB % 8hh 3  j F2j
3]z/
?+  °f

89$ 7· GG q @L
?+  °Ñ

NL-P
 A3 5=  °f (Basic Health Service Package)
8Y8‰
2/ #+:; .> A–
dj p; y!$; .B4+
\LM/ ]^
 8ŒB
@§
Š#+ A3 5=$; E™Y 8\› GG


2/ #+

8  8ŒB / B8i
@§ A3 5=$; Y- GG E\ # 7Z #+o
/  7Z Š#+o .Ò ]

œ; 8Y
b@^

.> A–  dj ;5C; .B4+
@§
Š#+ A3 5=$; ?+  °Ñ / A 8Y8‰+GG 3.3


AL~ #1/ #1/TE


B P   A] 43Ï \>|
41^ TE
AL~ #1 ] GG 4E!{ A] A


@ @ /
AL~ #1
>€ 442./ \>|/
§L-

$i
@ d A@X:;+ E!{ N8i + & N8i/


41./



.

j

E™T§

\L% GG

.B P






42.² AL~ A² –— @8i² \>|  -@A +h 8@ $ A@X:; u

. 8Œ 3& \L% GG
+h² ,- 4O3 O3
.

d AAƒi²  j -72²
@8i Aƒo A9
#+ >lo 5- @§ ˜B E 8ƒBf y! ; 5+ / B3] >@ GG

10

žX XÀA# \ i/ #1. Iže
8@B€ @8¾; 8.48
5@ N8¾; + ABY
\>ƒz/ 5.6 $i Th^GG
5 A42

87hX:;

3&z/ ]z/ AL NL 8@ $ U1 >41
42

U/GG

E™,+ -T
TE ,- E\
A] U +}
. d ABYˆ +h² 4.25 $i U²GG
[
TE ,- .4 . j ANX:; 6 $i T§ N8¾; \5p 2 $i Th^GG
§L8¾; TE
7p A@X:[z/ ^ T§zT GG A1X4 O3C; .²
TE ,- R=; O3 Y.² A+
B. d KX .²
AL~ +h ,- \ i/ #1. Iže
8@B€ @8¾;
\>ƒz/ 5 $i T§ A@X:; \5p 10 $i Th^GG O3 44o  8bb
 # .8@B€
Ó\^ 5 9? TE/ B.+ 15 $i Th GG Aa€ €T! ANX:; N8¾; .j Eu


dU

TE N8i/ >tP \>|  8@ $ E!!z/ 7.5 $i Th^GG ,.‰+
! A%C; @8i 4dj ,.‰+ Th^GG 4 4897@²
AL~ +h  
8.
AY« +48.² % .B P   48.„ +E; 3& @ @] GG

EUq+


\ i/

4T§ 30A /


Iže

01

N8¾;

2.5 $i E 5 u

.B P

T

2.5 $i
l -#

E™,+ 45 4\A Ko 4IÔ 3& E 4.%Õ; 43ˆ 30A . j A2–
dU/ AL~ @ @] GG A3;
B P   A] 4\>ƒz/ 6 $ B.+ A@X:; 3 $ E @8¾; 3 $ E™,+ §L8¾; 1 $ 5 .§L8¾; 8kBX TE 1 $ E™41^
8@ d
#1/
8Y8‰
 A3 5=$; U9 >Q


AL8@}
#2

]3]  
8@L8 E™d 8\› GG

11

9  j
?+  °f A?+ 5+ /

3.4
8%lU %
8%lU % 7U
8%lU % B.  /  z/ B.+ A]o
  8Œ Ö¡:;
 A3 5= @Q 8ŒB j ŒŒ+
829L/  Y+ A%h 8 bz/
.9 .7+
b„ ]X U/GG R-P +s (Adverse Selection) E (Moral Hazard) .A
 
%
8%lU %$; z/GG

R-P +s B.  j A] U .b81


2 y @:; AAƒi/
 ;5 .]z/
dj  A%h 29 U²GG 


8%lU

%

A] U

2\ˆU



8@L8

3

d 

B L@A A71
  
- &d+ B P
  / A] U 5š- NL \L3 dj
- % A\.+GG Moral Hazard B.
  A]


dU @/ A] U‰ 3‚² A Ur

BL5 43]/  A3 5=‰ .97+
2.5 A|B U/GG A]^ >\q /b E™3]
\3² . A3 5=
>h/ ^ >Q Ž
BF1 4dj % 80 U/GG  @L-P y! .BL%3 O3
A]
#+ A3 5=
B5‚ A B›

 u


B P





8ŒBz²

U


L%5§

X:; A/8T GG q, @L žX XÀA# j >Q/ 43&/ % .Bh9
8>@j
#+ AU$; j
BF2j d 4q 8kBX
?AA= )‰
894L †\ E™eL/ BL5 E A3 5= >? A]
7- #1 (co-payment) E™2… BL5 B.+ 8ˆ$ -Y:;
#+ >Qz² 20 $i E .8 -Y:;
>Qz² E4 55 $i
\
7- #1 89/ E™F2 BL5 T:v
% 7Ur  $; z/GG E™,+ -T
 j
\  s .7U 497]z/ 0š:; Y4

A3 5= –—

.8 #+ 420 E4 50 $i 89:;
7- #1 E™41^ BL5 d .8ˆ$ -Y 4 5 E@4 30 $i \b GG [
 A@ 8ˆ$ 12

-Y:; 4j Œ 89 4dz/ ¡ 4×bz/
) \>ƒz/ 10 $i 

E™41^ \L% GG 8kBX 8ˆ8/ .-4 A] j )

/ .A A]


41./ 9? >Q 448B/ ABY
@8i \>| 9

A E1 A.
. +GG €T! j †\
% %$; .7U
8.„
% 7Ur 0š:; 97B GG EUq+ A] TE 41./ E4 3 > L .A3 5= E™£„ BL5o A] 89

bd /¤-z/ u

} dU/
j A]

E™dj BL5o #+ >?
j 89:; 4#+ >Q/
8>@U  bz/ 7- E™41^ BL5 (15 $i)o A!
#+ A3 5= s 8ŒB
j @8¾; 8 /
#
2؁ 

 E™4/j BL5o .A]

?
#+ >Q:; (420000
€T! 30A 
dj) %

j
#+ ABYX:; ?
,- 2 9
d±-

#+

£- 415 7 E!  BL5 z/GG 8bb KX A] TE 41./ E4 60 7 L A3 5= b3Ï E™£„ BL5o
?AA= )‰
894L †\ E™eL/ BL5 O 5¼ >? A] 10 $i
7#1 (co-payment) E™2… BL5 z/GG E™,+ % A] TE 41./ E4 6 > L A3 5=
B3Ï do A3 5= –—

A] 9Ui #1

E™41^ \L% GG W#ž
 ev bz/ 4A2– >Q .44 A@2–/

A3 5=

9

E™[z/
bz/


#+

E .A]$[z/ s

8ŒB


97 d 83 %„
2 3/
#+ ]. A[ E
L9 A3 5= B5‚ A; +GG
8%lU % 4  8U=
B- ;5 .dU ;5€ .7U 83&
dj  $; 85]P \L5 A.]z/GG 4q Aa O3;
48^  $; ?+  E™/^ 8\› GG •

A] 4#+ >Qz/
8>@U/ AU8i 9 >™/j
7- #1 #2


F1j 
>Q % ) 0%6 (Co-payment) 13

•


  8Œ 7hU .BL%3
 ;5 %/ .B3|
9. T (Reinsurance) E™eL/ BL5o

•


 
?+  °f A] 1˜ 4 j
 A?+ % Bhh+ 3\Ao

•


?AA= ‹)‰
894L E™d BL5 ‹)‰ .Ž 5
hr #1 (by pass fee) E™41^ BL5 T T:v z/GG

q NL O3; A] A3 5= >? 10 $ .8 -Y:;
7- #1 (Co-payment) E™41^ \L% GG 8kBX+
?AA= ‹)‰
Ž -Y:; 50 $
hr #1 #2

E!.]z/ 8 #c GG

3.5
 A3 5= #1 (Provider Payment Mechanism) 4  ”K/ % ++U 2L+ A3 5=
@§
 8ŒB #1z/
3Ï]z/
8.„ 3Z; A^GG 8@§ A3 5=$;
U9 T% NL >Q/ 8@ $
42  (fee for service) o .8 .8ˆ$ -Y Ì

#1:;

8

89/

(Capitation) o ¾I¡U“ ›Ã’„‹” vL†¨<

|A

Ì

NL


\L5

#1

„ E
% vI] Sc[ƒ u¡õM u¡õM

uSSÅw ›”É” I¡U“ KSeÖƒ ¾T>ÁeðMѨ+
\LM²
8.„
#1  $; 97+
;^ d ,^+ 01

£
3ˆ
#1   E\R.  3]T GG O3;
AL8@}


 1 .Brr

E™L!  h& \LM .@§ A3 5=$; A7p

++U
8\L3 
A3 5=$;
U9 T% @L \L3 (fee for service with fixed fee schedule)
#1     .48


-7\ d d±14

\LM .@§

#+:; A2–
#+ >Q .£h9 E™[

°| @L \L3
#1

  .97+ -?Í GG 3.6
  8ŒBP A\LMK
B P    . T^ A:v O3C;
  ² 8.
4-8

Ž
[. AÙP 8Œ+
@L‰ d
8Œ 
4-8


£h9 E
  :;
B/h r A:v O3C;
    O¡U

U²GG q …,1 47L} ¿3C; > W#ž
B P 

 4R=;
B P T C5p; % Ah+ 9 
U L; d  A@ 29L² A@8!\P #YP ;5 +#
  A3 5= U= .B²h
Brr +M ²@  3i.;GG
  8ŒBP A\LMK 8.48
O3C;

+ E\48.² 7 A GG


žX XÀA# B P
  8Œ+ Al ]

–— /
A] j

4\ i/ #1. Iže 87hX:; 8kBX >\ 5. 7hX:; (self-employed) B O3X‰ ,^ A71
dU
 A3 5=
@ Azi A«P 8Œ+ U/GG  8Œ+
O3X‰ Azi
  A3 5= @Q 4dj ¡ (E.A.A 2000-2003 ).+.) Y-
 e; 89

7b7Ž U GG E.A.A. 1998

).+. .+bR
5 @8¾; + A[z/ A B 6
I{X/ 01 @8¾; 142
 B  E™,+
5

87hX:; 227


B  8!\€ U GG 
At  ) 84$
U L/ —˜;
  ŒÌ ? )U 841./
U L dj U/GG ¹/+
5 @8¾; +

A

+Ao


I{@X/

01

@8¾;

R

+A

E


5

87hX:;+ E™, R +A 8\f8/ 8.
–— ,-
  BŒŒ+ 7b7Ž £
-z/ U/GG -T
 j O3 A71 \LM 8ŒŒ 8Œ+/&C 8!\ GG
O3X‰
   
8Œ
 AY

d
8Œ  U# y! ; >h GG


-T A«P
     
>§
  :; 15


B2Ø+ %P 5š- A. GG 8Œ @ @ / TE Ž ;=
8!\ U/GG 4 4897Ž O3C; .
 .
B P   A\LMK
+848.² [ E!{
B P   48B \LM Ž ;=
48B/
ŒŒ+ d 48B \LM+
Ž
dU &C eLT GG 4A] TE
@A@Ao 4A3 5= @Q:; % /


5] #1
2Ø+ t¡U A./GG BE4P/ 5


48B 8!\C; j A8!\ X 78i A A@+6 de+ E!{ 48B
  ŒŒ 4-8 o
 A?hs @h

(
TE

9 > o
89U >@ 7+h o
@L-P t || 0%M o >08)GG , EÐ
48B  e; .%Bz/
 EL
48B 8!C;
ºº 5š- A.]z/GG A1XY .²
B P   A\LMK .4
KX B P   AÙP \LM 8ŒŒ A BE4P 8Œ+
 &d+ .89:; 7 h A3 5= 9 [./ 0 Y-
j  (B.+ 4A] TE @A@A .A3 5= A?&:; #1 #2 
b@^) A z/ œ8i >3 f$; (5-P >+ 5-P  dj dj ;^) A>!C /

9 @ GG
€T! B P
  ¿3 A71 \LM 8ŒŒ

AÙP
  8Œ+
 d

E\ KX  
\j 


@€. œ@8i >3e; A7+GG  Ì+ 8Œ
8792 A3 5= 9 [.² 0 8.„
¿3X‰ #1=; ?s1 /¤$; #2 A]‰ B3 3  3i GG
% B P   u^ AÙP \LM 8ŒŒ AÙP
  +# ¤
 ?s1 ™X# w/¤$; BT7  8B4. AN 
48

U/GG  +# ¤ A«P
  2 ./ d 2{+ 4A]

TE @ ] ™X#

(.q, 8A=
8h. -#/“ k+C)6 E™,+ E!{

\LM .8ŒŒ






8kBX T

16

(reinsurance) @h GG

™X# \LM
8ŒŒ
   3| 8ŒB dU/
bz/ B# y]”o
A8!\ AY  @8¾; z/ z/GG W#ž 4 E\83.Ø/ \ i/
Iže 01 87L/ .@€
5^ 01 87hX:;
5@ @8¾;


  k+C R=;
B P T

A3 5=$;
@§ ,.
8.„ 8ŒB ^ d 5 A@2–/ E3ƒ #  Ì \5]zT GG A,j –—
 \ 4R=; T@:; U= .B²h A2– $; E Brr:; >@  z²GG 4 Y- A3C; (%6 -ƒ6 €T!6 KX -T) 483‚² 8p#C Ub
  85]P .BL5 Ž
[. 8Œ+ BŒŒ+ E\2 5 - GG
  8Œ A¡ f A\.+GG  Ì+ 5
879.
 A5 5= A 6 ? 1 ²-BU  8@L8 AÚ¦
B!L )B
2…+ U/GG
 85] 82C² .% 8%l dj


–—²

5 8\5˜ 879. @L 8Œ
9] ½ 2
| d 8¡² 30A ²-B dU #  IÔ BL5
 A? E™94 \% GG 4q+ 85] A]
8>@Uz²
?+  °f
k >+
–—²
\y TE E™7z² .BL5
;

A?+ 19

8Œ ×b E!3] 44 GG dj+ EUq 85]C; .B4>
  ”K² E\A2–U‰ ?sÁ; ^ A
Ӛ

/¤ de ŒŒ

A5]AU eLT GG 4.
 
5  A?hs I  A,j >? h+ AU8i dU
 \LM 85   Y./
5

I³

8kBX ,. 8kBX  ‹)$;/ )U$; I  / 85]P E™dj -?Í GG EUq+
B P
  E
B L@A A71
  z/GG
B P   444 NP A] 87 \ i/ #1. Iže 5+ dU 5

(.1  8ŒŒ+ l+) 87L/
N€ 17

N8¾; E §L8¾z A] U
48‰  d GG 48B \ i ] dU #1. Iže
8@B/ N8i 39€ AAƒi/
AL8@A #1


F1 B L@A

A71
  (community based health insurance) 85]P d GG
B L@A A71
 
8>@U AY]& BE4

BL5 AL8@}
ŒŒ+

AL8@} Ž ™p#P dU 3 hz/ A]=;
€ z/GG EUq
B L@A A71
  8Œp; 4 \LM 8>@j # =; 85]P BL5 8p#C /@ O3 A71 \LM .B -?Í GG
B P
B L@A A71   f$; >\¡ A  BTO ,^+ AL8@A Y88
  A3 5=
@  ,- [[ GG

5.


B P   ŒŒ+ 5 
4./ >Q

E\->7/ A] .j 4\y TE 8kBX A@X:;+ 8ƒBf TE \%^GG q Aa 5 A@XU‰ .N8¾v
\3/ 8ƒBf TE 418i E\d 9  GG ¹/+G- 2009 E”A A] U
-7‡
5 N8¾; Aƒ 1.07   d
§L8¾; Aƒ \5p 0.34   U/GG .EUq A] 5
41./ 8ƒBf TE B.+ .N8¾;
\>ƒz/ 3 $i E™,+ .§L8¾;
§L- A z/ 1 $i +€ 319.15   \b GG 8bb 7h A-
N8¾;
§L8¾; Aƒ 7 7 E\3
« E\d 3 q/ 9 45
9 7/ TE E\3 «! GG R E\-
/ ALi/ ) 5 q L3
>h/ >Q A 524.2   \b

8A=

83+c GG A€
89:; Aƒ B.+ A] ¤8@~[z/ 2009 8.56   d ALi/ ) 11.07   \b 8kBX+ .j
Ur Y±-




5+ A.GG


d ½ 30A
 A‰ 85]P d 

–— A2–/
 B°M K \A 45 9  GG

18