亞洲各國如何提供醫療保健服務？
MIKE BISHOP
日
趨
老齡化的人口、更長的壽命以及對生活質量越來越高的期望正在給亞洲各地的公共醫療衛生系統帶來壓力。這種情況乍聽起來跟西方國家決策者面臨的挑戰相似，但
其中存在一個重大差別。美國和歐洲的領導人正在艱難地對現行效率低下的醫療系統進行調整，使之適應變化的形勢，而許多亞洲國家政府則有機會從頭開始打造醫
療系統。而在構建這個系統的時候，他們應當留心私營部門能夠在哪些方面提供幫助。
Zuma Press
安徽合肥的一家診所。
聯
合國數據顯示，2050年亞洲65歲以上老人的數量將飆升至8.57億人，2000年為2.07億人。如此一來，撫養比率預計將會大幅上升，從2000年
的每百人負擔9.1名年輕和年老的被撫養者，上升到2050年的每百人負擔27.8名被撫養者。越來越多的資源將被用於醫療保健。美國經濟年產出的大約
18%被用於醫療保健，而中國和印尼的這一比例則分別僅為5%和3%。
不過，決策者必須謹慎行動。單是支出的增加就可能造成動機的扭曲，並且永久性地削弱政府的資產負責表。決策者關注的焦點必須不僅是擴大獲得醫療保健服務的渠道，而且要從一開始就建立一個可持續的融資模式。
第一步是要意識到，包括外企在內的私營部門可以提供有價值的專業知識。通過積累數百萬客戶的反饋，這些商業實體能夠準確地意識到用戶的需要和訴求。此外，跨國公司的全球影響力提供了更廣闊的視角，可以幫助我們了解不同的解決方案是如何用於不同的政策目標的。
這樣的合作已經產生效果。香港政府2008年為醫療保健改革征求意見時，征集了私營部門有關加強基礎護理以及醫療保健融資改革等領域的想法。私營保險公司以及其他機構提供的見解、專業知識和數據對決策者極具價值。
國內外的私營保險公司在落實解決方案的過程中也能扮演有用的角色。過去10年，中國在醫療保健的儲備方面實現了較大的跨越，在各種公共計劃中納入了9億人，確保覆蓋范圍超過95%的中國公民。不過，目前的覆蓋並不均衡，這打擊了消費者信心，引發了對高醫療成本的擔憂。
中國政府表示，將依賴私營保險商填補基本覆蓋之外的缺口。福建省和重慶的地方政府已經允許私營保險公司管理公共項目。這一產業過去10年平均每年增長了27%。
在
這方面，新加坡於2002年開始的樂齡健保計劃(ElderShield
Plan)提供了一個可以效仿的良好范例。政府與保險行業磋商制定了該計劃，並讓民眾從一系列得到認可的計劃中選擇保險類別。在那之後，政府一直與私營合
作伙伴一起通過額外的公共咨詢和用戶調查不斷審查和改進這項服務，從而打造出適應性強、最具成本效益的保險類別。
然而，設計新的醫療保健計劃的技術細節只是挑戰之一。決策者們還必須留意醫療可持續性的其他幾個必要元素。其中最重要的就是教育。
首先，受過教育的消費者可能做出更明智的選擇。新加坡的公共衛生教育項目鼓勵新加坡人採用健康的生活方式，為自己的健康負責。循証健康篩查已被用於常見病的早期診斷，如癌症、心臟病、高血壓和糖尿病等。
政策教育同樣重要，即加強政府內部對於公眾長期需求的了解。在這方面打下共識的基礎對於保障變革的持續性而言非常重要。新加坡啟動改革的依據是其衛生部兩個基礎性報告的結果。這兩份報告考察了相關的問題，並建議讓私營保險公司參與進來，為政府內部的解決方案提供支持。
最後，決策者還需要確保融資解決方案從一開始就盡可能地包括所有費用。研究發現，將融資責任轉到私營部門往往對負擔得起更多醫護開支的中產階級和富人更有利。任何醫療項目都必須提供令人滿意的最低覆蓋水平，不僅僅是為了保証這類體系能獲得政治支持。
此
外，需要讓收入較低的消費者了解他們可以有哪些選擇，最好是通過政府和私營保險公司協調進行的溝通措施來實現。在馬來西亞，從2003年開始、由保險行業
提供支持的保險信息項目(Insurance Info
Programme)提供了易於理解的材料、網絡資源以及在校金融教育，以提高金融包容性。這類方案必須利用多種渠道，最大限度地讓人們了解。
憑借高速經濟增長，在公共衛生和老年人護理的成本變得難以承受、造成歐洲式危機之前，亞洲還有時間。亞洲各國政府應當利用這個“寬限期”，設計出政府與私營部門合作的醫療保健項目，使之真正有利於民眾。在人口因素的無情作用下，這個寬限期可能比他們想象的要短。
（本文作者為安盛集團亞太區總裁。）
How Asia Can Get Health Care Right
MIKE BISHOPAging populations, longer life spans and
ever-higher expectations of quality of life are placing burdens on
public health-care systems across Asia. At first this sounds similar to
the challenges facing policy makers in Western countries, but there is a
critical difference. While leaders in the U.S. and Europe struggle to
adapt existing but inefficient health-care systems to changing
circumstances, many Asian governments have the opportunity to build from
scratch. As they do so, they should be alert to ways the private sector
can help.
According to the United Nations, the number of Asians
older than age 65 will soar to 857 million in 2050 from 207 million in
2000. As a result, the dependency ratio is projected to rise sharply, to
27.8 young or elderly dependents per 100 people in 2050 from 9.1
dependents per 100 people in 2000. An ever-greater proportion of
resources will shift toward health care. While the U.S. economy devotes
roughly 18% of its annual output on health care, in China that number is
only 5% and in Indonesia 3%.
Policy makers must tread carefully,
however. Higher spending alone could skew incentives and permanently
cripple government balance sheets. The focus must be not only on
expanding access to care, but building a sustainable financing model
from the start.
A first step should be to recognize that the
private sector, including foreign companies, can offer valuable
expertise. Through the aggregate decisions of millions of customers,
commercial entities are acutely aware of consumer needs and demands.
Furthermore, the global reach of international players offers a broader
perspective of how different solutions can apply to various policy
goals.
Such collaboration already is bearing fruit. The Hong Kong
government, in its consultation on healthcare reform in 2008, solicited
input from the private sector in such areas as enhancing primary care
and reform of health-care financing. The insight, expertise and data
private insurers and others were able to provide proved valuable for
policy makers.
Private insurers, both domestic and foreign, also
can play a useful role in implementing solutions. Over the last 10 years
China has made great strides in its health-care provision, enrolling
900 million people in various public schemes to ensure coverage of more
than 95% of Chinese citizens. However, current coverage is patchy,
leading to a lack of confidence among consumers and fears of high costs.
Beijing
says it will rely on private insurers to fill the gap beyond basic
coverage. Already local governments in Fujian province and Chongqing
allow private insurers to manage public schemes. The industry has grown
27% annually over the past 10 years.
In this regard, Singapore's
ElderShield Plan, started in 2002, provides a particularly good example
for others to follow. The government developed the scheme in
consultation with the insurance industry, and works by allowing citizens
to select coverage from a slate of approved plans. Since then, the
government has worked with its private partners to review and improve
the service through additional public consultation and surveys from
users, resulting in adaptable, more cost effective coverage.
However,
the mechanics of designing a new health program are only part of the
challenge. Policy makers must also be alert to several other necessary
components of health-care sustainability. Education is the most
important.
First, educated consumers are likely to make wiser
choices. Singaporeans are encouraged, through public health education
programs, to adopt healthy lifestyles and be responsible for their own
health. Evidence-based health screening has been introduced for the
early detection of common ailments, such as cancer, heart disease,
hypertension and diabetes mellitus.
Alongside this is the
importance of policy education building an understanding within
government of the long-term needs of the public. Laying the foundations
for consensus in this regard is important for lasting change. Singapore
initiated its reforms based on the findings of two foundational reports
from the Ministry of Health. These helped explore the issues at play and
recommended the involvement of private insurers, building support for
the solution within government.
Finally, policy makers need to
ensure that financing solutions are as inclusive as possible right from
the beginning. Studies show that shifting responsibility for financing
onto the private sector does tend to favor the middle class and wealthy
who can afford more care. Any program must provide satisfactory minimum
levels of coverage not least to maintain political support for such
systems.
Furthermore, lower-income consumers need to be made
aware of the options available to them, ideally through coordinated
outreach efforts by governments and private insurers. In Malaysia, the
industry-backed Insurance Info Programme since 2003 has provided
easy-to-understand materials, online resources and financial education
in schools to promote financial inclusion. Such schemes must use
multiple channels to engage the broadest possible audience.
Sustained
by its high growth rates, Asia has time yet before the cost of health
and aged care becomes an overwhelming force and threatens a
Eurozone-style crisis. Governments across Asia should use this grace
period to devise health-care public-private partnerships that actually
work for their citizens. With the unrelenting demographic forces at
play, time may be shorter than they think.
(Mr. Bishop is chief executive of AXA Asia.)
