1、本科毕业设计（论文）外文翻译原文THEROLEOFINSURANCEINHEALTHCAREMANAGEMENTININDIATHEWORLDHEALTHORGANIZATIONDENESHEALTHASCOMPLETEPHYSICAL,MENTALANDSOCIALWELLBEING,NOTMERELYTHEABSENCEOFDISEASEANDINJURYPAREKH,2003ACCORDINGLY,ACOUNTRYSHEALTHSYSTEMCOMPRISESALLTHEORGANIZATIONS,INSTITUTIONSANDRESOURCESDEVOTEDTOPRODUCEHEALTH
2、SERVICESHEALTHCAREHASALWAYSBEENAPROBLEMAREAFORINDIA,ANATIONWITHALARGEPOPULATIONANDASUBSTANTIALPORTIONLIVINGBELOWTHEPOVERTYLINECONSEQUENTLY,HEALTHCAREACCESSANDEQUITYBECOMEIMPORTANTISSUES,ANDHEALTHINSURANCEHASNOTBEENDEVELOPEDTOITSIMMENSEPOTENTIALINTHEWORLDSFTHLARGESTECONOMYANESTIMATED13BILLIONPEOPLEWO
3、RLDWIDELACKACCESSTOEFFECTIVE,AFFORDABLEHEALTHCARE,WHILEMORETHAN150MILLIONPEOPLEIN44MILLIONHOUSEHOLDSWORLDWIDEEVERYYEARFACENANCIALRUINASADIRECTRESULTOFLARGEMEDICALBILLSYETMOSTPOLICYMAKERSHAVEASSUMEDUNTILRECENTLYTHATPOORFAMILIESINDEVELOPINGCOUNTRIESWHOSESURVIVALISPRECARIOUSWOULDNOTPAYHEALTHINSURANCEPR
4、EMIUMSEVENTOFORESTALLTHECOSTSOFFUTUREHOSPITALIZATIONINTERNATIONALCONFERENCEONSOCIALHEALTHINSURANCEINDEVELOPINGCOUNTRIES,2005TABLEISUGGESTSTHATPUBLICHEALTHCAREISCONCENTRATEDINRURALAREASTHATLEANTOWARDSPREVENTIONWHILEPRIVATEUNITSARECURATIVEONLYMAINLYTODISCOURAGEMALPRACTICEISSUESFURTHER,PUBLICDOMAINEXPE
5、NDITUREISMETBYCENTER,STATE,LOCALANDSOCIALINSURANCEIFWEANALYZETHESITUATIONINTHEPRIVATEDOMAIN,THEMAXIMUMCONTRIBUTIONISOUTOFPOCKET,FOLLOWEDBYPHARMACEUTICALINDUSTRYANDSOONININDIAUNTILNOW,THEPRIMARYHEALTHCARESYSTEMHASBEENMANAGEDMAINLYBYLIMITEDGOVERNMENTHEALTHCAREFACILITIESANDOTHERPUBLICHEALTHCARESYSTEMSI
6、NATRADITIONALMODELOFHEALTHFUNDINGANDPROVISIONHOWEVER,THISSTRUCTUREISUNABLETOMEETTHEDEMANDFROM200MILLIONPLUSHEALTHINSURABLEINDIANPEOPLEMOREOVER,ITHASBECOMEEXPENSIVEOWINGTOHIGHHEALTHSERVICECOSTS,INADEQUATEPHYSICIANNUMBERS,WEAKEDUCATIONPROGRAMMES,LOWHOSPITALNUMBERS,POORMEDICALEQUIPMENTANDINSUFCIENTGOVE
7、RNMENTHEALTHSERVICEBUDGETALLOCATIONEVENTHEINDIANSOCIALINSURANCEPROGRAMMES,SUCHASTHEEMPLOYEESTATEINSURANCESCHEMEESISANDCENTRALGOVERNMENTHEALTHSCHEMECGHSARERESTRICTEDTOASMALLSEGMENT3PERCENTOFTHEPOPULATIONNAGENDRANATHANDCHARI,2002TABLEIISHOWSTHATINDIASPENDSUPTO7PERCENTOFGDPONHEALTHCARE,OUTOFWHICH13PERC
8、ENTISINTHEGOVERNMENTSECTORACCOUNTINGFOR22PERCENTOFOVERALLSPENDINGAND47PERCENTINTHEPRIVATESECTOR78PERCENTOFOVERALLSPENDINGPAREKH,2003SPENDINGIMPACTDATAAREINTERESTINGINDIASLIFEEXPECTANCY,64YEARS,ISHIGHERCOMPAREDTOCHINASSPENDINGONHEALTHCARE5PERCENTOFITSGDPWITHA525YEARSLIFEEXPECTANCYTHEUSASPENDSAROUND13
9、2PERCENTOFITSGDPONHEALTHCARE,ANDITSLIFEEXPECTANCYIS725YEARSPARERA,2004ESTIMATINGFUTUREHEALTHINSURANCEEXPENDITUREONEINDIANGOVERNMENTCOMMISSIONESTIMATEDFUTUREHEALTHINSURANCENEEDSITWASASSUMEDTHAT10PERCENTOFINDIASPOPULATIONWOULDSTILLBEINPOVERTYBY2016SINHA,2005DESIRABLEHEALTHINSURANCECOVERAGESHOULDBE50PE
10、RCENTOFTHEPOPULATION,INLINEWITHCHINAANDKOREATHECOSTOFGOVERNMENTINSURANCEISASSUMEDTOBERUPEES400PERYEARPERPERSONFORTHEPOPULATIONBELOWTHEPOVERTYLINETHECOSTOFPRIVATEINSURANCE,ONTHEOTHERHAND,ISESTIMATEDATRUPEES1,200PERYEARPERPERSONFORALLPERSONSOTHERTHANTHOSEBELOWTHEPOVERTYLINEBASEDONTHESEASSUMPTIONS,HEAL
11、THINSURANCEEXPENDITUREISESTIMATEDTOBERUPEES645,320MILLIONPERYEAR,OFWHICHRUPEES49,640MILLIONCOMESFROMTHEPUBLICSECTORANDRUPEES595,680MILLIONFROMTHEPRIVATESECTOR,ASSUMING40PERCENTCOVERAGEINSTEADOF50PERCENTTABLEIIITHISAMOUNTSTOSLIGHTLYOVER1PERCENTOFGNPBY2015HEALTHINSURANCEOPERATIONALCOSTSTHEREISUSUALLYA
12、SUBSTANTIALDIFFERENCEINTHECOSTOFRUNNINGAPRIVATEHEALTHINSURANCECOMPAREDTOAPUBLICSCHEMETHEDIFFERENCECANBEVETOTENTIMESLOWERINTHECASEOFPUBLICSYSTEMSTABLEIVTHEMAINREASONFORSUCHDIFFERENCESISTHATPUBLICSYSTEMSARECOMPULSORYPEOPLECANNOTOPTOUTOFTHEMTHECOSTOFACQUISITIONISTHUSLOWERTHEREISALSOARANGEOFNONGOVERNMEN
13、TORGANIZATIONSNGOSANDSELFHELPGROUPSTHATOPERATETHEIROWNHEALTHINSURANCESCHEMESPROBABLYTHEMOSTWELLKNOWNISTHEINDIANSELFEMPLOYEDWOMENSASSOCIATIONSEWAFORMEMBERS,THESCHEMECHARGESANANNUALPREMIUMOFRUPEES30TOAMAXIMUMOFRUPEES1,200PERYEARTHEREISALSOAXEDDEPOSITOPTION,IEASETAMOUNTISDEPOSITEDWITHAHOSPITALIRRESPECT
14、IVEOFANYSCHEMETHEACTUALHEALTHCARESCHEMEISRUNONAGROUPBASISBYTHEGOVERNMENTOWNEDINSURERNEWINDIAASSURANCE,ANDTHEREAREANUMBEROFHEALTHINSURANCETYPEPLANSALONGSEWALINESSINHA,2005ISSUESANDCONCERNSTHEREISAVARIETYOFPROBLEMSWITHINDIASHEALTHCOVERAGEPLANSTHECOMMONNEGATIVEFACTORSINCLUDEPAREKH,2003GROSSLYINFERIORSE
15、RVICEWHENTHEPLANGIVER,ESIS,CGHSETC,OWNSFACILITIESREJECTIONANDUNWARRANTEDREIMBURSEMENTDELAYSSERVICELIMITATIONSEITHERLOWPOLICYLIMITSONREIMBURSEMENTAMOUNTSORRESTRICTSAPPLIEDTOPREEXISTINGANDCHRONICAILMENTSINADEQUATEINFORMATIONREGARDINGHEALTH,AILMENTS,PROCEDURESANDTREATMENTS,CORRESPONDINGCOSTSANDOUTCOMES
16、PROVIDERMALPRACTICEPRICINGFORCOMPREHENSIVETOTALCAREINADEQUATEMEDICALCARECOVERAGEINTERNATIONALHEALTHINSURANCEREFORMANEVALUATIONOFTHEREFORMMEASURESADOPTEDINSOMEDEVELOPEDMARKETSLIKEFRANCEANDGERMANY,FOUNDTHESERESULTSPAREKH,2003ASHIFTTOECONOMICANDMEDICALEFCIENCYTHEINTRODUCTIONOFHEALTHCAREACTIVITYBUDGETIN
17、GANDEVALUATIONCHANGESINTHEHEALTHRISKCOVERAGE,INTRODUCTIONOFGATEKEEPERMECHANISMSANDDIFFUSIONOFHEALTHCARENETWORKSWEAKENEDPROVIDERSANDSTRENGTHENEDSTATEPROMOTINGCOMPETITIONHEALTHREFORMISNOTANDNEVERWILLBEADISPASSIONATEMATTEROFSELECTINGPOLICYINSTRUMENTSFROMSOMEMENUOFIDEALIZEDOPTIONSANENLIGHTENED,PROGRESSI
18、VESTRATEGYINHEALTHCAREMUSTTAKEINTOACCOUNTTHEPOLITICALCONTEXTOFREFORMITMUSTCONSIDERTHEDIFFERENTENVIRONMENTSTHATAREOBVIOUSPOSSIBILITIESFORTHENEXTDECADEANDBEYONDWEMAYCONCLUDEFROMTHISREVIEWTHATIFTHEWILLEXISTSTHENSTATESCANSUBSTANTIALLYEXPANDCOVERAGEHOWEVER,ASONEMOVESUPTHEINCOMESCALE,POLITICALSUPPORTANDRE
19、SOURCESAREHARDERTOCOMEBYFURTHER,CONCERNSGROWABOUTTHEINTERFACEBETWEENPUBLICANDPRIVATECOVERAGE,WITH“CROWDOUT”ISSUESANDOTHERDISTRIBUTIONALQUESTIONSDOMINATINGTHEDISCUSSIONABOUTCOVERAGEEXPANSION,ASPOLICYMAKERSFOCUSLESSONHOWTOCOVERPEOPLETHANONHOWTOMAKESUREONEKINDOFCOVERAGEDOESNOTPREEMPTANOTHERCONCERNABOUT
20、“CROWDOUT”LEADSTOPOLICIESTHATKEEPOUTSOMEOFTHEPEOPLEPOLICYMAKERSMAYWANTTOCOVERINTHISCONTEXT,THEQUESTIONWHETHERSTATESORTHEFEDERALGOVERNMENTISMORELIKELYTOEXPANDCOVERAGEISECLIPSEDBYTHEMOREFUNDAMENTALCHALLENGESRAISEDBYPLURALISMNEITHERFEDERALNORSTATEGOVERNMENTISLIKELYTOBEFULLYSUCCESSFULWITHOUTRSTIDENTIFYI
21、NGBETTERWAYSOFCOORDINATINGPUBLICANDPRIVATEACTIVITIESANDRESOURCESTOPROVIDECONTINUOUSANDAFFORDABLECOVERAGEGOLDANDMITTLER,2001CURRENTPOLICIESAVAILABLEINTHEMARKETANDTHEMAJORPLAYERSTHERSTPOLICYTHATCOMESTOMINDISGENERALINSURANCECORPORATIONSGICMEDICLAIMHEALTHINSURANCESCHEMECURRENTLYTHEREAREONLYTWOPLAYERSINT
22、HISELD,LIFEINSURANCECORPORATIONANDGENERALINSURANCECORPORATIONWITHITSFOURSUBSIDIARIESMEDICLAIMISTHEHEALTHINSURANCESCHEMEOFFEREDBYGIC,WHILEJEEVANASHAISOFFEREDBYLIFEINSURANCECORPORATIONLICCOMPETITIONHAS,HOWEVER,BROUGHTINMANYNEWPLAYERSEMERGINGMARKETS,COMPRISING86PERCENTOFWORLDPOPULATION,INCLUDINGSOMEOFT
23、HEPOPULATEDNATIONSLIKECHINA13BILLION,INDIA11BILLIONANDINDONESIA02BILLIONACCOUNTFOR23PERCENTOFGLOBALECONOMICOUTPUTEMERGINGMARKETSCOLLECTIVELYACCOUNTEDFOR11PERCENTOFGLOBALLIFEINSURANCEPREMIUMSIN2003SWISSRE,2004OVERTHENEXT50YEARS,BRAZIL,RUSSIA,INDIAANDCHINABRICCOULDBECOMEAMUCHLARGERFORCEINTHEWORLDECONO
24、MYTABLEVSEVERALCOMPANIESENTEREDTHEHEALTHINSURANCEMARKETANDADOZENCOMPANIESLINKEDWITHFOREIGNPARTNERSGROWTHINTHETWENTYRSTCENTURYWILLCOMEFROMCOUNTRIESLIKESOUTHKOREA,CHINA,TAIWAN,SOUTHAFRICAANDINDIATABLEVIDELAYMAYDOOMTHEFUTUREEFFORTSOFINSURANCECOMPANIESTOSTAKEACLAIMINTHESEHIGHPOTENTIALMARKETSSWISSRE,2004
25、INDIANANDGLOBALSTATISTICSTHISSECTIONGIVESTHEUSERSIMPORTANTANDDETAILEDSTATISTICSABOUTTHEINDIANASWELLASGLOBALINSURANCEINDUSTRIESTHESESTATISTICSGIVEIMPORTANTINSIGHTSWHERETHERESPECTIVEMARKETSAREHEADEDTHEGLOBALLIFEINSURANCEMARKETSTANDSAT1,5212BILLIONWHILETHENONLIFEINSURANCEMARKETISPLACEDAT9224BILLIONTHEU
26、SAACCOUNTSFORABOUTONETHIRDOFTHE24436BILLIONGLOBALINSURANCEMARKETANDJAPANSTANDSNEXTWITHA206PERCENTSHAREINDIATAKESTHE23RDPOSITIONWITHUS9933BILLIONANNUALPREMIUMCOLLECTIONSANDAMEAGRE04PERCENTSHAREINDIASLIFEINSURANCEPREMIUMASAPERCENTAGEOFGDPISJUST18PERCENTTHEINCOMEDERIVEDBYGICANDITSSUBSIDIARYCOMPANIESTHR
27、OUGHINVESTMENTWASRS249176CROREANDTHEINVESTIBLEFUNDGENERATEDWASRS2843CROREIN19992000INDIANINSURANCEMARKETISSETTOTOUCH25BILLIONBY2010,ONTHEASSUMPTIONOFA7PERCENTANNUALGROWTHINGDPANAND,2003INDIASHEALTHCAREINDUSTRYISCURRENTLYWORTHRS73,000CROREWHICHISROUGHLY4PERCENTOFITSGDPTHEINDUSTRYISEXPECTEDTOGROWATTHE
28、RATEOF13PERCENTFORTHENEXTSIXYEARS,WHICHAMOUNTSTOANADDITIONALRS9,000CROREEACHYEAROVERTHELASTVEYEARS,THEREHASBEENANATTITUDINALCHANGEAMONGSTASECTIONOFINDIANSWHOARESPENDINGMOREONHEALTHCAREABIGOPPORTUNITYEXISTSFORTHEINDUSTRY,EMERGINGFROMPRIVATISINGTHEINSURANCESEGMENT,WHICHEXTRAPOLATESINTOANEWDELIVERYSYST
29、EMININDIAWITHGLOBALREVENUESOFAPPROXIMATELYUS28TRILLION,THEHEALTHCAREINDUSTRYISTHEWORLDSLARGESTANDINDIAISEMERGINGASAMAJORPLAYERNOTLEASTBECAUSEOFITSPOPULATIONSIZEACCORDINGTOTHEINSURANCEREGULATORYANDDEVELOPMENTAUTHORITYIRDA,THEINDIANHEALTHCAREINDUSTRYHASTHEPOTENTIALTOSHOWTHESAMEEXPONENTIALGROWTHTHATTHE
30、SOFTWAREANDPHARMACEUTICALINDUSTRIESHAVEINTHEPASTDECADEFURTHER,IRDAEXPLAINTHATONLY10PERCENTOFTHEMARKETPOTENTIALHASBEENTAPPEDANDMARKETSTUDIESINDICATEA35PERCENTGROWTHINTHECOMINGYEARSINSHORT,INDIAHASAVASTINSURABLEPOPULATIONBUTCURRENTLYONLY2MILLIONPEOPLE02PERCENTOFTHETOTALPOPULATIONARECOVEREDUNDERMEDICLA
31、IMANDACCORDINGTOARECENTSTUDY,THEREARE315MILLIONPOTENTIALLYINSURABLELIVESINTHECOUNTRYBAHADUR,2001THEATTRACTIVENESSOFTHEINDUSTRYGIVESRISETOMORECORPORATEPLAYERSINTHEELDTHEEMERGENCEOFPRIVATEHEALTHINSURANCEISYETTOEXERTANYSIGNICANTPRESSUREONTHEWAYINDIANHOSPITALSCOMPETEOROPERATEINSTITUTIONALCUSTOMERSGOVERN
32、MENTAGENCYEMPLOYEESORCOMPANIESREIMBURSINGTHECOSTOFMEDICALCARETOSTAFFHAVEEMERGEDASANIMPORTANTSOURCEOFREGULARANDLUCRATIVEBUSINESSFORTHEPRIVATEHEALTHINSURERSTHEINDIANCREDITRATINGAGENCYICRAHASOBSERVEDTHATMOSTHOSPITALSAREBENETINGFROMEMERGINGPRIVATEHEALTHINSURANCECOMPANIESANDHAVESETUPADMINISTRATIVESYSTEMS
33、TOSERVICEENROLLEDCUSTOMERSANOTHERREASONFORTHEGROWTHINHEALTHINSURANCEISTHECASHLESSCLAIMFACILITY,WHICHHASBEENINTRODUCEDBYANUMBEROFPRIVATEINSURERSTHENATIONALHEALTHPOLICYNHPSETTHEGOALOFINCREASINGPUBLICHEALTHEXPENDITUREFROM09TO2PERCENTOFGDPBY2010VERMA,2003COMPANIESAREALSOTALKINGABOUTNEWPRODUCTSTHEYWILLIN
34、TRODUCEINTHEMARKET,FROMSMARTCARDSTOPATIENTGUIDANCESERVICESALLTHISISEXPECTEDTOREDUCETHECOSTOFHEALTHCAREANDMAKETHEINDUSTRYMOREPROFESSIONALNEVERTHELESS,ITISESTIMATEDTHATTHEUS761MILLIONHEALTHINSURANCEBUSINESSININDIAWILLSWELLVEFOLDTOUS4BILLIONBY2005MOSTOFTHEFOREIGNCOMPANIESENTERINGINDIAHAVEDECIDEDTOFOCUS
35、ONLIFEINSURANCERATHERTHANHEALTHINSURANCEALONE,JUSTBECAUSEABROADERINSURANCEPRODUCTRANGEISAVAILABLEALSO,THEREARECOMPANIESLIKEBAJAJALLIANCEWHICHHASLAUNCHEDAMEDICLAIMPOLICYWITHACASHLESSCLAIMFACILITYTHEINSUREDUNDERTHISPOLICYRECEIVECASHLESSTREATMENTFROM41HOSPITALSACROSSTHECOUNTRYTOTHEEXTENTOFTHESUMINSURED
36、FORAILMENTSCOVEREDBYTHEPOLICYTHEMAJORADVANTAGEISTHATUNDERSUCHPLANS,THEPOLICYHOLDERISNOTREQUIREDTOSETTLEHISORHERHOSPITALBILLUPFRONTANDTHENMAKEACLAIMWITHTHEINSURERINSTEAD,THEINSURERSETTLESTHEHOSPITALBILLSONBEHALFOFTHEPOLICYHOLDERITISAPRECURSORTOTHEFORMALTRANSITIONTOATHIRDPARTYADMINISTRATORREGIME,WHICH
37、PROVIDESHASSLEFREEHEALTHINSURANCEANDALSOSTANDARDIZESMEDICALDIAGNOSTICANDHOSPITALIZATIONEXPENSEPROCEDURESTHISISSOMETHINGTHATISMISSINGINTHECURRENTGICMEDICLAIMPOLICY,WHICHREQUIRESPAYMENTFORHOSPITALEXPENSESFROMPATIENTSWHOSUBMITBILLSTOTHEIRINSURANCECOMPANYAPROBLEMISTHATREIMBURSEMENTOFTENTAKESTIMEOWINGTOT
38、HEBUREAUCRATICPROCEDURESINVOLVEDSOURCEHIMAGUPTATHEROLEOFINSURANCEINHEALTHCAREMANAGEMENTININDIAJINTERNATIONALJOURNALOFHEALTHCAREQUALITYASSURANCE,2006（05）P379391译文医疗保险在印度卫生保健管理体系中的作用世界卫生组织定义健康为完整的生理，心理和社会幸福，而不仅仅是没有疾病和损伤。因此，一个国家的卫生系统包括所有的组织，机构和资源专门致力于提供健康服务。卫生保健一直是印度这样一个人口众多而大多数人生活在贫困线以下的国家的重要事项。因此，医疗保
39、健的发展和公平成为重要的问题，同时健康保险没有发展到其作为世界第五大经济体系所存在的巨大潜力。大约13亿人无法获得有效及负担得起的卫生保健，同时有44万个家庭超过15亿人面对大型的医疗费用导致的最直接的经济破产的结果。然而，直到最近大多数决策者预测在发展中国家的贫困地区那些生存岌岌可危的人将不愿支付医疗保险费甚至防止发生住院产生的成本。在农村地区的公共医疗主要集中在预防治疗上，而私人单位主要是劝阻舞弊问题。进一步说，公共领域的支出，即是满足国家和本地的社会保险。直到现在，印度的初级卫生保健系统主要由政府卫生保健设施和其他公共健康护理系统根据传统的卫生筹资模式进行管理。然而，这种结构是无法满足2
40、亿拥有医疗保险的印度人民的。此外，由于医疗服务成本高，缺乏执业医师数，脆弱的教育计划，低下的住院人数，不良的医疗设备和政府对医疗服务不足的预算分配，其负担成本变得很昂贵。即使是印度社会保险计划，比如ESIS和CGHS，也只是限于一小部分人口得到保障。印度把国内生产总值的7用于医疗保健。其中13用于政府部门，47用于私人部门。由于对医疗保健支出程度的不同，我们得到一个有趣的数据。印度人的预期寿命是64岁，比医疗保健支出占国内生产总值5的中国高，中国人为525岁。美国在其医疗保健上的支出占到了国内生产总值的132，美国人的预期寿命为725岁。假设到了2016年，仍有百分之十的印度人口生活在贫困中，
41、理想的医疗保险覆盖率应该达到百分之五十的人口，与中国和韩国同列。假设每年给生活在贫困线以下的人口支付政府保险的费用为每人400卢比。在个人保险上，除了生活在贫困线以下的其他人，假设费用为每人每年1200卢比。基于这些假设，健康保险的支出估计为每年64532亿卢比，其中4964亿卢比来自公共部门和59568亿卢比来自私营部门，假设覆盖率为百分之四十而不是百分之五十。这项支出略超过2015年国民生产总值的1。与公共计划相比，在运行私人医疗费用保险时通常有一个很大的差异。造成这种差异的主要原因是因为公共系统是强制性的，人们无法选择，收购成本因此较低。还有非政府组织和自助团体经营自己的健康保险计划。可
42、能最有名的是印度自雇妇女协会。对于会员，该计划每年收取费用30卢比到最大额1200卢比。实际的卫生保健计划由政府所有的保险公司运行新印度保险，还有一系列的健康保险计划。印度的健康保险计划，还存在着各种问题。常见的负面因素包括排斥和毫无根据的拖延偿还期限；服务的限制无论是在偿还金额的低政策界限还是在对已存在和慢性疾病的限制；有关健康，疾病，程序和治疗，相应的成本和成果的资料不足；供应商的弊端；全面照顾的高定价；对经济和医疗效率的转变；对医疗保健活动的预算编制和评价的介绍；把关机制的引入和扩散的医疗网络。卫生改革在某种理想化的政策选择中不是也永远不会成为一个冷静的问题。一个开明，进步的卫生保健战略
43、必须考虑到改革的政治背景。它必须考虑到未来十年或更久的不同环境存在的明显的可能性。我们由此可以从审查中得出结论，如果存在，则国家可以大幅度扩大覆盖范围。然而，作为一个向上移动的收入规模，政治支持和资源是很难得的。其次，在出现“挤出效应”和其他关于覆盖范围的扩大导致的分配问题的讨论时，关注有关公共和私人之间覆盖面衔接的增长。对“挤出效应”问题的关注会导致出现让出一些原本政策制定者想要归于计划下的名额之类的政策。如果不是首先确定更好的途径来协调公共和私人活动和资源，以提供持续和负担得起的范围，无论是联邦政府还是州政府都不可能完全取得成功。第一个想到的政策是GIC健康保险计划。目前，在这个领域只有两
44、个公司，人寿保险公司和一般保险公司。MEDICLAIM是由GIC提供的健康保险计划，而JEEVANASHA是由人寿保险公司提供的。竞争带来了很多新成员。占了世界人口的百分之八十六的新兴市场，包括一些国家像中国（13亿人口），印度（11亿人口）和印度尼西亚（02亿人口），占全球经济产出的百分之二十三。2003年，这个新兴市场占了全球寿险保费的百分之十一。在接下来的五十年，巴西，俄罗斯，印度和中国将成为世界经济一股更强大的力量。有几家公司进入了健康保险市场，同时十多家公司与外国的合作伙伴有联系。二十一世纪，经济的增长将来自于韩国，中国，台湾，南非和印度。全球寿险市场维持在15212亿美元的水平，而
45、非寿险市场占了9224亿美元。美国约占了24436亿的全球保险市场的三分之一，日本以206的份额位于第二位。印度以9933亿美元的年保费额排在第二十三位，占了04的份额。印度的人寿保险额只占到了国内生产总值的18。GIC和其附属公司投资所得的收入为249176亿卢比。到2010年，预计印度的保险市场保费总额可以攀升到250亿美元，假设国内生产总值每年增长百分之七。印度的医疗行业目前价值73000卢比，大概是其国内生产总值的百分之四。业内人士预计未来六年会以百分之十三的速度增长，每年增长9000亿卢比。在过去的五年，在医疗保健开支较多的印度人身上已经有了一个态度的转变。随着新兴的保险部门私有化，
46、印度的保险业存在着一个巨大的机会。随着全球总收入达到了约28万亿美元，这是世界上最大的医疗保险行业，印度将成为新兴的主要成员不仅仅由于庞大的国民总数。据保险监督管理和发展局指出，印度的医疗保险行业会保持在过去十年中同软件与制药行业同样的指数增长。其次，保险监督管理和发展局解释，只有百分之十的潜力已经被挖掘，市场研究表明，在未来几年会保持百分之三十五的增长率。总之，印度有一个庞大的人口，但目前只有200万人口享受MEDICLAIM医疗计划。改行业的吸引力使越来越多的公司进入这个领域。私人医疗保险的出现还没有对印度医院的竞争或操作方式产生很大的压力。机构客户（政府机构的工作人员或公司报销医疗费用的
47、雇员）已经成为经常出现的重要群体和利润丰厚的业务。印度信用评级机构（互联网内容评级协会）观察到，大部分医院受益于新兴的私营健康保险公司，同时已成立管理系统为登记的客户服务。非现金索赔功能是健康保险增长的另一个原因，已由很多私人保险公司说明。国家卫生政策（天然保健产品）提出了到2010年公共卫生支出占国内生产总值的比例从09到2的目标。很多公司申明会在市场上推出新产品，从智能卡到病人指导服务。所有这一切都有望降低医疗保健的成本和使该行业更专业。不过，据预计，在印度，761亿美元的医疗保险业务到2005年会膨胀5倍至四十亿，大多数进入印度的外国公司已经决定把重点放在人寿保险单上，而不单单是医疗保险上。同时，已经有公司比如BAJAJALLIANCE利用非现金索赔功能推出一个MEDICLAIM计划。最大的优点在于，在这样的计划之下，投保人不需要解决其前期的住院费用，然后向保险公司提出索赔。相反，保险人代表投保人解决了医疗费用。这是目前目前的政府资讯中心的MEDICLAIM政策中缺少的东西，这就要求患者向保险公司提交在医院治疗费用的账单。另外一个问题是，由于涉及很多官方程序，得到索赔款往往需要很长时间。出处印度希马古普塔，医疗保险在印度卫生保健管理体系中的作用，国际健康护理质量保障期刊,2006年第五期379391
