Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

Zandian, Hamed,Takian, Amirhossein,Rashidian, Arash,Bayati, Mohsen,Moghadam, Telma Zahirian,Rezaei, Satar,Olyaeemanesh, Alireza The Korean Society for Preventive Medicine 2018 예방의학회지 Vol.51 No.2

Objectives: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households' income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

Hamed Zandian,Amirhossein Takian,Arash Rashidian,Mohsen Bayati,Telma Zahirian Moghadam,Satar Rezaei,Alireza Olyaeemanesh 대한예방의학회 2018 예방의학회지 Vol.51 No.2

Objectives: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

독립 이후, 카자흐스탄의 의료민영화 추진 과정과 향후 과제

김태경,이지은 한국외국어대학교(글로벌캠퍼스) 러시아연구소 2024 슬라브연구 Vol.40 No.1

카자흐스탄 정부는 2015년 12월에 ‘2016-2020 종합 민영화 계획’, 2020년 12월에는 ‘2021-2025 종합 민영화 계획’에 대한 정부결의안을 채택하며, ‘민영화’ 추진에 대한 카자흐 정부의 의지를 표명했다. 실제로 카자흐스탄은 2016년부터 국가의 재정 건전성 강화를 위해 정부의 재산을 매각하는 방식 등으로민영화를 적극 추진하고 있다. 사실 카자흐스탄의 민영화는 1990년대부터 시작되었다고 볼 수 있다. 다만, 에너지⋅통신⋅언론 등의 분야에서 민영화가 비교적 활발하게 진행된 것에 비해, ‘보건⋅의료’는 분야의특수성으로 인해 다소 제한적인 민영화가 이루어진 것이 특징이다. 또한 보건⋅의료 분야의 경우, 2000년대 이후부터는 민영화보다는 정부 주도로 열악했던 보건⋅의료 인프라 개선을 위한 다양한 개혁⋅발전정책이 추진되었다. 하지만 세계 경제위기(2008) 이후, 경제성장률이 하락하며 전반적인 국가 재정 상황이 악화하자, 카자흐 정부는 보건 재정 건전성 강화를 위한 방안을 찾기 시작했고, 2010년대 중반부터는 ‘보건ㆍ의료’의민영화도 본격적으로 추진하였다. 이를 주도한 것은 당시 보건부 장관이었던 비르타노프(Birtanov)였는데, 그의 재임 시(2017.1–2020.6) 총 9개의 국영 보건ㆍ의료 관련 기관이 민영화되었다. 하지만 2020년6월 비르타노프가 경질되고, 코로나19 상황을 겪으며, 최근의 보건ㆍ의료 민영화 속도는 다소 늦춰지는모양새다. 더욱이 2023년 2월, 자마이바예프(Jamaibayev) 재무부 장관은 ‘사회적 대상’이란 단어를 사용하며, ‘사회적 대상’에 포함되면 민영화에서 제외될 수 있다고 공식 발표했다. ‘보건ㆍ의료’는 민심과 국가통치력에 직결되는 부분이기에 나자르바예프(Nazarbaev)의 영향력을 약화하려 하는 토카예프(Tokaev)로서는 민심 이반이 우려되는 보건ㆍ의료의 급속한 민영화가 부담될 법하다. 따라서 향후 보건ㆍ의료 분야는민영화 대상에서 축소 또는 제외될 가능성이 높다. 이에 향후 카자흐스탄 ‘보건ㆍ의료’ 민영화 정책의 추이를 유의 깊게 살펴보며, 전반적 보건ㆍ의료 정책의 변동 및 발전 방향 등에 관한 연구를 이어가야 할 것이다. The Kazakh government adopted “a resolution on the Comprehensive Privatization Plan for 2016-2020” in December 2015 and “another resolution on the Comprehensive Privatization Plan for 2021-2025” in December 2020. These resolutions demonstrate the Kazakh government’s commitment to privatization efforts, and Kazakhstan has in fact been pursuing privatization since 2016, primarily by selling government assets to strengthen the country’s fiscal health. Privatization in Kazakhstan began in the 1990s, immediately after gaining independence. However, while privatization has progressed relatively briskly in sectors such as energy, telecommunications, and media, the healthcare and medical sector has seen somewhat limited privatization due to the nature of the field. In the case of this sector, various reforms and development policies to improve inadequate healthcare and medical infrastructure have been pursued under the Kazakh government’s lead rather than through privatization since the 2000s. However, following the global economic crisis in 2008 and the subsequent decline in economic growth rates, along with the overall worsening of national fiscal conditions, the Kazakh government began seeking measures to ensure the fiscal soundness of the healthcare sector. From the mid-2010s, they actively pursued the privatization of healthcare and medical sector. This was spearheaded by Birtanov, then Minister of Health, during his tenure from January 2017 to June 2020, during which a total of nine state-run healthcare and medical institutions were privatized. However, with Birtanov’s replacement in June 2020 and the challenges posed by the COVID-19

의료기관 자본조달 우선순위 분석

이우천,안영창 한국병원경영학회 2008 병원경영학회지 Vol.13 No.3

According to Myers(1984) and Myers and Majluf(1984), there exists a financial hierarchy from internal to external financing, from long-term debt to equity, due to information costs. The purpose of this study is to assess the profit-making corporation of healthcare institutions. Data was collected from 130 hospital presidents and financial managers. We analysed the frequency and one way ANOVA by SPSS Windows 14.0K. The major findings of the study were as follows: We found that the priorities which a healthcare institutions financing were internal financial, other allowance, a credit loan, a security loan, and a lease through this study. The priorities which a healthcare institutions raised the capital differed as to the number of beds and revenues. The priorities were no difference from ownership, location and an annual business. According to Myers(1984) and Myers and Majluf(1984), there exists a financial hierarchy from internal to external financing, from long-term debt to equity, due to information costs. The purpose of this study is to assess the profit-making corporation of healthcare institutions. Data was collected from 130 hospital presidents and financial managers. We analysed the frequency and one way ANOVA by SPSS Windows 14.0K. The major findings of the study were as follows: We found that the priorities which a healthcare institutions financing were internal financial, other allowance, a credit loan, a security loan, and a lease through this study. The priorities which a healthcare institutions raised the capital differed as to the number of beds and revenues. The priorities were no difference from ownership, location and an annual business.

의료기관 자본조달 우선순위 분석

이우천 ( Woo Chun Lee ),안영창 ( Young Chang Ahn ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.3

According to Myers(1984) and Myers and Majluf(1984), there exists a financial hierarchy from internal to external financing, from long-term debt to equity, due to information costs. The purpose of this study is to assess the profit-making corporation of healthcare institutions. Data was collected from 130 hospital presidents and financial managers. We analysed the frequency and one way ANOVA by SPSS Windows 14.0K. The major findings of the study were as follows: We found that the priorities which a healthcare institutions financing were internal financial, other allowance, a credit loan, a security loan, and a lease through this study. The priorities which a healthcare institutions raised the capital differed as to the number of beds and revenues. The priorities were no difference from ownership, location and an annual business.

Financing of Healthcare Facilities in Pension System Assets of Ecologically Problematic Regions in Kazakhstan

YESSENTAY, Aigerim,KIREYEVA, Anel A.,KHALITOVA, Madina,ABILKAYIR, Nazerke A. Korea Distribution Science Association 2020 The Journal of Asian Finance, Economics and Busine Vol.7 No.7

The purpose of the study is a theoretical and practical justification for building a mechanism for financing health facilities based on public-private partnerships from a pension fund in regions with environmental problems. The theoretical background is built on works of local and foreign authors on state and non-state pension provisions issues, pension funds' assets management. This study provides an analysis of the health status of the population of the Kyzylorda region; it analyzes also the worldwide and Kazakhstan practice of investing pension funds and implementing projects. There has been legislative and methodological framework for financing health projects based on public-private partnerships in Kazakhstan. The scientific methods considered in this study made it possible to develop a mechanism for financial support for the modernization of a healthcare facility using the budget of pension funds. The authors point out possible risks in the implementation of projects in the field of healthcare and make recommendations on the construction a mechanism for financing healthcare facilities in the regions of Kazakhstan with environmental problems. In addition, they underline the key insights of the analysis, which are requisites for identifying the profitability of project for business and social effects for the public. Factors influencing efficacy, effect and implementation risks identified.

MRI 외부병원 판독 수가 인상의 효과 분석: 뇌 관련 자기공명영상을 중심으로

김록영 ( Logyoung Kim ),사공진 ( Jin Sakong ),조민호 ( Minho Jo ),위세아 ( Seah Wee ),이진용 ( Jinyong Lee ),김용규 ( Yongkyu Kim ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.3

Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

Social Health Insurance for Informal Sector on the path to Universal Health Coverage: A Case of Kenya National Hospital Insurance Fund (NHIF)

정진경(Jin-Kyung Jung) 국제개발협력학회 2021 국제개발협력연구 Vol.13 No.2

연구목적: 본고는 케냐 경제에서 80%에 육박하는 비율을 차지하고 있는 비공식 부문에 종사하고 있는 인구의 보험가입과 유지를 저해하는 요소에 대한 고찰을 통해 국가병원보험기금(NHIF)의 재원조달 및 운영체계가 보편 적 의료달성에 기여할 수 있는 구조인지를 살펴보고자 한다. 연구의 중요성: 건강보험을 실시하고 있는 아프리카 국가 중 하나로 케냐 정부는 2022년까지 전국민에 대한 보편적 의료보장 달성을 천명하였으며 국가병원보험기금을 중심으로 전 국민의 보험가입을 전략적으로 추진해 왔으나 2018년 기준 NHIF 가입 비율은 전체 인구의 20%에도 미치지 못한다. 이는 80% 이상의 국민이 의료서비스 이용 시 발생하는 경제적 비용에 대한 보호를 받지 못한다는 것을 의미한다. 연구방법론: 분석을 위한 데이터는 케냐의 비공식 부문 인구 및 보건의료분야에 대한 동료검토를 거친 문헌과 관련 정부 문서에서 취합하였으며 효율성(efficiency), 자원 배분에 있어서의 형평성(equity), 투명성(transparency) 과 책임성(accountability)을 분석의 틀로 삼아 보험재정체계를 평가하였다. 연구결과: 분석 결과, 불평등한 보험기여금과 요양급여, 임의가입, 사전보험료 납입 방식의 의료보험은 비공식경제 부문 인구에 가입에 대한 유인을 제공하기 어려운 것으로 드러났다. 등록에 필요한 서류 및 복잡한 과정으로 비롯된 행정적 비효율성 또한 가입을 저해하는 요소로 작용한다. 다중지급방식은 의료서비스 공급자들이 높은 요양급여가 책정되어 있는 공무원 가입자들을 우선시하도록 한다. 보험혜택에 대한 일관성이 결여된 정보와 취약한 감시구조는 의료서비스 질에 대한 모니터링을 저해하고 부정한 보험청구와 부패를 조장하는 것으로 드러났다. 그 결과 비공식부문 인구의 보험가입과 혜택수급 비율은 낮을 수밖에 없고 환자부담 의료비용에 대한 보호를 제공받지 못한다. 결론 및 시사점: 결론적으로 케냐정부가 목표로 하는 전 국민에 대한 보편적 의료보장 달성을 위해서는 경제의 3/4이상을 차지하고 있는 비공식경제부문에 종사하는 인구의 보험가입과 유지가 이루어져야 달성가능하며 이를 가능하게 하기 위해서는 현재 국가병원보험기금의 재원 창출 및 운영 구조를 개선하여 효율성, 형평성, 투명성과 책임성을 향상시켜야 한다. 아울러, 비공식 경제부문 인구에 대한 체계적이고 다양한 연구가 뒷받침되어 이 부문 인구가 직면하고 있는 건강 관련 위험과 건강실태에 대한 이해를 촉진하고 보험제도 개선에 반영되어야 한다. Purpose: This paper aims to appraise if the health financing system of the National Hospital Insurance Fund (NHIF) in Kenya is feasible to attain universal health coverage (UHC) with a specific research interest in expanding enrolment and retention of the population in the informal economy. Originality: The Kenyan government has committed to achieving UHC by 2022, and the NHIF has been used as one of the key strategies to expand population coverage with a contributory, prepaid mechanism through several reforms undertaken. Nevertheless, NHIF coverage is less than one-fifth of the population as of 2018. This means that more than 80 percent of the total population needs financial protection from healthcare costs. Methodology: Comparable information and secondary data on the Kenya informal sector and health domain were compiled from published and grey literature. Health financing configurations of the NHIF were assessed based on the framework that considers efficiency, equity in resource distribution, transparency, and accountability. Result: It was found that inequitable premium contributions rate and benefit package do not appeal to informal sector individuals to be a member of the prepaid insurance scheme. Administrative inefficiency serves as a deterrence to enrolment. Differential payer mechanisms incentivize the providers to prioritize civil servants members for a higher reimbursement rate. Inconsistent information on the entitlements and weak accountability mechanism undermined monitoring of the quality of service provided and encouraged fraudulent claims and corruption cases. Conclusions and Implication: The paper concludes that the health financing arrangement of the NHIF is required to improve its equity, efficiency, and transparency/accountability to expand population coverage to the informal sector and to attain UHC in Kenya. Vigorous additional research on the marginalized population group is urged to fill the knowledge gap in risk exposure and health outcomes per subgroup in the informal sector.

영국 노동당 정부의 국영보건서비스 개혁(1998-2010)에 대한 고찰

윤태호(Yoon, Tae-Ho) 비판과 대안을 위한 사회복지학회 2013 비판사회정책 Vol.- No.40

2차 세계대전 종전 직후인 1948년에 탄생한 영국의 국영보건서비스는 보편주의와 서비스 제공의 포괄성에 근거하여 무상의 의료서비스를 제공하는 제도로 개혁이 이루어질 때마다 전 세계 보건정책 결정자들의 높은 관심을 받아 왔다. 본 논문에서는 지난 노동당 정부 아래에서 추진되었던 국영보건서비스의 개혁 내용을 검토한다. 먼저, 노동당 정부의 국영보건서비스 개혁배경을 살펴보고, 개혁의 내용을 목표의 설정, 보건 재정체계, 보건의료 공급체계로 구분하여 탐색한다. 마지막으로, 개혁의 성과를 접근성, 효과성, 형평성, 효율성, 국민 만족도의 측면에서 평가해 본다. 지난 노동당 정부 아래에서 국영보건서비스에 대한 목표량의 설정과 이를 달성하기 위한 구체적 투자계획의 수립과 대대적인 예산의 투입, 서비스 제공 과정에서의 효율성을 높이기 위한 정책 수단 등을 통해 획기적인 대기시간의 감소, 의료서비스의 질 향상, 국민들이 만족하는 국영보건서비스로 자리매김하는 성과를 거두었다. 하지만, 민간자본의 참여 확대 정책은 국영보건서비스의 재정 부담으로 다가왔고, 경쟁을 통해 효율성을 높이려는 각종 정책들은 현 연립정부의 국영보건서비스 시장화 개혁의 밑거름을 제공해준 것으로 평가할 수 있다. 영국은 한국의 보건의료체계와 상당한 차이가 있음에도 불구하고, 명확한 목표 설정, 의료 공급자의 자발적 참여를 위한 인센티브의 적절한 활용, 병원운영에서의 민주적 관리 기전의 확보, 시장 실패 부작용에 대한 충분한 고려등은 한국의 보건의료 개혁 과정에서 고려해야 할 교훈이라 할 수 있다. The National Health Service in the United Kingdom was the first health system to offer free health care service to whole population based on comprehensiveness and universalism in the western countries. Also, its reform always has paid worldwide attention to health policy makers whenever it has made. The aim of this paper is to offer the successes and the limitations of the recent NHS reform during New Labor Government period(1998-2009). This study investigates the characteristics of the labor government’s NHS reform in three dimensions: setting goals or targets, healthcare financing system, and healthcare provision system. Finally, this study reviews the outcomes of the NHS reform in terms of accessibility, effectiveness, equity, efficiency, and user’s satisfaction. In conclusion, NHS has been transformed into a high-performing health system since 1998, but there has been a big criticism on privatization or marketization of the NHS. UK?s NHS system is considerably different from that of Korea, although, the experience of recent NHS reform provides some useful policy implications to the Korean healthcare system: importance of definite target setting, incentive for voluntary participation of medical providers, ensuring participation of patients or community people and democratic process in hospital management, and a full consideration of market failure problems in health care reform.

듀퐁 분석을 통한 한국 병원계의 경영 현황 분석

노진원,이해종,차선정,이예진 한국병원경영학회 2018 병원경영학회지 Vol.23 No.4

Purposes: The hospitals needs to generate a minimum profit, in order to perform its own role such as providing high-quality medical services. The demand for hospital management is increasing, as the social demands are diversified and the financial transparency is emphasized. The purpose of this study is to compare hospitals management based on Dupont Identity, by various hospital classification. Methodology: This study is based on ʻ2016 Statistics for Hospital Managementʼ provided by the Korea Health Industry Development Institute. The hospitals were classified according to the scope of care, the type of establishment, the location, and the number of beds. We analyzed the general and financial characteristics of over 337 hospitals using the method of Dupont Identity. Findings: Net profit margin (PM) has the biggest impact on return of equity (ROE). By the number of beds, general hospital with 160-299 beds have the highest return on equity (ROE). By location, hospitals in local municipalities have higher return on equity than hospitals in urban municipalities. According to the type of establishment, public hospitals have lower business performance, and although they invest more than private hospitals. Practical Implications: This study can inspire interest and provide understanding in hospital management and financial structure, by analyzing through an intuitive indicator named Dupont identity. It is possible to provide basic data for hospital management methods for each financial elements, in order to increase the profitability of hospitals.