医療保険制度改革と管理競争：オランダの経験に学ぶ

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎㧦ࠝ࡜ࡦ࠳ߩ⚻㛎ߦቇ߱

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㧔৻ᯅᄢቇᄢቇ㒮⚻ᷣቇ⎇ⓥ⑼㧘࿖㓙࡮౏౒᡽╷ᄢቇ㒮ಎᢎ᝼㧕

㧔೨ળ⸘ᬌᩏ㒮․೎⎇ⓥቭ㧕

䋱䋮䈲䈛䉄䈮㩷

90 ᐕઍએ㒠᰷Ꮊ⻉࿖ߢߪޟᏒ႐㧔┹੎㧕ේℂޠߩዉ౉ࠍࡌ࡯ࠬߣߒߚක≮೙ᐲᡷ㕟߇⹜ߺࠄࠇߡ߈ߚޕ 80 ᐕઍ߹ߢߩޟ✚੍▚೙ޠ߿ޟ∛ᐥⷙ೙ޠࠍ฽߻✚㗵▤ℂ᡽╷ߪක≮⾌ߩ᜛ᄢࠍᛥ߃ࠆߎߣߢߪ৻ቯߩᚑ ᨐࠍ᜼ߍߡ޿ߚ߇㧘ࡒࠢࡠ࡮࡟ࡌ࡞ߢߺࠆߣක≮⾗Ḯߩല₸⊛ߥ㈩ಽࠍ៊ߥߞߡ޿ߚߣߐࠇࠆޕߘߩౖဳ ଀߇⧷࿖╬ߦߺࠄࠇࠆᓙᯏ࡝ࠬ࠻ߢ޽ࠆޕߘ߽ߘ߽៊ᄬ଻㓚ߐࠇࠆ౏⊛଻㒾⠪㧔∔∛㊄ᐶ㧕ߦߪ⥄ᓞ⊛ߦ ࠦࠬ࠻೥ᷫ߿ක≮ߩ⾰ߩะ਄ߦദ߼ࠆ⺃࿃߇ߥߊ㧘ޟࠨ࡯ࡆࠬߩ⾰ࠍ៊ߥ߁ߎߣߥߊක≮⾌ߩㆡᱜൻޠ߇ㅴ ߼ࠄࠇߡ߈ߚߣߪ⸒޿㔍޿ޕߘߎߢ90 ᐕઍ߆ࠄߪࡑࠢࡠ▤ℂ߆ࠄࡒࠢࡠ࡮࡟ࡌ࡞ߢߩක≮⾗Ḯ㈩ಽ࡮⺃࿃ ലᨐࠍ㊀ⷞߔࠆᣇะ߳ߩක≮᡽╷ߩォ឵߇ߥߐࠇߚޕౕ૕⊛ߦߪ࠼ࠗ࠷߿ࠝ࡜ࡦ࠳ߦ߅ߌࠆട౉⠪ߦࠃࠆ ଻㒾⠪㧔∔∛㊄ᐶ㧕ߩ⥄↱ߥㆬᛯ㧘଻㒾⠪ߦࠃࠆක≮ᯏ㑐ߩㆬᛯ߿୘೎੤ᷤߥߤ߇᜼ߍࠄࠇࠆޕ޿ߕࠇߩ ᡷ㕟߽㧘Ꮢ႐㧔┹੎㧕ේℂߩዉ౉ߣಽᮭൻ㧔଀㧦଻㒾⠪ߩⵙ㊂ߩ᜛ల㧕ࠍࡌ࡯ࠬߣߒߡ޿ߚޕߚߛߒ㧘␠ ળ଻㒾ߩℂᔨߚࠆ␠ળㅪᏪߪၷᜬߒߡ߅ࠅ㧘౏⊛ක≮଻㒾೙ᐲ⥄૕ߩ᳃༡ൻ߿࿖᳃ోߡ߳ߩᦨૐ㒢ߩක≮ ߳ߩࠕࠢ࠮ࠬߩ᡼᫈ࠍᗧ࿑ߒߡ޿ߚࠊߌߢߪߥ޿ޕ ࠊ߇࿖ߢ߽଻㒾⠪ᯏ⢻ߩᒝൻ߇࿑ࠄࠇߡ޿ࠆޕ2006 ᐕߩක≮଻㒾೙ᐲᡷ㕟ߦ߅޿ߡ᡽▤ஜ଻߿Ꮢ↸᧛࿖ ଻ߩㇺ㆏ᐭ⋵න૏ߢߩಽഀ࡮⛔ว߿࿾ၞဳஜ଻⚵วߩ⸳┙ߥߤߪ଻㒾⠪ߩౣ✬ᚑ࡮⽷᡽ၮ⋚ߩ቟ቯൻߣว ࠊߖߡ㧘ޟ଻㒾⠪ᯏ⢻߇⊒ើߐࠇࠆਥ૕ߦࠃࠆ଻㒾ㆇ༡ޠࠍ⁓޿ߣߒߡ޿ࠆޕߘߩߚ߼ޟౣ✬ߐࠇߚ଻㒾⠪ ߪ㧘࡟࠮ࡊ࠻ὐᬌ╬ߩข⚵ࠍᦝߦᒝൻߔࠆߣߣ߽ߦ㧘ⵍ଻㒾⠪⋧⺣㧘࿾ၞߩක≮ࠨ࡯ࡆࠬ╬ߦ㑐ߔࠆᖱႎ ឭଏ㧘߈߼⚦߆ߥ଻ஜ੐ᬺߦߟ޿ߡㇺ㆏ᐭ⋵න૏ߢ౒หታᣉࠍផㅴߔࠆޠ߽ߩߣߐࠇࠆ 1)ޕஜᐽჇㅴኻ╷ ߦߟ޿ߡ߽2008 ᐕ 4 ᦬ࠍ⋡ㅜߦޟ↢ᵴ੍㒐ߦߟ޿ߡߩ଻㒾⠪ߩᓎഀࠍ᣿⏕ߦߒ㧘ⵍ଻㒾⠪࡮ⵍᛔ㙃⠪ߦኻ ߔࠆലᨐ⊛࡮ല₸⊛ߥஜ⸻࡮଻㒾ᜰዉࠍ⟵ോઃߌࠆޠ2)ߣߒߡ޿ࠆޕߣߪ޿߃㧘଻㒾⠪⥄り߇ක≮ᯏ㑐ࠍ ㆬ೎ߒߚࠅ㧘⸻≮ႎ㈽߿ක≮ߩ⾰ߦߟ޿ߡ୘೎ߦ੤ᷤࠍⴕߞߚࠅߢ߈ࠆࠊߌߢߪߥ޿ޕ⟵ോ࡮⽿છࠍ⽶ߞ * ᧄⓂߪ⪺⠪߇ળ⸘ᬌᩏ㒮․೎⎇ⓥቭ࿷છਛߩ 2006 ᐕ 9 ᦬ߦታᣉߒߚᶏᄖⴕ᡽ታᘒ⺞ᩏߩᚑᨐߦၮߠߊ߽ߩߢ޽ࠆޕ ** 1969 ᐕ↢߹ࠇޕ92 ᐕ৻ᯅᄢቇ⚻ᷣቇㇱතᬺ㧘98 ᐕࠢࠖ࡯ࡦ࠭ᄢቇ⚻ᷣቇㇱ Ph.D ขᓧޕ99 ᐕ৻ᯅᄢቇᄢቇ㒮⚻ᷣቇ⎇ⓥ⑼ኾછ⻠Ꮷࠍ⚻ߡ㧘 02 ᐕࠃࠅ⃻⡯ޕߎߩ㑆㧘05 ᐕ 4 ᦬߆ࠄ 07 ᐕ 3 ᦬߹ߢળ⸘ᬌᩏ㒮․೎⎇ⓥቭޕኾ᡹㧦࿾ᣇ⽷᡽㧘౏౒⚻ᷣቇ㧘␠ળ଻㓚ޕᚲዻቇળ㧦ᣣᧄ⚻ᷣ ቇળ㧘ᣣᧄ⽷᡽ቇળޕ _{ޟක≮଻㒾೙ᐲ૕♽෸߮⸻≮ႎ㈽૕♽ߦ㑐ߔࠆၮᧄᣇ㊎ߦߟ޿ߡޠ㧔ᐔᚑ15 ᐕ 3 ᦬ 28 ᣣ㑑⼏᳿ቯ㧕} _{ޟஜᐽ଻㒾ᴺ╬ߩ৻ㇱࠍᡷᱜߔࠆᴺᓞ᩺ߦߟ޿ߡޠ㧔ෘ↢ഭ௛⋭㧕}

ߡ߽ක≮ᯏ㑐߳ߩⷙᓞઃߌ╬㧘ᔅⷐߥᮭ㒢߇ઃਈߐࠇߥ޿ߥࠄ߫㧘଻㒾⠪߇ක≮⾌ㆡᱜൻߦะߌߚദജࠍ ᛄ߁૛࿾ߪߥ޿ޕ ᧄⓂߢߪ㧘ࠝ࡜ࡦ࠳ߩ⚻㛎߆ࠄࠊ߇࿖ߩ޽ࠆߴ߈ක≮଻㒾೙ᐲᡷ㕟ߦߟ޿ߡ⠨߃ߡ޿߈ߚ޿ޕߒ߫ߒ߫㧘 ┹੎ේℂߪല₸ᕈߩㅊ᳞ߣᒙ⠪ߩಾᝥߡࠍ᜗ߊߣ⸒ࠊࠇߡ߈ߚޕߒ߆ߒ㧘┹੎ࡔࠞ࠾࠭ࡓߪߘࠇ߇ㆡಾߦ ▤ℂߐࠇߡ޿ࠆߥࠄ߫㧘␠ળ଻㒾ߩޟㅪᏪޠ㧔ౣಽ㈩㧕ߩේೣߣ⍦⋫ߒߥ޿ߎߣ߇㧘ࠝ࡜ࡦ࠳ߩᡷ㕟߆ࠄ߽ ᣿ࠄ߆ߦߥࠆޕᧄⓂߩ᭴ᚑߪᰴߩߣ߅ࠅߢ޽ࠆޕ2 ▵ߢߪ੺⼔଻㒾㧘᳃㑆଻㒾ࠍ฽߻ਃጀ߆ࠄߥࠆࠝ࡜ࡦ ࠳ߩක≮଻㒾೙ᐲࠍ᭎ⷰߔࠆޕ90 ᐕઍߦ౏⊛ක≮೙ᐲߩᨒౝߢዉ౉ߐࠇߚޟ▤ℂ┹੎ޠߦߟ޿ߡߪ 3 ▵ߢ ㅀߴࠆޕ଻㒾⠪㑆ߢߩ┹੎ࠍଦߒߟߟ␠ળㅪᏪࠍᔀᐩ㧘߆ߟ࡝ࠬࠢㆬᛯߩ⺃࿃ࠍㆱߌࠆߚ߼ߩޟ࡝ࠬࠢ᭴ ㅧ⺞ᢛࡊ࡟ࡒࠕࡓޠߩℂ⺰ߣታ㓙ߪ4 ▵ߢ⺑᣿ߔࠆޕࠝ࡜ࡦ࠳ߪ 2006 ᐕߦᓥ᧪ߩ∔∛㊄ᐶߣ᳃㑆଻㒾ࠍ⛔ วߒߚක≮଻㒾೙ᐲᡷ㕟ࠍታᣉߒߡ޿ࠆޕ5 ▵ߢߪߘߩ᭎ⷐߦߟ޿ߡㅀߴࠆޕ6 ▵ߪ⚿⺆ߢ޽ࠆޕ

䋲䋮䉥䊤䊮䉻䈱ක≮଻㒾೙ᐲ䈱᭎ⷐ㩷

ߪߓ߼ߦࠝ࡜ࡦ࠳ߩක≮೙ᐲࠍ᭎ⷰߒߚ޿ޕ࿑⴫1 ߩߣ߅ࠅ㧘ห࿖ߩ৻ੱᒰߚࠅක≮⾌㧔2004 ᐕ㧕ߪ 3,661 ࡙࡯ࡠߢ㧘GDP ߩ 12.8㧑޽߹ࠅࠍභ߼ࠆ3)_{ޕห࿖ߩක≮଻㒾೙ᐲߪࠊ߇࿖ห᭽㧘␠ળ଻㒾ᣇᑼࠍၮ␆ߦ㧔1㧕} 㐳ᦼ౉㒮߿੺⼔╬ߦⷐߔࠆක≮⾌ࠍ⵬ఘߔࠆ╙1 ጀ㧘㧔2㧕ᕆᕈ∔ᖚࠍਥߦኻ⽎ߣߔࠆ╙ 2 ጀ㧘㧔3㧕౏⊛ක ≮⛎ઃએᄖࠍ฽߻╙3 ጀ߆ࠄ᭴ᚑߐࠇࠆޕߎߩ߁ߜ㧘ᧄⓂ߇⌕⋡ߔࠆߩߪ╙ 2 ጀߢ޽ࠆޕ ࿑⴫ 㪈㩷 䉥䊤䊮䉻䈱ක≮೙ᐲ䈱᭎ⷐ㩷 ৻ ੱ ޽ ߚ ࠅ ක ≮ ⾌ 2004 ᐕ 3,661 ࡙࡯ࡠ ක≮⾌㧔ኻGDP Ყ㧕 2004 ᐕ 12.80㧑 20 ᱦએਅ 24.3㧑 20 ᱦએ਄ 65 ᱦએਅ 61.4㧑 ੱ ญ ᭴ ᚑ 65 ᱦએ਄ 2006 ᐕ 14.3㧑 ੱญජੱ޽ߚࠅකᏧᢙ 3.1 ੱ ੱญජੱ޽ߚࠅ⋴⼔Ꮷᢙ 2003 ᐕ 13 ੱ ৻ ⥸ ∛ 㒮 7.2 ᣣ ᐔဋ࿷㒮ᣣᢙ ᄢቇ㧔ࠕࠞ࠺ࡒ࠶ࠢ㧕∛㒮 2003 ᐕ 8.7 ᣣ ක≮⾌ߦභ߼ࠆഀว㧔2000㧕 ╙㧝ጀ ․೎ක≮⾌⵬ఘ೙ᐲ 44㧑 ∔∛㊄ᐶ 37㧑 ╙2 ጀ ᳃㑆଻㒾 16㧑 ක≮଻㒾೙ᐲ ╙3 ጀ ⵬ቢ⊛଻㒾 3㧑 ಴ᚲ㧦ࠝ࡜ࡦ࠳ળ⸘ᬌᩏ㒮ឭଏ⾗ᢱ㧘Lamers et all㧔2003㧕 _{OECD ၮḰ㧔ޟ✚଻ஜක≮ᡰ಴ޠ㧕ߢߪ߆ࠆߣኻGDP Ყߪ 9.8㧑㧔2003 ᐕ㧕ߦ⇐߹ࠆ߇㧘ࠊ߇࿖ߩኻ GDP Ყ㧔หᐕ 7.9㧑㧕ࠃࠅ߽㜞޿ޕ}

╙ 㪈 ጀ䋺㪘㪮㪙㪱㩷 ╙1 ጀߦ޽ߚࠆޟ․೎ක≮⾌⵬ఘ೙ᐲޠ㧔AWBZ㧕 ߪ 1968 ᐕࠃࠅታᣉߐࠇ㧘㐳ᦼ౉㒮㧔৻ᐕએ਄㧕㧘♖ ␹⑼ᴦ≮ߩ߶߆㧘㜞㦂⠪࡮㓚ኂ⠪ߩߚ߼ߩᣉ⸳࡮࿷ቛ੺⼔ߥߤࠍࠞࡃ࡯ߔࠆ೙ᐲߢ޽ࠆ㧔ᑝἑ(2000)㧕ޕAWBZ ߪࠝ࡜ࡦ࠳ߩක≮ᡰ಴ߩ44㧑޽߹ࠅࠍභ߼ࠆ㧔࿑⴫ 1㧕ޕ⛎ઃ⾗ᩰߦᐕ㦂೙㒢ߪߥߊ㧘ࠝ࡜ࡦ࠳ዬ૑⠪࡮ⵍ ↪⠪ࠍኻ⽎ߣߒߚ࿖᳃ᒝ೙଻㒾ߢ޽ࠆޕ⛎ઃኻ⽎ߪ᜛ᄢߒߡ߈ߡ߅ࠅ㧘⃻࿷㧔2006 ᐕᤨὐ㧕ߪ㧔1㧕ኅ੐ េഥ㧔㘩੐ߩḰ஻㧘᝹㒰╬㧕㧘㧔2㧕り૕੺⼔㧘㧔3㧕⋴⼔࡮↢ᵴᜰዉ㧘㧔4㧕↢ᵴᡰេ㧘㧔5㧕㧔ᔃり㓚ኂ⠪߿໧ 㗴ⴕേ⠪߳ߩ㧕࠮࡜ࡇ࡯㧘㧔6㧕㧔∔∛߆ࠄߩ࿁ᓳᤨߩ㧕࡝ࡂࡆ࡝㧔ޟ╙ 3 ᰴ੍㒐ޠ㧕㧘㧔7㧕ᣉ⸳ࠤࠕߣ޿ߞߚ ޟᯏ⢻ޠ㧔Function㧕ࠍᜂ߁ޕᣉ⸳㧘࿷ቛ㧘࡝ࡂࡆ࡝࡮࠮ࡦ࠲࡯ߣ޿ߞߚଏ⛎ࡌ࡯ࠬߢߪߥߊ㧘ⷐ⺧ߐࠇࠆ ᯏ⢻㧔࠾࡯࠭㧕ߦၮߠ޿ߡ⾗ᩰⷐઙ㧔Entitlement㧕߇ቯ⟵ߐࠇࠆߩ߇․ᓽ⊛ߢ޽ࠆޕߎࠇߦࠃࠅ㧘㘃ૃߒ ߚࠨ࡯ࡆࠬ㧔ࠤࠕ㧕ࠍឭଏߔࠆਥ૕㧔∛㒮㧘ᣉ⸳㧘ࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ㧕߿ߘࠇࠄࠍ㔛ⷐߔࠆᖚ⠪ߪᡰ ᛄ޿㧘ⷙ೙࡮⋙〈਄㧘ห৻ߦᛒࠊࠇࠆޕ৻ᣇ㧘ࠊ߇࿖ߢߪᣉ⸳ࠤࠕ㧔㐳ᦼ≮㙃㧕ߢ޽ߞߡ߽․೎㙃⼔⠧ੱ ࡎ࡯ࡓ㧔␠ળ⑔␩ᴺੱ㧕㧘੺⼔⠧ੱ଻ஜᣉ⸳෸߮≮㙃ဳ∛ᐥ⟲ߩ㑆ߢߪⷙ೙㧔කᏧ࡮⋴⼔Ꮷߩ㈩⟎╬㧕߇⇣ ߥࠆޕᦝߦ㧘≮㙃ဳ∛ᐥ⟲ߢ޽ߞߡ߽ක≮଻㒾ㆡ↪ߣ੺⼔଻㒾ㆡ↪ߢߪ⛎ઃ▸࿐࡮ႎ㈽૕♽㧔੺⼔଻㒾ㆡ ↪ߪ౉㒮߇㐳ᒁ޿ߡ߽ක≮଻㒾ߩࠃ߁ߥႎ㈽ߩㅛᷫ೙ߪߥ޿㧕ߦ㆑޿߇޽ࠆޕ

AWBZ ߆ࠄ⛎ઃࠍฃߌࠆߦߪ㧘ޟࠤࠕ್ቯ࠮ࡦ࠲࡯ޠ㧔Care Indication Determination center㧔CIZ㧕㧕߆ࠄߩ ⹺ቯ߇ᔅⷐߢ޽ࠆޕᣣᧄߩ੺⼔଻㒾೙ᐲߩࠃ߁ߥⷐ੺⼔ᐲߦࠃࠆ඙ಽߪߥ޿߇㧘ᔅⷐߥࠤࠕߩ⒳㘃㧘ᤨ㑆㧘 ᦼ㑆ߥߤ߇CIZ ߦࠃߞߡ᳿߼ࠄࠇࠆޕࠊ߇࿖ߩ੺⼔଻㒾೙ᐲߣߩ㗼⪺ߥ⋧㆑ߪޟ୘೎ࠤࠕ੍▚ޠߣ޿߁ᒻ ߢߩ⃻㊄⛎ઃ߇⹺߼ࠄࠇߡ޿ࠆߎߣߦ޽ࠆޕߎߩ೙ᐲߪ1996 ᐕߦዉ౉ߐࠇ㧘AWBZ ኻ⽎⠪ߪᏗᦸߔࠇ߫㧘 ᒰዪ߇ᄾ⚂ߒߚ੐ᬺ⠪߆ࠄߩ⃻‛⛎ઃߦઍ߃ߡ㧘࿷ቛ੺⼔࡮ᡰេะߌߩ੍▚㧔⃻㊄⛎ઃ㧕ࠍฃߌขࠅ㧘੺ ⼔⠪߳ߩᡰᛄ޿ߦలᒰߔࠆ㧔CVZ(2005)㧕ޕ੺⼔⠪ߪኅᣖ㧘෹ੱ㧘ㄭ㓞૑᳃ߢ߽ࠃ޿ޕ㧔․ߦ⾗ᩰߪ໧ࠊࠇ ߥ޿ޕ㧕ታ㓙㧘੍▚4 ഀᒙ߇ࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ㧔ኅᣖ㧘⍮ੱ╬߳ߩᡰᛄ޿㧕ߦలߡࠄࠇߡ޿ࠆ㧔࿑⴫ 2㧕ޕ ੺⼔੐ᬺ⠪߆ࠄ⋥ធࠨ࡯ࡆࠬࠍ⾼౉ߔࠆߎߣ߽ߢ߈ࠆޕߚߛߒ㧘୘೎੍▚ࠍᣉ⸳ࠤࠕߦలᒰߔࠆߎߣߪ⹺ ߼ࠄࠇߡ޿ߥ޿ޕ   ࿑⴫ 㪉㩷 ୘೎䉬䉝੍▚㩷 ೑ ↪ ⠪ ᢙ 2005/9/1 ᤨὐ 77,883 ੱ ᦨૐ✚㗵㧔100 ਁ࡙࡯ࡠ㧕 994.3 ೑ ↪ ₸ 2005 ᐕ 85㧑 ࠣ ࡠ ࠬ 14,000 ⥄ Ꮖ ⽶ ᜂ 1,000 ᐔဋ੍▚㗵㧔࡙࡯ࡠ㧕 ࡀ ࠶ ࠻ 13,000 หዬੱ߳ߩᡰᛄ޿ 21㧑 หዬੱએᄖ߳ߩᡰᛄ޿ 17㧑 ࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ ว ⸘ 38%   

AWBZ ߪ᡽ᐭ߆ࠄߩ⵬ഥ㊄㧔౏⾌㧕ߩ߶߆଻㒾ᢱߦࠃߞߡ⾔ࠊࠇࠆޕ଻㒾ᢱߪᚲᓧߦኻߒߡ⺖ߐࠇ㧘2005 ᐕߩ଻㒾ᢱ₸ߪ13.45㧑ߢ޽ߞߚޕⵍ↪⠪ߩ AWBZ ଻㒾ᢱߪᚲᓧ⒢߿ઁߩ଻㒾ᢱߣวࠊߖߡḮᴰᓽ෼ߐࠇ ࠆ৻ᣇ㧘⥄༡ᬺ⠪࡮ᐕ㊄↢ᵴ⠪╬ߪ⒢ോ⟑߆ࠄ㧔ᚲᓧ⒢ห᭽㧕⾮⺖ᓽ෼ߐࠇࠆޕߥ߅㧘ࠤࠕ⛎ઃᤨߦߪ⥄ Ꮖ⽶ᜂ߽޽ࠆޕ⥄Ꮖ⽶ᜂߪ୘ੱߩ⺖⒢ᚲᓧ߿ዬ૑⁁ᴫ㧔࿷ቛ߆ᣉ⸳߆㧕ߦଐሽߔࠆޕ଻㒾⠪ߪ࿖ߢ޽ࠆ߇㧘 ੐ᬺ⠪ߣߩᄾ⚂╬଻㒾⠪ᯏ⢻ࠍ⊒ើߔࠆߩߪ࿾ၞߏߣߦ⸳ߌࠄࠇࠆࠤࠕ࡮ࠝࡈࠖࠬߢ޽ࠆ㧔ᄢ᫪(2001)㧕ޕ ╙ 㪉 ጀ㩷 ╙2 ጀߪ AWBZ ߦ฽߹ࠇߥ޿ᕆᕈ∔ᖚ㧘1 ᐕએౝߩ౉㒮ߥߤࠍࠞࡃ࡯ߔࠆ߽ߩߢ㧘2006 ᐕએ೨ߪ∔∛㊄ ᐶ෸߮᳃㑆଻㒾߇ਗ┙ߒߡ޿ߚޕක≮ᡰ಴ߦභ߼ࠆഀวߪ53㧑޽߹ࠅ㧘߁ߜ∔∛㊄ᐶ㧘᳃㑆଻㒾ߩࠪࠚࠕ ߪฦޘ37㧑㧘16㧑ߢ޽ࠆ㧔࿑⴫ 1㧕ޕ଻㒾⛎ઃߩ▸࿐ߦߪ৻⥸ක㧔GP㧕ฃ⸻㧘ኾ㐷කᴦ≮㧘౉㒮㧔1 ᐕએౝ㧕㧘 ᱤ⑼ᴦ≮㧔18 ᱦએਅ㧕࡮⟵ᱤ㧘ක≮ౕེ㧘ౝ᦯⮎࡮⮎೷ᴦ≮㧘಴↥㧘ᢇᕆゞ╬ᖚ⠪ㆇ៝㧘ℂቇ≮ᴺ㧘଻ஜ ᜰዉ߇฽߹ࠇࠆޕᚲᓧ߇৻ቯ㗵એਅߩⵍ↪⠪ߪ∔∛㊄ᐶ߳ߩട౉߇⟵ോઃߌࠄࠇߡ޿ࠆޕ2000 ᐕ߆ࠄߪૐ ᚲᓧߩ⥄༡ᬺ⠪㧔ㆊ෰3 ᐕߩޟ⺖⒢ᚲᓧޠᐔဋ 18,695 ࠡ࡞࠳࡯એਅ㧕߿ᐕ㊄ฃ⛎⠪㧔1,860 ࠡ࡞࠳࡯એਅ㧕 ߦ߽ട౉⟵ോ߇⺖ߖࠄࠇࠆߎߣߦߥߞߚ㧔Pott-Buter (2000)㧕ޕᓟㅀߔࠆࠃ߁ߦ∔∛㊄ᐶߪਛᄩၮ㊄㧔Central Fund㧕߆ࠄ㈩ಽߐࠇࠆޟ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓޠߣⵍ଻㒾⠪߆ࠄ⋥ធᡰᛄࠊࠇࠆ㧔ᚲᓧߦଐሽߒߥ޿㧕 ޟቯ㗵㧔৻ᓞ㧕଻㒾ᢱޠߦࠃߞߡࡈࠔࠗ࠽ࡦࠬߐࠇࠆޕᓟㅀߔࠆࠃ߁ߦ1992 ᐕએ㒠㧘ⵍ଻㒾⠪ߪ∔∛㊄ᐶ ࠍㆬᛯߢ߈ࠆࠃ߁ߦߥߞߚޕ 2006 ᐕએ೨㧘㜞ᚲᓧ⠪ߪ᳃㑆଻㒾߳છᗧട౉ߒߡ޿ߚޕ㧔ࠊ߇࿖ߣ⇣ߥࠅ㧘࿖᳃⊝଻㒾ߩ઀⚵ߺߦߪߥ ߞߡ޿ߥ߆ߞߚޕ㧕⑳⊛଻㒾ߪ∔∛㊄ᐶߣ߶߷ห৻ߩක≮࡝ࠬࠢࠍࠞࡃ࡯ߒߡ޿ࠆ߇㧘∔∛㊄ᐶߣ⇣ߥࠅ଻ 㒾ᢱߪ㧘ஜᐽ࡝ࠬࠢࠍ෻ᤋߔࠆࠃ߁᳿߹ߞߡߊࠆޕ⸻≮ᤨ⥄Ꮖ⽶ᜂ߇⺖ߖࠄࠇࠆ႐ว߽޽ࠆޕ߽ߞߣ߽㜞 ࡝ࠬࠢ㧘․ߦ㜞㦂⠪ߦኻߔࠆ଻㒾ᢱ߇ᕆ㛛ߒߚߩࠍฃߌߡ㧘86 ᐕ߆ࠄ଻㒾ᢱ₸ߦ೙㒢߇ട߃ࠄࠇࠆࠃ߁ߦ ߥߞߚޕ ࿑⴫ 㪊㩷 ଻㒾ળ␠ᢙ䈱ផ⒖㩷 2001 2002 2003 2004㧔ᐕ㧕 ∔ ∛ ㊄ ᐶ 25 25 22 22㧔␠㧕 ᳃ 㑆 ଻ 㒾 47 46 44 35㧔␠㧕 ว ⸘ 72 71 66 57㧔␠㧕 ಴ᚲ㧦ޟක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎޠ 2006 ᐕ㧘ක≮଻㒾Ꮢ႐ߢ 33 ߩක≮଻㒾ળ␠߇༡ᬺ㧘ߎࠇࠄࠍડᬺࠣ࡞࡯ࡊߏߣߦಽߌࠆߣ 14 ߩ଻㒾ឭ ଏ⠪ߦ߹ߣ߼ࠄࠇࠆ㧔ޟ2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽޠ㧕ޕක≮଻㒾ળ␠ᢙߪᄢ᏷ߦᷫዋߒߡ߈ߡ޿ࠆ㧔࿑ ⴫3㧕ޕ2003 ᐕߦߪ 66 ␠ߩ଻㒾ળ␠㧔∔∛㊄ᐶ࡮᳃㑆଻㒾㧕߇ሽ࿷ߒߚ߇㧘2004 ᐕߦߥࠆߣߘߩᢙߪ 57 ␠ߦᷫߞߚޕ޿ߊߟ߆ߩ଻㒾ળ␠ߪ㧘ว૬߿ᒁ⛮߉ߦࠃߞߡߘߩᏒ႐ࠪࠚࠕࠍ㧔ߐࠄߦ㧕᜛ᄢߒߡ޿ࠆ㧔ޟක ≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎޠ㧕ޕ⚿ᨐ⊛ߦ㧘৻ីࠅߩᏂᄢߥડᬺࠣ࡞࡯ࡊ߇⊒↢ߔࠆ৻ᣇߢ㧘ઁᣇߢߪ Ყセ⊛ዊߐߥක≮଻㒾ળ␠ߩࠣ࡞࡯ࡊ߽ሽ࿷ߔࠆߣ޿߁⁁ᴫ߇↢ߓߚޕ․ߦᒝ೙ஜᐽ଻㒾ળ␠߿᳃㑆଻㒾 ળ␠ࠍๆ෼ߒߚᄢᚻ5 ♽೉ߩᏒ႐භ᦭₸ߪ 72㧑޽߹ࠅߦ਄ࠆ㧔ޟක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎޠ㧕ޕ

╙ 㪊 ጀ㩷 ╙3 ጀߪ AWBZ ߿∔∛㊄ᐶ㧔౏⊛ක≮଻㒾㧕ߩ⛎ઃኻ⽎ߣߥࠄߥ޿ 18 ᱦએ਄ߩᱤ⑼㧘㜞ᐲవㅴක≮㧘 ઍᦧක≮㧘࿷ቛ੺⼔㧘੍㒐࡮ᬌᩏߥߤࠍࠞࡃ࡯ߔࠆޟ⵬ቢ଻㒾ޠ߆ࠄߥࠆޕߎߩ଻㒾ߪ᳃㑆଻㒾ߦࠃߞߡ ឭଏߐࠇ㧘⾼౉ߪછᗧߢ޽ࠆ߇㧘ⵍ଻㒾⠪ߩ⚂9 ഀ߇ട౉ߒߡ޿ࠆޕ౏⊛㧔ᴺቯ㧕⛎ઃߩ▸࿐ߩ೥ᷫߦ઻ ޿㧘ㆊ෰10 ᐕ㑆ߦ߅ߌࠆ⵬ቢ⊛଻㒾ߩᄁ਄㜞ߪ 14 ୚ߦჇᄢߒߡ޿ࠆޕ2004 ᐕߦߪ∔∛㊄ᐶߩ⛎ઃ▸࿐߇ ᄢ᏷ߦ೙㒢ߐࠇߡ޿ࠆ߇㧘೥㒢ߐࠇߚㇱಽߩᄢඨߪ㧘⵬ቢ଻㒾ߦᒁ߈⛮߇ࠇߚ㧔ޟක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎޠ㧕ޕ

䋳䋮▤ℂ┹੎䈱ዉ౉㩷

 ▤ℂ┹੎䈫䈲䋿㩷 ▤ℂ┹੎ߪ Enthoven(1988)ߦࠃߞߡ⊒ዷߐࠇߚ᭎ᔨߢ޽ࠅ㧘ࠝ࡜ࡦ࠳ࠍߪߓ߼᰷Ꮊ⻉࿖ߩක≮೙ᐲᡷ㕟 ߦᄙᄢߥᓇ㗀ࠍ෸߷ߒߡ޿ࠆޕ▤ℂ┹੎ߪ⥄↱┹੎ࠍᗧ๧ߒߥ޿ޕ౏⊛ක≮೙ᐲߩ᳃༡ൻ㧘޽ࠆ޿ߪⷙ೙ ✭๺ߣ޿߁ࠃࠅ߽㧘ⷙ೙ߩᄌᦝߣ޿߃ࠆߛࠈ߁ޕવ⛔⊛ߦ᡽ᐭߩⷙ೙ߪ┹੎ឃ㒰⊛ߢ޽ࠅ㧘଻㒾⠪߿ක≮ ᯏ㑐ߦࠃࠆഃᗧᎿᄦࠍଦߔߎߣߪߥ߆ߞߚޕߒ߆ߒ㧘ක≮ࠨ࡯ࡆࠬߩଏ⛎ᒻᘒ㧘㔛ⷐ߇ⶄ㔀ߦߥࠆ߶ߤ㧘 ߘߩోߡࠍ᡽ᐭ߇㓸ᮭ⊛ߦࠦࡦ࠻ࡠ࡯࡞ߔࠆߎߣߪ࿎㔍ߦߥߞߡߊࠆޕ୘೎ߩක≮࠾࡯࠭ߦ㑐ߔࠆᖱႎ෼ 㓸߿ଏ⛎૕೙߳ߩࡈࠖ࡯࠼ࡃ࠶ࠢߪᏒ႐ᯏ⢻ࠍ੺ߒߡⴕ߁㧘ߟ߹ࠅ㧘┹วߔࠆ଻㒾⠪ߦߘߩᓎഀࠍᆔߨࠆ ߎߣ߇߻ߒࠈല₸⊛ߣ޿߃ࠆޕ᡽ᐭߪޟࠬࡐࡦࠨ࡯ޠߣߒߡⵍ଻㒾⠪ߩ೑⋉ࠍઍᑯ㧘Ꮢ႐ߩஜోߥᯏ⢻ࠍ ࠨࡐ࡯࠻ߔࠆޕౕ૕⊛ߦ޿߃߫㧘᡽ᐭߪ଻㒾⠪߇ឭଏߔࠆߴ߈ᦨૐ㒢ߩ଻㒾ࠨ࡯ࡆࠬ㧔଻㒾ߩኻ⽎ߣߥࠆ ක≮ࠨ࡯ࡆࠬ㧕ࠍቯ߼㧘୘ੱ߇଻㒾ട౉ߦ㑐ߒߡᱜߒ޿ㆬᛯ߇ߢ߈ࠆࠃ߁ᖱႎࠍឭଏߔࠆޕᓟㅀߔࠆ࡝ࠬ ࠢㆬᛯࠍ࿁ㆱߔࠆߴߊ㧘ࠃࠅ♖ᐲߩ㜞޿࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ㐿⊒߽᡽ᐭߩᨐߚߔߴ߈㊀ⷐߥᯏ⢻ ߢ޽ࠆޕක≮଻㒾㧘ක≮ࠨ࡯ࡆࠬᏒ႐ࠍ⛘߃ߕ⋙ⷞ㧘⹏ଔߔࠆߎߣ߽᳞߼ࠄࠇࠆޕ 䊂䉾䉦䊷䊶䊒䊤䊮㩷 ࠝ࡜ࡦ࠳ߢߪ 80 ᐕઍࠍㅢߓߡ㧘ක≮ឭଏਥ૕㧔∛㒮࡮ኾ㐷ක╬㧕ߦኻߒߡⷙ೙ࠍᒝൻߔࠆߎߣߢක≮

⾌ߩᛥ೙ࠍ࿑ߞߡ߈ߚޕ∛㒮ߦኻߔࠆ✚੍▚ᨒ೙㧔Global Budget System㧕ߪ 1983 ᐕߦዉ౉ߐࠇߚޕᒰೋߪ

∛㒮ߩ⚻Ᏹ⚻⾌ߩߺࠍኻ⽎ߣߒߡ޿ߚ߇㧘⠉84 ᐕߦߪ౉㒮ᴦ≮ో૕ߦㆡ↪ߐࠇࠆࠃ߁ߦߥߞߚޕ∛㒮ߩน

ᄌ⾌↪߳ߩ੍▚㈩ಽߪ㧘∛㒮ߩ೑↪⁁ᴫ㧔౉㒮₸㧘౉㒮ᣣᢙ㧘ᄖ᧪ฃ⸻₸╬㧕߳ߩ⷗ㄟߺߦଐ᜚ߒߡ޿ࠆޕ ߚߛߒ㧘ߘߩ⷗ㄟߺ⥄૕㧘∛㒮ߣ଻㒾⠪ߣߩ㑆ߢߩ੤ᷤߢ᳿߼ࠄࠇߡ޿ߚߎߣߢ޽ࠅ㧘੤ᷤߩ⿠ὐߪㆊ෰ ߩታ❣߆ࠄ⁛┙ߢߪߥ޿ߚ߼㧘ߎߩ✚੍▚ᨒ೙߇∛㒮߳ߩቢోߥޟ൮᜝ᛄ޿ޠߢ޽ߞߚࠊߌߢߪߥ޿ޕ∛ 㒮߳ߩ੍▚㈩ಽ࡞࡯࡞ߪ1988 ᐕߦߪ৻ጀߩ♖✺ൻ㧔ⶄ㔀ൻ㧕߇ߥߐࠇߡ޿ࠆ㧔Schut and Van de Ven (2005)㧕ޕ ∛㒮߳ߩᡰᛄ޿ߩ߶߆㧘ኾ㐷ක߳ߩ⸻≮ႎ㈽ߩᛥ೙߽ታᣉߐࠇߡ߈ߚޕ1984 ᐕߦߪኾ㐷කදળߣ᡽ᐭߩว ᗧߦࠃࠅ㧘ᚲቯߩ⋡ᮡ᳓Ḱࠍ⿥ㆊߒߚᖚ⠪ߩᴦ≮ߦኻߒߡߪႎ㈽㧔಴᧪㜞ᛄ޿㧕ࠍࠞ࠶࠻ߔࠆޟㅛᷫဳ⸻ ≮ႎ㈽ޠ߇ታᣉߐࠇࠆࠃ߁ߦߥߞߚޕߚߛߒ㧘ᖚ⠪ߩታᢙࠍᛠីߔࠆߎߣ߇࿎㔍ߥߚ߼㧘ߎߩ᡽╷ߩࠦࠬ ࠻ᛥ೙ലᨐߪ㒢ࠄࠇߡ޿ߚޕ1989 ᐕߦߪኾ㐷කᴦ≮ߦኻߔࠆ✚ᡰ಴೙㒢߇⺖ߐࠇߡ޿ࠆߦ⥋ߞߚޕ ߘߩ৻ᣇߢ୘ޘߩ଻㒾⠪߿ක≮ᯏ㑐ߥߤ߇ࠗ࠾ࠪࠕ࠹ࠖࡉࠍ⊒ើߔࠆ૛࿾ߪ߶ߣࠎߤᱷߐࠇߡ޿ߥ߆ ߞߚޕฦ∔∛㊄ᐶߪ࿾ၞ⁛භ㧘ක≮ᯏ㑐߳ߩ⸻≮ႎ㈽ᡰᛄ޿ߪᦨ⚳⊛ߦోߡਛᄩၮ㊄ߦࠃߞߡ⵬ఘߐࠇࠆ ߚ߼㧘⾌↪೥ᷫദജࠍⴕ߁⺃࿃߽ߥ߆ߞߚޕ᭽ޘߥࠬ࠹ࠗࠢࡎ࡞࠳࡯㧔଻㒾⠪㧘ක≮ᯏ㑐㧘ഭ௛⚵วߥߤ㧕

߇ടࠊࠆߎߣߢ㧔ޟࠦ࡯ࡐ࡜࠹ࠖ࠭ࡓޠߣߒߡ⍮ࠄࠇࠆࠃ߁ߦ㧕᡽╷᳿ቯߩࡊࡠ࠮ࠬ߇ⶄ㔀ൻߦߥࠅ߇ߜߛ ߞߚޕක≮ߦ㑐ࠊࠆ⸘↹┙᩺㧔∛㒮ᛩ⾗ߥߤ㧕ߣߘߩ⽷Ḯ⺞㆐ߦ㑐ࠊࠆ᳿ቯߪ⛔৻⊛ߦⴕࠊࠇߡ޿ߥ߆ߞ ߚߎߣߥߤ߽ᡰ಴߳ߩ⽷᡽⽿છࠍਇ᣿⍎ߦߒߚߣߐࠇࠆ㧔Van de Ven and Schut (2000)㧕ޕ

∛㒮߳ߩޟ✚੍▚ᨒ೙ޠ╬㧘ଏ⛎ࠨࠗ࠼߳ߩⷙ೙ߩ⚿ᨐ㧘ක≮⾌ߩኻGDP Ყߪ 8㧑೨ᓟߦᛥ߃ࠄࠇߡ߈ ߚޕߒ߆ߒ㧘✚㊂ⷙ೙ߦ઻߁ක≮⾗Ḯߩ㈩ಽߩ㕖ല₸ൻ㧘ޟᓙᯏ࡝ࠬ࠻ޠߩ᜛ᄢߥߤක≮ࠨ࡯ࡆࠬߩ⾰ૐਅ ߳ߩ ᔨ߽⴫㕙ൻߒߚޕߘߩߚ߼⛔೙ߢߪߥߊᒰ੐⠪㧔ක≮ᯏ㑐࡮଻㒾⠪㧕ߩ⺃࿃ߦ௛߈߆ߌߚല₸ൻ߇ ᮨ⚝ߐࠇߪߓ߼ߚޕਛ㆏ฝᵷ᡽ᮭߩਅߢ⊒⿷ߒߚ࠺࠶ࠞ࡯ᆔຬળߪ␠ળ଻㒾ߩේೣߢ޽ࠆ౏ᐔᕈ㧔ోߡߩ ୘ੱߩක≮ࠨ࡯ࡆࠬ߳ߩࠕࠢ࠮ࠬߩ଻⸽㧕ࠍ⏕଻ߒߟߟ㧘଻㒾⠪࡮ක≮ᯏ㑐߳ߩ⽷᡽⊛ⷙᓞߠߌࠍㅢߓߚ ല₸⊛ㆇ༡ߩଦㅴࠍ⋡ᜰߒߚޕหᆔຬળߪല₸ߣ౏ᐔߩ㑆ߩࡃ࡜ࡦࠬࠍᮨ⚝ߒߟߟ㧘ᓥ᧪ߩᣇ㊎㧔᡽ᐭߦ ࠃࠆ⋥ធⷙ೙㧕ߣߪోߊ⇣ߥࠆᏒ႐ᔒะဳߩᡷ㕟᩺㧔1987 ᐕ㧕ࠍឭ␜ߒߚޕ  ࿑⴫ 㪋㩷 䊂䉾䉦䊷䊶䊒䊤䊮㩷 䉴䊘䊮䉰䊷 ୘ੱ ଻㒾⠪ 䇭ක≮ᯏ㑐 ⸻≮ႎ㈽ ␠ળ଻㒾ᢱ䋨ᚲᓧଐሽ䋩䇭䇭䇭 䊥䉴䉪᭴ㅧ⺞ᢛ䊒䊧䊚䉝䊛 㻛␠ળ଻㒾ᢱ ቯ㗵଻㒾ᢱ   ᡷ㕟᩺ߩ᭎ⷐߪએਅߩࠃ߁ߦ߹ߣ߼ࠄࠇࠆ㧔࿑⴫4 ෳᾖ㧕ޕ (a) ߎࠇ߹ߢಽ┙ߒߡ޿ߚ⑳⊛଻㒾࡮∔∛㊄ᐶ࡮AWBZ ╬ߩක≮଻㒾೙ᐲࠍ⛔วߒ㧘ක≮㧔ᕆᕈ࡮ᘟᕈ∔ ᖚ㧕ߣߘࠇߦ㑐ㅪߔࠆ␠ળ⑔␩ࠨ࡯ࡆࠬ㧔ᣉ⸳੺⼔ߥߤ߽฽߻㧕ࠍ൮᜝⊛ߦឭଏߔࠆၮ␆଻㒾ࠍ⸳┙ߔ ࠆޕක≮ߣ੺⼔߇೙ᐲ⊛ߦ඙೎ߐࠇࠆߎߣ߽ߥ޿ޕߎߩၮ␆଻㒾ߪోੱญࠍኻ⽎ߣߒߚᒝ೙଻㒾ߢ޽ࠅ㧘 ක≮⾌ో૕ߩ85㧑ࠍࠞࡃ࡯ߔࠆ߽ߩߣߔࠆޕᱷࠅߪ⵬ቢ⊛଻㒾෸߮⥄Ꮖ⽶ᜂߢ߽ߞߡ⾔ࠊࠇࠆޕ (b) ଻㒾⠪ߪක≮ࠨ࡯ࡆࠬឭଏਥ૕ߣ⥄↱ߦᄾ⚂ࠍ⚿߱ߎߣ߇ߢ߈ࠆޕᄾ⚂ߩ⹦⚦߽ᒰ੐⠪㑆ߩ੤ ᷤߦᆔߨࠆޕฦ⒳ක≮ࠨ࡯ࡆࠬߦߟ޿ߡ㧘ᄾ⚂ኻ⽎ߪ∛㒮࡮ᣉ⸳೎ߦⷙቯߐࠇߡ޿ࠆࠊߌߢߪ ߥߊ㧘ක≮᳓Ḱ㧔⾰㧕ߦ㑐ߔࠆᚲቯߩၮḰࠍḩߚߒߡ޿ࠆߥࠄ߫㧘ߤߩଏ⛎ਥ૕ߣ߽ᄾ⚂ࠍ੤ ࠊߔߎߣ߇ߢ߈ࠆޕ (c) ␠ળ଻㒾ᢱߪ㧘⋥ធ୘ੱ߆ࠄ଻㒾⠪ߦᡰᛄࠊࠇࠆߩߢߪߥߊ㧘޿ߞߚࠎਛᄩၮ㊄ߦ㓸߼ࠄࠇࠆޕਛ ᄩၮ㊄ߪ଻㒾⠪ߦኻߒߡⵍ଻㒾⠪ߩ࡝ࠬࠢࠍ⺞ᢛߒߚޟ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓޠࠍ㈩ಽߔࠆޕ (d) ฦ଻㒾⠪߇ਛᄩၮ㊄߆ࠄฃߌขࠆߩߪᐔဋ⊛⚻⾌ߩ 75㧑޽߹ࠅߢ㧘ᱷࠅߩ 25㧑ߪోട౉⠪߳ ৻ᓞߦ⺖ߔቯ㗵଻㒾ᢱ㧔Nominal Premium㧕ߢ߽ߞߡ⾔ࠊࠇࠆޕ (e) ୘ੱߪ଻㒾⠪ࠍ⥄↱ߦㆬᛯߔࠆߎߣ߇ߢ߈ࠆޕ 

 ࿑⴫ 㪌㩷 䇸䊒䊧䊚䉝䊛䇹䈱⒳㘃䈫ᯏ⢻㩷  ᯏ  ⢻ ᦼᓙߐࠇࠆലᨐ ␠ ળ ଻ 㒾 ᢱ ᚲ ᓧ ౣ ಽ ㈩ ౏ ᐔ ߩ ⏕ ଻ ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ ଻㒾⠪ߩ࡝ࠬࠢ࡮ࡋ࠶ࠫ ࡝ ࠬ ࠢ ㆬ ᛯ ߩ ࿁ ㆱ ቯ 㗵 ଻ 㒾 ᢱ ଔ ᩰ ┹ ੎ ല ₸ ᕈ ߩ ଦ ㅴ    ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦߦࠃࠇ߫㧘ᓥ᧪ߩ⋥ធⷙ೙ߦઍ߃ߡ㧘᡽ᐭߩᓎഀߪ౏⊛଻㒾೙ᐲౝߦഃ⸳ߐࠇߚ଻㒾 Ꮢ႐㧘ක≮ࠨ࡯ࡆࠬᏒ႐ࠍޟ▤ℂޠߔࠆߎߣߦߥࠆޕ᡽ᐭߩⷙ೙ߪᏒ႐ߩᯏ⢻ࠍઍᦧߔࠆߩߢߪߥߊ㧘߻ ߒࠈ⵬ቢߔࠆ߽ߩߢ޽ࠆߴ߈ߢ޽ࠆߣ޿߁ߩ߇ᡷ㕟᩺ߩၮᧄ⊛┙႐ߢ޽ࠆޕౕ૕⊛ߦߪ㧔i㧕ਛᄩၮ㊄ߩㆇ ༡㧘␠ળ଻㒾ᢱߩ᳿ቯߣߣ߽ߦ㧘㧔ii㧕ၮ␆଻㒾೙ᐲ߇ࠞࡃ࡯ߔࠆක≮ࠨ࡯ࡆࠬߩ▸࿐ߣߣ߽ߦ㧘ᦨૐ㒢଻ ⸽ߐࠇࠆߴ߈᳓Ḱࠍⷙቯ㧘㧔iii㧕଻㒾⠪߿ක≮ᯏ㑐ߩㆡᩰᕈࠍ⺞ᩏ࡮⹏ଔ㧘㧔iv㧕୘ੱ߇଻㒾⠪ࠍㆬᛯߔࠆ ਄ߢᔅⷐߥᖱႎ㧔ฦ଻㒾⠪ߩឭଏߔࠆࠨ࡯ࡆࠬߩౝኈ࡮⾰߳ߩ⹏ଔ㧘ቯ㗵଻㒾ᢱ᳓Ḱߥߤ㧕ࠍឭଏߔࠆߎ ߣ߇᜼ߍࠄࠇࠆޕ ൮᜝⊛ߥක≮ࠨ࡯ࡆࠬࠍࠞࡃ࡯ߔࠆᒝ೙⊛ၮ␆଻㒾೙ᐲߩഃ⸳ߪ㧘଻㒾⠪߇ห╬ߩലᨐࠍᜬߟක≮ࠨ࡯ ࡆࠬ⟲ߩਛ߆ࠄᦨ߽ല₸⊛ߥ߽ߩࠍㆬᛯ࡮ឭଏߔࠆߎߣࠍน⢻ߦߒ㧘ක≮ࠨ࡯ࡆࠬ㑆ߩઍᦧࠍଦㅴߔࠆޕ ߎࠇ߹ߢߩ଻㒾⠪ߦᦼᓙߐࠇߡ޿ߚߩߪක≮ᯏ㑐߆ࠄߩ⸻≮ႎ㈽⺧᳞ߩಣℂߣ޿ߞߚਥߣߒߡ੐ോಣℂ⢻ ജߢ޽ߞߚޕᡷ㕟ߪ଻㒾⠪ߦ࡝ࠬࠢ▤ℂਥ૕ߣߒߡߩ㧘ࠃࠅડᬺኅ⊛ߥᯏ⢻ࠍઃਈߔࠆߎߣࠍ⋡⊛ߣߒߡ ޿ࠆޕ⾌↪೥ᷫദജߣ㜞޿ක≮ߩ⾰ߩ⏕଻߳ߩ⺃࿃ߪ㧘୘ੱߦ⹺߼ࠄࠇߚ⥄↱ߥ଻㒾⠪ㆬᛯߣߘࠇߦ⿠࿃ ߔࠆ଻㒾⠪㑆┹੎ߦࠃߞߡଦㅴߐࠇࠆޕ଻㒾⠪㑆┹੎ߪ⾰ߣଔᩰߩਔ㕙߇޽ࠅ㧘ᓟ⠪ߪ଻㒾⠪ߩࠦࠬ࠻ࡄ ࡈࠜ࡯ࡑࡦࠬࠍ෻ᤋߔࠆቯ㗵଻㒾ᢱࠍㅢߓߡⴕࠊࠇࠆߎߣߦߥࠆ㧔࿑⴫5㧕ޕቯ㗵଻㒾ᢱߪหߓ଻㒾⠪ߣห ৻ߩ଻㒾ᄾ⚂ࠍ੤ࠊߒߡ޿ࠆ୘ੱ㑆ߢߪဋ৻ߢ޽ࠆ߇㧘଻㒾⠪㑆ߢߪല₸ᕈߩ㆑޿ࠍ෻ᤋߒߡ⇣ߥߞߡߊ ࠆޕ ട౉⠪ߩ଻㒾ᢱ⽶ᜂߪᚲᓧଐሽဳ␠ળ଻㒾ᢱߣߎߩቯ㗵଻㒾ᢱߩว⸘ߣߥࠆޕߎߩ߁ߜᚲᓧଐሽဳ଻㒾 ᢱߣ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⚵ߺวࠊߖߪޟ␠ળㅪᏪޠ㧔ౣಽ㈩㧕ࠍၷᜬߔࠆ߽ߩߢ޽ࠅ㧘ቯ㗵଻㒾ᢱ ߪଔᩰࡔࠞ࠾࠭ࡓߣߒߡᯏ⢻ߔࠆ㧔࿑⴫5㧕ޕ଻㒾⠪㑆┹੎ߪ㧘ട౉⠪₪ᓧߩߚ߼㧘ฦ଻㒾⠪ߦኻߒ㧘ࠃࠅ ല₸⊛ߥක≮ᯏ㑐ߣᄾ⚂ࠍ⚿߱⺃࿃ࠍਈ߃㧘ߎࠇ߇ක≮ࠨ࡯ࡆࠬឭଏਥ૕㑆ߢߩ┹੎ࠍᵴ⊒ൻߔࠆߛࠈ߁ޕ ᓥߞߡ㧘଻㒾⠪㑆┹੎෸߮ଏ⛎ਥ૕㑆┹੎ߩଦㅴߪᡷ㕟᩺ߦ߅޿ߡ㧘৻૕ߦߥߞߡ޿ࠆޕ ᡷ㕟᩺ߦߪޟ㓸ᮭൻޠߣޟಽᮭൻޠߩਔ㕙߇฽߹ࠇߡ޿ࠆޕ᡽ᐭߦࠃࠆක≮ࠨ࡯ࡆࠬ߳ߩଔᩰ࡮ᢙ㊂ⷙ ೙ࠍᑄߒ㧘Ꮢ႐ࠍㅢߓߚߘࠇࠄߩ᳿ቯࠍኈ⹺㧔ಽᮭൻ㧕ߔࠆ৻ᣇ㧘଻㒾೙ᐲߩ৻రൻ㧘ਛᄩၮ㊄ࠍㅢߓߚ ࡝ࠬࠢߩࡊ࡯࡞ൻ㧔㓸ᮭൻ㧕ߥߤ␠ળ଻㒾ߣߒߡߩⷐ⚛߽⛽ᜬߔࠆߎߣࠍᗧ࿑ߒߡ޿ߚߣ޿߃ࠆޕ᡽ᐭߩ ⷙ೙ߪᱷࠆ߇㧘਄ㅀߩࠃ߁ߦၮ␆଻㒾ߢࠞࡃ࡯ߔࠆක≮ࠨ࡯ࡆࠬߩ▸࿐߿ᦨૐ᳓Ḱߩⷙቯ㧘଻㒾⠪߳ߩ࡝ ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩᡰᛄ޿㧘଻㒾⠪㑆ࠞ࡞࠹࡞ߩ㒐ᱛߥߤ㧘Ꮢ႐ᯏ⢻ࠍઍᦧߔࠆߩߢߪߥߊ㧘߻ߒ ࠈߘߩஜోߥᯏ⢻ࠍࠨࡐ࡯࠻ߔࠆߎߣࠍ⋡ᜰߔޕ

ᡷ㕟᩺䈻䈱ୃᱜ䈫䈠䈱ᓟ䈱⚻✲䋨㪐㪇 ᐕઍ䋩㩷 Helderman et al (2005) ߪ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦએ㒠ߩක≮ᡷ㕟ߩᵹࠇࠍ㧔1㧕Ꮢ႐ේℂߩዉ౉߇࿑ࠄࠇߚᦼ㑆 㧔1988-1994 ᐕ㧕㧘㧔2㧕▤ℂ┹੎ߣⷙ೙࡮⛔೙ߩ㑆ߢំࠇߚᦼ㑆㧔1994-2000 ᐕ㧕෸߮㧔3㧕࠺࠶ࠞ࡯࡮ࡊ࡜ ࡦ߇ᓳᵴߒߚ2000 ᐕએ㒠ߦ඙ಽߒߡ޿ࠆޕ ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦߪ൮᜝⊛㧘߆ߟ࡜࠺ࠖࠞ࡞ߥ߽ߩߢ޽ߞߚޕߒ߆ߒ㧘90 ᐕઍೋ㗡㧘᡽ᴦ⊛ᅷදߣᡷ㕟 ࠍታᣉߒߡ޿ߊ਄ߢ↢ߓߚ㧔࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⸳⸘ߣ޿ߞߚ㧕ᛛⴚ⊛໧㗴ߦࠃࠅ㧘ᡷ㕟᩺ߪୃ ᱜࠍ㊀ߨ㧘ᡷ㕟ߩࠬࡇ࡯࠼߽✭߼ࠄࠇߡ޿ߞߚ㧔ᡷ㕟ߩផ⒖ߪ࿑⴫6 ߦ߹ߣ߼ߚㅢࠅ㧕ޕ߽ߞߣ߽㧘ᡷ㕟ߩ ᣇะߪၮᧄ⊛ߦ⛽ᜬߐࠇߡ߈ߡ޿ࠆޕ90 ᐕߩ⺀↢ߒߚਛ㆏Ꮐᵷ᡽ᮭߪ㧘ޟ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦޠࠍଔᩰ┹੎ ߩⷐ⚛ࠍᒙ߼ࠆᒻߢୃᱜߒߚޟࠨࠗࡕࡦ࠭⸘↹ޠࠍᛂߜ಴ߒߚޕห⸘↹ߢߪ㧔i㧕ၮ␆଻㒾ߩࠞࡃ࡯ߔࠆ▸ ࿐ࠍᒰೋߩ 85㧑߆ࠄ 96㧑߹ߢᒁ਄ߍࠆ㧔ߘߩಽ⵬ቢ⊛଻㒾ߩᓎഀ߇ૐਅ㧕߶߆㧘㧔ii㧕଻㒾⠪෼౉ߦභ߼ ࠆਛᄩၮ㊄߆ࠄߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߣ৻ᓞࡊ࡟ࡒࠕࡓߩᲧ₸ࠍᡷ㕟᩺ߩ75 ኻ 25 ߆ࠄ㧘85 ኻ 15 ߦᄌᦝߔࠆޕߐࠄߦ㧘ᄖ᧪߿⺞೷ߥߤࠍᣂߚߦ⛎ઃኻ⽎ߣߔࠆߥߤAWBZࠍ᜛లߔࠆߎߣߢၮ␆଻㒾߳ߩ ⒖ⴕࠍ⋡ᜰߒߚ߇㧘␠ળ଻㒾ߩ⤘ᒛߣ౏⊛⽶ᜂߩჇᄢߦ⚳ࠊߞߚ㧔Helderman et al (2005)㧕ޕ⚿ዪ㧘95 ᐕߦ ߪක≮଻㒾ߩ৻రൻߩᣇ㊎ࠍ᡼᫈㧘AWBZߦߟ޿ߡߪᓥ᧪ߩ᡽ᐭⷙ೙ࠍ⛮⛯㧘╙ 1 ጀ߳ߩᏒ႐ේℂߩዉ౉ ߪ⷗ㅍࠆߎߣߦߥߞߚޕ▤ℂ┹੎ߩὶὐߪ╙2 ጀࠍ᭴ᚑߔࠆ∔∛㊄ᐶߦ⒖ߞߡ޿ߞߚ4)_ޕ   ࿑⴫ 㪍㩷 䉥䊤䊮䉻ක≮ᡷ㕟䈱ផ⒖㩷 1987 ᐕ㧦ޟ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦޠ 1990 ᐕ㧦ޟࠨࠗࡕࡦ࠭⸘↹ޠ 1992 ᐕ㧦i㧕∔∛㊄ᐶ߇ో࿖࡟ࡌ࡞ߢᵴേߔࠆߎߣࠍ⸵น iiട౉⠪߇ 2 ᐕߦ 1 ࿁㧘∔∛ၮ㊄ࠍ⒖ࠆߎߣࠍ⸵น       㧔96 ᐕએ㒠ߪᐕ 1 ࿁ߩࡍ࡯ࠬ㧕 1993 ᐕ㧦࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩዉ౉ 㧦∔∛ၮ㊄߇ኾ㐷කࠍㆬᛯ㧘ᄾ⚂ࠍ⚿߱ߎߣࠍ⸵น 1995 ᐕ㧦AWBZ ࠍ฽߻ක≮଻㒾೙ᐲߩ৻రൻࠍᢿᔨ   2005 ᐕ㧦଻㒾⠪ߣක≮ᯏ㑐㧔∛㒮㧕ߩ୘೎੤ᷤ㧔੍▚ߩ 10㧑㧕ࠍ⸵น   2006 ᐕ㧦∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⛔ว㧔2006 ᐕᡷ㕟㧕   ട౉⠪ߦࠃࠆ଻㒾⠪ㆬᛯߪ1992 ᐕ߆ࠄน⢻ߦߥߞߚޕᒰೋߪ 2 ᐕߦ৻࿁ߩࡍ࡯ࠬߛߞߚ߇㧘96 ᐕ߆ࠄ ߪ଻㒾⠪ࠍ⒖ࠆᯏળߪᐕ৻࿁ߣߐࠇߡ޿ࠆޕߥ߅㧘࠼ࠗ࠷ߦ߅޿ߡ߽หᐕޟㅪᏪਅߩ┹੎ޠߣߒߡ଻㒾⠪ 㧔∔∛㊄ᐶ㧕ㆬᛯ߇ో㕙⊛ߦዉ౉ߐࠇߡ޿ࠆޕ93 ᐕ߆ࠄߪ㧘ࠝ࡜ࡦ࠳ߩ∔∛ၮ㊄ߪኾ㐷කߣㆬᛯ⊛ߥᄾ⚂ ࠍ⚿߱ߎߣ߇ߢ߈ࠆࠃ߁ߦߥߞߚޕ㧔ߚߛߒ㧘∛㒮ߣߩ୘೎ᄾ⚂ߪ2005 ᐕ߹ߢ⹺߼ࠄࠇߡ޿ߥ޿ޕ㧕߽ߞߣ ߽଻㒾⠪㧔∔∛㊄ᐶ㧕߇ઃਈߐࠇߚᮭ㒢ࠍⓍᭂ⊛ߦⴕ૶ߒߡ޿ߥ߆ߞߚޕߎࠇߪ㧘ᓟㅀߔࠆࠃ߁ߦ଻㒾⠪ _{ߚߛߒ㧘Ꮢ႐ේℂ߇╙1 ጀ߆ࠄቢోߦឃ㒰ߐࠇߚࠊߌߢߪߥ޿ޕ97 ᐕߦߪࠨ࡯ࡆࠬଏ⛎ਇ⿷ߦࠃࠆޟᓙᯏ࡝ࠬ࠻ޠߩჇടߦኻಣߔߴߊ㧘༡} ೑ߩ࿷ቛ੺⼔੐ᬺ⠪ߩෳ౉߇⹺߼ࠄࠇߚޕ༡೑੐ᬺ⠪ߩ࡝ࠬࠢㆬᛯ㧔ࠢ࡝࡯ࡓ࡮ࠬࠠࡒࡦࠣ㧕߇㗼⪺ߛߞߚߚ߼㧘৻ᤨਛᢿߐࠇߚ߇2000 ᐕ߆ ࠄߪෳ౉߇ౣ㐿ߐࠇߡ޿ࠆ㧔Helderman et al (2005)㧕ޕ

ߩޟ⽷᡽⽿છޠ㧔࡝ࠬࠢ⽶ᜂ㧕߇චಽߦ⏕┙ߒߡ޿ߥ޿㧔៊ᄬߩ97.5㧑߇੐ᓟ⊛ߦ⵬Ⴏߐࠇߡ޿ߚ㧕ߎߣߦ ⿠࿃ߔࠆ߽ߩߣ⠨߃ࠄࠇࠆޕߘߩ৻ᣇߢ∔∛㊄ᐶ㑆ߩว૬߿㧔หߓ଻㒾ࠣ࡞࡯ࡊߩ஺ਅߦ∔∛㊄ᐶߣ᳃㑆 ଻㒾߇౉ࠆߥߤ㧕∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⚻༡ㅪ៤߇ㅴࠎߛޕ┹੎߇ᯏ⢻ߔࠆ೨ߦ㧘Ꮢ႐ߩኦභൻ߇ㅴࠎߛ ߩߢ޽ࠆޕ㧔ή⺰㧘଻㒾⠪ߩ⛔วߪⷙᮨߩ⚻ᷣ߿࡝ࠬࠢ▤ℂߩ⍮⼂ߩ⫾Ⓧ╬ߦࠃࠆ⚻༡ല₸ߩะ਄ߥߤᦸ߹ ߒ޿஥㕙߽޽ࠆޕ㧕 90 ᐕઍࠍㅢߓߡᡷ㕟ߩࡍ࡯ࠬ߇ㆃ߆ߞߚℂ↱ߣߒߡߪ㧘╙ 1 ߦਛᄩၮ㊄߆ࠄ଻㒾⠪ߦᡰᛄࠊࠇࠆ࡝ࠬࠢ ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖ኒൻ߇ㅴࠎߢ޿ߥ߆ߞߚߎߣ߇᜼ߍࠄࠇࠃ߁ޕ4 ▵ߢ⹦ㅀߔࠆࠃ߁ߦ࡝ࠬࠢⷐ࿃ ߣߒߡ㧘ᕈ೎࡮ᐕ㦂ߩ߶߆ߦዬ૑࿾߿り૕㓚ኂߩ᦭ή߇ട߃ࠄࠇࠆࠃ߁ߦߥߞߚ߽ߩߩ㧘୘ੱߩஜᐽ࡝ࠬ ࠢࠍᱜߒߊ෻ᤋߔࠆ㧘ࠃࠅᱜ⏕ߦ޿߃߫㧘଻㒾⠪ࠄ߇⹺⼂ߒߡ޿ࠆ୘ੱߩ࡝ࠬࠢߣ৻⥌ߔࠆߦߪ⥋ߞߡ޿ ߥ޿ޕᓥߞߡ㧘࡝ࠬࠢㆬᛯߩน⢻ᕈ߇ឃ㒰ߢ߈ߕ㧘ਛᄩၮ㊄ߪ∔∛㊄ᐶߣߩࠦࠬ࠻࡮ࠪࠚࠕ࡝ࡦࠣࠍ૛௾ ߥߊߐࠇߡ޿ࠆߩߢ޽ࠆޕߎࠇ߇଻㒾⠪ߩല₸⊛⚻༡㧔ല₸⊛ක≮ᯏ㑐ߩㆬ೎㧕ߩ⺃࿃ࠍ៊ߨ㧘ᡷ㕟ߩല ᨐࠍૐ߼ߡ޿ࠆߣ⠨߃ࠄࠇࠆޕ╙2 ߦ଻㒾⠪࡮ක≮ᯏ㑐ߩឭଏߔࠆࠨ࡯ࡆࠬߩ⾰ߥߤߦ㑐ߔࠆᖱႎ߇චಽ ߦឭଏߐࠇߡߎߥ߆ߞߚޕ଻㒾⠪ࠍㆬ߱ߦᒰߚߞߡ୘ੱ߇ᱜߒ޿ㆬᛯࠍⴕ߁ߦߪ㧘ᓐࠄߦᱜߒ޿ᖱႎ߇ឭ ଏߐࠇߡ޿ߥߊߡߪߥࠄߥ޿ޕฦක≮ᯏ㑐࡮଻㒾⠪ߩࠨ࡯ࡆࠬߦ㑐ߔࠆᖱႎࠍ࠺࡯࠲࡮ࡌ࡯ࠬൻߒߡߘߩ ขᓧࠍኈᤃߦߔࠆߣߣ߽ߦ㧘ක≮ߩ⾰࡮ࠦࠬ࠻ࠍቴⷰ⊛ߦ᷹ࠆᜰᮡߩ㐿⊒ߥߤၮḰൻߦࠃߞߡ㧘ߘ߁ߒߚ ᖱႎࠍᲧセߢ߈ࠆࠃ߁ߥⅣႺᢛ஻߇ᔅⷐߣߐࠇߡ޿ࠆޕ ߣߪ޿߃ᡷ㕟⥄૕߇㗐ᝂߒߚࠊߌߢߪߥ޿ޕ∔∛㊄ᐶ߳ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖✺ൻߣߣ߽ߦ㧘 ଻㒾⠪ߩ⽷᡽⽿છ߽3㧑⒟ᐲ߆ࠄ 2004 ᐕߦߪ 50㧑޽߹ࠅߦ߹ߢᒁ߈਄ߍࠄࠇߚ㧔4 ▵ෳᾖ㧕ޕቯ㗵଻㒾ᢱ ߩഀว߽ක≮ᡰ಴ߩ10㧑߆ࠄ 15㧑߶ߤࠍභ߼ࠆࠃ߁ߦߥࠅ㧘∔∛㊄ᐶ㑆ߢߩ଻㒾ᢱߩᩰᏅ߽ᐢ߇ߞߚޕᤨ 㑆ߩ⚻ㆊߣߣ߽ߦଔᩰ┹੎߇ᶐㅘߒߟߟ޽ࠆޕኾ㐷කߣߩㆬᛯ⊛ᄾ⚂ߩ߶߆㧘ᒰೋߪ⹺߼ࠄࠇߡ޿ߥ߆ߞ ߚ∛㒮ߣߩ୘೎੤߽ᷤ 05 ᐕ߆ࠄ㒢ቯ⊛ߥ߇ࠄน⢻ߦߥߞߡ߈ߡ޿ࠆޕታ㓙㧘∛㒮ߣᖚ⠪ߩᦨᄢᓙᯏᦼ㑆 㧔waiting time㧕 ߦߟ޿ߡ⁛⥄ߦวᗧߔࠆ଻㒾ળ␠߽⃻ࠇߡ޿ࠆޕ࠼ࠗ࠷ߢ߽ኾ㐷ක߿∛㒮ߣߩ⸻≮ႎ㈽੤ ᷤߪ㧔৻ㇱࠍ㒰߈㧕∔∛㊄ᐶㅪวળߦᆔߨࠄࠇߡ޿ߚޕ2000 ᐕ߆ࠄߪ଻㒾කදળߣߩ㓸࿅੤ᷤߦઍ߃㧘ක ⑼࡮ᱤ⑼ᄖ᧪ߦߟ޿ߡߪ୘ޘߩ∔∛㊄ᐶ߇଻㒾ක࡮∛㒮ߣ⋥ធᄾ⚂ࠍ੤ࠊߔޟ⛔วࠨ࡯ࡆࠬޠߩ઀⚵ߺ߇ ዉ౉ߐࠇߡ޿ࠆ㧔↰ਛ(2006)㧕ޕ߽ߞߣ߽㧘ᒰ੐⠪㑆ߩ੤ᷤ߇㔍⥶ߒ㧘ߎߩޟ࠼ࠗ࠷ဳࡑࡀࠫ࠼ࠤࠕޠߪ߹ ߛ᥉෸ߔࠆߦߪ⥋ߞߡ޿ߥ޿ߣߩᜰ៰߽޽ࠆ㧔↰ਛ(2003)㧕ޕࠝ࡜ࡦ࠳ߢߪ 2002 ᐕߩ✚ㆬ᜼ᓟߩ㧔଻቞࡮ ਛ㆏߆ࠄߥࠆ㧕ㅪ┙᡽ᮭߪⷙ೙✭๺㧘┹੎ߩଦㅴࠍឝߍ㧘5 ▵ߢ⹦ㅀߔࠆ∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⛔วࠍ฽ ߻Ꮢ႐ᔒะဳᡷ㕟ࠍ2006 ᐕߦታ⃻ߔࠆߦ⥋ߞߚ㧔Helderman et al (2005)㧕ޕ

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㧕ߦၮߠߊᔅⷐ߇޽ࠆޕ଻㒾⠪߇ⵍ଻㒾⠪ߦߟ޿ߡࠬࡐࡦࠨ࡯ࠃࠅ߽⹦⚦ߥᖱႎ㧔଀߃߫㧘 ㆊ෰ߩ∛ᱧ࡮↢ᵴ⠌ᘠ∛ߥߤ㧕ࠍ᦭ߒߡ޿ࠆߥࠄ߫㧘ߘߩᖱႎࠍ૶ߞߡޟ࡝ࠬࠢㆬᛯޠࠍⴕ߁㧔଻㒾⠪߇ ੍ᗐߔࠆක≮⾌ߦኻߒߡ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ߇⷗วࠊߥ޿୘ੱࠍ࿁ㆱߔࠆ㧕⺃࿃ࠍᜬߟߎߣߦߥࠆ ߛࠈ߁ޕ ࠝ࡜ࡦ࠳ߢߪᚲᓧଐሽߩ␠ળ଻㒾ᢱߪਛᄩၮ㊄ߦ㓸߼ࠄࠇ㧘ቯ㗵଻㒾ᢱߩߺ߇ⵍ଻㒾⠪߆ࠄ⋥ធᡰᛄࠊ ࠇࠆޕ଻㒾⠪ߪട౉⠪ߩஜᐽ࡝ࠬࠢࠍᒁ߈ฃߌࠆߎߣߪ޽ߞߡ߽㧘ᓐ╬ߩᚲᓧߦࠃߞߡᓇ㗀ߐࠇࠆߎߣߪ ߥ޿ޕ࡝ࠬࠢ᭴ㅧ⺞ᢛߪᢥሼߤ߅ࠅ଻㒾⠪ߩ㑆ߢߩஜᐽ࡝ࠬࠢ㓸࿅ߩᏅ⇣ࠍၒ߼วࠊߖࠆߩߢ޽ࠆޕ৻ᣇ㧘 ࠼ࠗ࠷ߩࠃ߁ߦᚲᓧଐሽဳ଻㒾ᢱ߇଻㒾⠪ߦኻߒߡ⋥ធᡰᛄࠊࠇࠆ႐ว㧘଻㒾⠪ߪஜᐽ࡝ࠬࠢߩߺߥࠄߕ㧘 ⵍ଻㒾⠪ߩᚲᓧߩᓇ㗀ࠍⵍߞߡߒ߹߁ޕࠃߞߡ㧘࡝ࠬࠢ᭴ㅧ⺞ᢛߪ଻㒾⠪㑆ߩᚲᓧᩰᏅ߽⠨ᘦߦ౉ࠇߥߊ ߡߪߥࠄߥ޿ޕታ㓙㧘࠼ࠗ࠷ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߪᚲᓧࠍ⺞ᢛᄌᢙߣߒߡ฽ࠎߢ߅ࠅ㧘∔∛㊄ᐶ 㑆ߩ⒖ォߩ7 ഀ޽߹ࠅ߇ߎߩᄌᢙߦ᜚ࠆߣߐࠇࠆ㧔Buchner and Wasem (2003)㧕6)ޕ

 䊥䉴䉪ㆬᛯ䈻䈱 ᔨ㩷 ࡝ࠬࠢㆬᛯߪ᡽ᐭߣ଻㒾⠪ߣߩ㑆ߩޟᖱႎߩ㕖ኻ⒓ᕈޠ㧔ᒰዪ߇଻㒾⠪ߩ᦭ߒߡ޿ࠆᖱႎࠍ࡝ࠬࠢ᭴ㅧ ⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߢ߈ߥ޿ߎߣ㧕ߦ⿠࿃ߔࠆޕ଻㒾⠪߇ⵍ଻㒾⠪ߦ㑐ߒߡ⁛⥄ߦᖱႎࠍᓧࠆᚻᲑߪ᭽ޘ ߢ޽ࠆޕㆊ෰ߩ∛ᱧߪ୘ੱߩ࡝ࠬࠢ࡮࠲ࠗࡊࠍ⍮ࠆ਄ߢ߆ߥࠅ᦭↪ߢ޽ࠆޕᄖ⷗߆ࠄ߽୘ੱߩஜᐽ⁁ᘒߪ 㘃ផน⢻߆߽ߒࠇߥ޿ޕᱤߩ޽ࠆ㧘޽ࠆ޿ߪ⿷⣶ߩߒߞ߆ࠅߒߡ޿ࠆ㜞㦂⠪ߢ޽ࠇ߫㧘ૐ࡝ࠬࠢߦಽ㘃ߢ ߈ࠆߛࠈ߁ޕ࡝ࠬࠢㆬᛯߩ⺃࿃ߪ㧘୘ੱߦࠃࠆ଻㒾⠪ㆬᛯ߇ᰳᅤߒߚ⁁ᘒߢߪ⿠ߎࠅᓧߥ޿ߎߣߦᵈᗧߖ ࠃޕዬ૑࿾㧘߽ߒߊߪ⡯ᬺߦࠃߞߡ੍߼ട౉ߔࠆ଻㒾⠪߇᳿߹ߞߡ޿ࠆ㒢ࠅ㧘଻㒾⠪ߦ߽ട౉⠪ࠍㆬᛯߔ ࠆᚻᲑߪߥ޿߆ࠄߛޕࠃߞߡ㧘࡝ࠬࠢㆬᛯߩ໧㗴ߪ┹੎⊛଻㒾Ꮢ႐ߦ࿕᦭ߩ߽ߩߣ޿߃ࠆߛࠈ߁ޕട߃ߡ ༡೑ડᬺߩ႐ว㧘ᩣਥߦࠃࠆ೑Ảᦨᄢൻߩⷐ⺧߆ࠄ࡝ࠬࠢㆬᛯ߳ߩ⺃࿃ߪ㜞޿߽ߩߣ⠨߃ࠄࠇࠆޕ࡝ࠬࠢ ㆬᛯࠍឃ㒰ߔࠆࠃࠅ⋥ធ⊛ߥᚻᲑߣߒߡߪ㧘଻㒾⠪ߦኻߒోߡߩട౉Ꮧᦸ⠪ߩฃߌ౉ࠇࠍᒝ೙ߔࠆ Open enrollment ߇޽ࠆޕߎࠇߪ㧘ട౉ᜎุߩࠃ߁ߥ㧘޽߆ࠄߐ߹ߥ࡝ࠬࠢㆬᛯߪឃ㒰ߔࠆߛࠈ߁ޕߚߛߒ㧘ߎ ߩട౉ฃߌ౉ࠇ⟵ോߪࠝ࡜ࡦ࠳ߩ⵬ቢ଻㒾ߦߪㆡ↪ߐࠇߥ޿ޕⵍ଻㒾⠪ߪㅢᏱ㧘ၮ␆଻㒾ߣ⵬ቢ଻㒾ࠍห ߓ଻㒾⠪߆ࠄ⾼౉ߔࠆߎߣ߆ࠄ㧘⵬ቢ଻㒾ߩ⛎ઃ▸࿐ࠍᠲ૞ߔࠆ㧔੍㒐ක≮ߥߤ⛎ઃኻ⽎ࠍૐ࡝ࠬࠢߥ୘ ੱߦߣߞߡᅢ߹ߒ޿߽ߩߦ㒢ቯߔࠆ╬㧕ߎߣߢஜᐽ࡝ࠬࠢߩ㜞޿ⵍ଻㒾⠪ࠍ࿁ㆱߔࠆߎߣ߽น⢻ߢ޽ࠆޕ ࠝ࡜ࡦ࠳ห᭽㧘଻㒾⠪ㆬᛯࠍዉ౉ߒߚ࠼ࠗ࠷ߢߪᒰೋ㧘㊀ᐲ㓚ኂఽࠍᛴ߃ࠆኅᣖߩട౉↳⺧ࠍᒁ߈િ߫ߒ ߚࠅ㧘੐ോᚲࠍ㜞㦂⠪߿ゞ᫹ሶߩੱ߇਄߇ࠇߥ޿ࠃ߁ߥࠛ࡟ࡌ࡯࠲ߩࡆ࡞ߩ਄㓏ߦ⟎޿ߚࠅߔࠆⴕേ߇⷗ ฃߌࠄࠇ㧘␠ળ⊛ᛕ್ࠍ᜗޿ߚ㧔↰ਛ(2006)㧕ޕ _{∔∛㊄ᐶߩஜᐽ࡝ࠬࠢ㧔ක≮࠾࡯࠭㧕ߣวࠊߖߡ෼౉ࠍട๧ߒߡ޿ࠆὐߢ࠼ࠗ࠷ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩࡈࠜ࡯ࡒࡘ࡜ߪࠊ߇࿖ߩ࿾} ᣇ੤ઃ⒢㧔᡽ᐭ㑆⽷᡽⒖ォ㧕೙ᐲߦૃߡ޿ࠆޕ

࡝ࠬࠢㆬᛯ߇ᷓೞߥ໧㗴ߦߥࠅ߁ࠆߎߣࠍᜰ៰ߔࠆ⎇ⓥ߽ᢙᄙ޿ޕ࡝ࠬࠢㆬᛯߩ᦭ήߪ଻㒾⠪߇࡝ࠬࠢ ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ❱ࠅㄟ߹ࠇߡ޿ࠆ࡝ࠬࠢⷐ࿃એᄖߦ㧘ട౉⠪ߩ࡝ࠬࠢ࡮࠲ࠗࡊ㧔⸻≮ࠦࠬ࠻㧕ࠍ੍ ⷗ߔࠆ਄ߢ᦭↪ߥᖱႎࠍ᦭ߒߡ޿ࠆ߆ߤ߁߆㧘߆ߟ㧘ߘߩᖱႎࠍ↪޿ߡട౉⠪ࠍㆬ೎ߔࠆߎߣߦ઻߁೑⋉ ߇㜞޿߆ߤ߁߆ߦࠃߞߡ޿ࠆޕHamilton(1995)ߪࠝ࡜ࡦ࠳ߩࠤ࡯ࠬࠍขࠅ਄ߍߚታ⸽⎇ⓥࠍ⚫੺ߒߡ޿ࠆޕ ߎߩ⎇ⓥߦࠃࠇ߫㧘ኅᣖᢙ࡮㓹↪᧦ઙ㧘␠ળ⚻ᷣ⊛ⷐ࿃㧔ዬ૑࿾ߩㇺᏒൻߩᐲว޿ߥߤ㧕㧘ᘟᕈ∔ᖚߥߤ଻ 㒾⠪ߦߣߞߡ߽Ყセ⊛ኈᤃߦ౉ᚻน⢻ߥ࠺࡯࠲ࠍ↪޿ࠆߎߣߢ㧘ᕈ೎ߣᐕ㦂ߒ߆෻ᤋߒߥ޿㧔ਛᄩၮ㊄߆ ࠄ∔∛㊄ᐶߦᡰᛄࠊࠇࠆ㧕࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓࠃࠅ߽ᱜ⏕ߦ㧘ട౉⠪ߩක≮ࠦࠬ࠻ࠍ੍᷹ߔࠆߎߣ ߇ߢ߈ࠆޕ࡝ࠬࠢㆬᛯߩ᦭ήࠍ⋥ធ⊛ߦ⏕⹺ߒߡ޿ࠆࠊߌߢߪߥ޿߇㧘଻㒾⠪㧔∔∛㊄ᐶ㧕ߪ㧘ࡊ࡟ࡒࠕ ࡓߦ⷗วࠊߥ޿ട౉⠪ࠍឃ㒰ߔࠆߎߣ߆ࠄ↢ߓࠆ೑⋉߇㜞޿㒢ࠅ㧘ߎ߁ߒߚᖱႎߦၮߠ޿ߡታ㓙ߦ㜞࡝ࠬ ࠢߥട౉⠪ࠍឃ㒰ߔࠆ⺃࿃ࠍᜬߟߛࠈ߁ޕ ࡝ࠬࠢㆬᛯࠍᅤ૗ߦขࠅ㒰ߊ߆߇㧘▤ℂߐࠇߚ┹੎ࠍ᦭ലߦᯏ⢻ߐߖߡ޿ߊ਄ߢ㧘㊀ⷐߢ޽ࠆޕߐ߽ߥ ߌࠇ߫㧘଻㒾⠪㑆┹੎ߪૐ࡝ࠬࠢࠍᎼࠆ߽ߩߦ㒢ቯߐࠇ㧘ᦨ߽଻㒾ࠍᔅⷐߣߒߡ޿ࠆ㜞࡝ࠬࠢ⠪߇ක≮଻ 㒾೙ᐲ߆ࠄឃ㒰ߐࠇࠆ߅ߘࠇ߇޽ࠆ߆ࠄߛޕട౉⠪ߩஜᐽ࡝ࠬࠢࠍน⢻ߥ㒢ࠅ࡝ࠬࠢ᭴ㅧ⺞ᢛߦ෻ᤋߐߖ ࠆᔅⷐ߇޽ࠆޕEnthoven(1988)߿ Van de Ven and van Vliet (1992)ߪㆊ෰ߩ∛ᱧ࡮౉㒮⸥㍳߿⸻≮ࠦࠬ࠻ࠍ࡝ ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߐߖࠆߎߣࠍឭ໒ߒߡ޿ࠆޕታ㓙㧘04 ᐕ߆ࠄߪ㧘∔∛ಽ㘃㧔DRG㧕߇࡝ࠬ ࠢ᭴ㅧ⺞ᢛߐࠇࠆࠃ߁ߦߥߞߚޕ߽ߞߣ߽㧘ㆊ෰ߩ⸻≮ࠦࠬ࠻㧘౉㒮╬⸻≮ⴕὑߩㆬᛯߪක≮ᯏ㑐࡮଻㒾 ⠪ߩࠗࡦ࠮ࡦ࠹ࠖࡉߦࠃߞߡ߽Ꮐฝߐࠇࠆޕ⃻࿷ߩട౉⠪ߩ⸻≮ࠦࠬ࠻߇዁᧪ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕ ࡓߦ❱ࠅㄟ߹ࠇࠆߎߣࠍ଻㒾⠪߇⷗⿧ߒߡ޿ࠆߥࠄ߫㧘ක≮ᯏ㑐߳ߩࡕ࠾࠲࡝ࡦࠣ㧘ㆬ೎ࠍㅢߓߚࠦࠬ࠻ ೥ᷫദജ߇៊ߥࠊࠇࠆน⢻ᕈ߇޽ࠆޕ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ૕♽ߩ᭴▽ߦ޽ߚߞߡߪ㧘ߎ߁ߒߚࡑࠗ ࠽ࠬ㕙߽⠨ᘦߐࠇߥߊߡߪߥࠄߥ޿ޕ 䉥䊤䊮䉻䈱䊥䉴䉪᭴ㅧ⺞ᢛ䊒䊧䊚䉝䊛㩷 ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ߇ዉ౉ߐࠇߚ1993 ᐕᤨὐߢ࡝ࠬࠢⷐ࿃ߦ❱ࠅㄟ߹ࠇߡ޿ߚߩߪ㧘㧔i㧕ᕈ೎ߣ 㧔ii㧕ᐕ㦂ߩߺߢ޽ߞߚޕ95 ᐕએ㒠ߪ࡝ࠬࠢ᭴ㅧ⺞ᢛߦᕈ೎㧘ᐕ㦂ߩ߶߆㧘㧔iii㧕ዬ૑࿾෸߮㧔iv㧕り૕㓚 ኂߩ᦭ή㧔99 ᐕએ㒠ߪ㓹↪࡮␠ળ଻㒾⛎ઃߩ᦭ήߦᄌᦝ㧕߇ട߃ࠄࠇࠆߥߤ♖ᐲ㧔ട౉⠪ߩޟ⌀ߩ࡝ࠬࠢޠ ߣߩㆡวᕈ㧕ߩᡷༀ߇࿑ࠄࠇߡ߈ߡ޿ࠆ 7)ޕ2002 ᐕ߆ࠄߪᘟᕈ∔ᖚߩ࡝ࠬࠢⷐ࿃ߣߒߡ㧔v㧕⺞೷⾌ಽ㘃 㧔Pharmacy Based Cost Groups㧔PCGs㧕㧕߇㧘04 ᐕ߆ࠄߪ౉㒮ᴦ≮ߩ࡝ࠬࠢⷐ࿃ߣߒߡ㧔vi㧕∔∛೎⾌↪ಽ 㘃㧔Diagnostic Cost Groups㧔DCG㧕㧕 ߇⠨ᘦߐࠇࠆࠃ߁ߦߥߞߡ޿ࠆޕ㧔PCGsߪᄖ᧪ߩ⺞೷ 13 ⒳㘃ࠍኻ⽎ ߣߒߡ߅ࠅ㧘ᄖ᧪ᴦ≮⾌ߩઍℂᄌᢙߣ߽⠨߃ࠄࠇࠆ㧔Van de Ven et al (2004)㧕㧕ޕએਅߢߪ㧘ࠝ࡜ࡦ࠳ߩ࡝ࠬ ࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ▚ቯࠍ᭎ⷰߔࠆޕ

ⵍ଻㒾⠪ߩ㧔᡽ᐭ߇࡝ࠬࠢ⺞ᢛߔࠆ㧕ᦼᓙක≮⾌ߪ㧘Ԙᄖ᧪㧔Outpatient care㧕ԙኾ㐷කᴦ≮㧔Specialist care㧕 Ԛ∛㒮ࠦࠬ࠻㧔⚻Ᏹ⾌㧕ԛ∛㒮ࠦࠬ࠻㧔⾗ᧄ⚻⾌㧕ߏߣߦ▚಴ߐࠇ㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߐ ࠇࠆޕ⾌↪㗄⋡ߏߣߦࡊ࡟ࡒࠕࡓߩ▚ቯߪ࿑⴫7 ߩㅢࠅᰴߩ 4 Ბ㓏߆ࠄߥࠆ㧔Lamer et al(2003)㧕ޕ ╙1 Ბ㓏ߣߒߡⵍ଻㒾⠪ߩᕈ೎࡮ᐕ㦂╬࡝ࠬࠢⷐ࿃ࠍ❱ࠅㄟࠎߛࡊ࡟ࡒࠕࡓ j I

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_asߪታ❣୯ࠍࡌ࡯ࠬߣߒߟߟ߽㧘∔∛㊄ᐶᆔຬળ㧔The Sickness Fund Council㧕ߢ߽ߞߡ᳿߼ࠄࠇ ߡ߈ߚޕߒ߆ߒ㧘଻㒾⠪ߩⵙ㊂߇Ⴧߔߦߟࠇ㧘⹏ଔ߽ⶄ㔀ൻߒߡ޿ࠆޕ৻ᣇ㧘࠼ࠗ࠷ߢߪᐔဋක≮⾌ߩታ ⃻୯߇ߘߩ߹߹↪޿ࠄࠇߡ޿ࠆ㧔Buchner and Wasem(2003)㧕ޕⷙᮨߩᄢ߈޿∔∛㊄ᐶ߇ሽ࿷ߔࠆ႐ว㧘ޟᐔ ဋක≮⾌ޠߦኻߒߡᓇ㗀ജࠍⴕ૶ߔࠆߎߣ߇ߢ߈ࠆߚ߼㧘ක≮⾌ㆡᱜൻ߳ߩ⺃࿃ࠍ៊ߥ޿߆ߨߥ޿ޕ ታ㓙ߩߣߎࠈ㧘 j I

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ߪ㧘ኾ㐷කᴦ≮߇70㧑㧘∛㒮ߩ⚻Ᏹࠦࠬ࠻߇ 25㧑㧘⾗ᧄࠦࠬ࠻߇ 95㧑޽߹ࠅ ߣߥࠆ㧔࿑⴫7㧕ޕ ࿑⴫ 㪎㩷 ଻㒾⠪䈻䈱⒖ォ㩷 ࡝ࠬࠢ⺞ᢛ ㆊ෰ߩ⚻⾌ Outlier risk ੐ᓟ⊛⺞ᢛ ⾌ ↪ 㗄 ⋡ Σ Τ Υ Φ ᄖ ᧪ 030㧑 ޽ࠅ 00㧑 ኾ㐷කᴦ≮ 70㧑 ⚻Ᏹ ᕈ೎࡮ᐕ㦂╬ 030㧑 ޽ࠅ 25㧑 ∛㒮ࠦࠬ࠻ ⾗ᧄ 100㧑 95㧑 ಴ᚲ㧦Lamer et al (2003) 

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಴ᚲ㧦Van de Ven, W.P.M.M., R.C.J.A.,Van Vliet, and L.M. Lamers (2004)

䋵䋮䉥䊤䊮䉻䈱 㪉㪇㪇㪍 ᐕᐲᡷ㕟㩷

ޟක≮଻㒾ᴺޠ߇2006 ᐕ 1 ᦬ 1 ᣣߦᣉⴕߐࠇߚޕหᴺߩਅߢߪ㧘ߎࠇ߹ߢಽ┙ߒߡ޿ߚ∔∛㊄ᐶ㧘᳃㑆 ଻㒾ࠍ⛔ว㧘╙2 ጀߦ޽ߚࠆᕆᕈ∔ᖚ࡮⍴ᦼߩ౉㒮╬ߦଥࠊࠆක≮଻㒾ߪ᳃㑆଻㒾ળ␠ߦࠃߞߡឭଏߐࠇ ࠆߎߣߦߥߞߚޕක≮଻㒾ળ␠ߪၮᧄ଻㒾ߦട߃ߡ⵬ቢ⊛଻㒾ࠍឭଏߔࠆޕᓥ᧪㧘∔∛㊄ᐶߪ㕖༡೑ߢ޽ ߞߚ߇㧘ක≮଻㒾ᴺߪ଻㒾⠪ߦࠃࠆ༡೑ࠍ⹺߼ߡ߅ࠅ㧘᳃㑆଻㒾ળ␠ߪᩣਥߦኻߒߡ㈩ᒰࠍᡰᛄ߁㧔೑⋉ ಣಽߔࠆ㧕ߎߣ߽ߢ߈ࠆޕⵍ଻㒾⠪ߪ଻㒾ળ␠ࠍㆬᛯน⢻ߛ߇㧘޿ߕࠇ߆ߩක≮଻㒾ߩ⾼౉߇⟵ോઃߌࠄ ࠇߡ޿ࠆ㧔ޟᒝ೙଻㒾ޠߢ޽ࠆ㧕ޕ06 ᐕએ೨ߪ㧔∔∛㊄ᐶߩട౉߇⹺߼ࠄࠇߥ޿㧕৻ቯᚲᓧએ਄ߩ୘ੱߩ᳃ 㑆ක≮଻㒾ߩ⾼౉ߪછᗧߢ޽ߞߚޕ੹࿁ߩක≮଻㒾ᴺߦࠃࠅ㧘೙ᐲ⊛ߦޟ࿖᳃⊝଻㒾ޠ߇ታ⃻ߒߚߎߣߦ ߥࠆޕ଻㒾⠪ߪട౉Ꮧᦸߩ୘ੱߩฃߌ౉ࠇࠍᜎุߢ߈ߥ޿Open enrollment ߇⺖ߐࠇߡ޿ࠆޕߚߛߒ㧘਄ㅀ ߩࠃ߁ߦ⵬ቢ⊛଻㒾ࠍ↪޿ߚ࡝ࠬࠢㆬᛯߩน⢻ᕈ߇ᱷߐࠇࠆޕᄢㇱಽߩⵍ଻㒾⠪ߪၮᧄ଻㒾ߣ⵬ቢ⊛଻㒾 ࠍห৻଻㒾ળ␠߆ࠄ⾼౉ߒߡ޿ࠆ߆ࠄߛޕ ක≮଻㒾ળ␠ߪ㧘⇣ߥࠆ଻㒾ᄾ⚂ࠍᏒ႐ߢᄁࠅ಴ߔߎߣ߇ߢ߈㧘2006 ᐕߦߪ 43 ⒳㘃ߩ㧔ᴺቯ⛎ઃࠍࠞ ࡃ࡯ߒߚ㧕ၮᧄ଻㒾߇Ꮢ႐ߦ಴ߐࠇߡ޿ࠆ㧔ޟ2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽޠ㧕ޕࠝ࡜ࡦ࠳ߩක≮଻㒾⠪ߪ ࿾ၞන૏ߦ㒢ቯߐࠇߡ޿ࠆࠊߌߢߪߥ޿ޕක≮଻㒾ᴺ㧔╙29 ᧦╙ 2 㗄㧕ߪᄢⷙᮨߥ଻㒾⠪ߦߟ޿ߡߪ㧘ߔ ߴߡߩᎺߦ߅ߌࠆ଻㒾ឭଏࠍ⟵ോઃߌߡ޿ࠆޕⵍ଻㒾⠪ߪක≮଻㒾ળ␠ࠍㆬᛯߢ߈ࠆ߇㧘⥄ಽ߇ዬ૑ߔࠆ Ꮊߢᄾ⚂ߔࠆߎߣߦߥࠆޕ ଻㒾ߩࡕ࠺࡞ᄾ⚂ߩᒻᘒߣߒߡߪ㧘㧔1㧕⃻‛⛎ઃဳ଻㒾㧘㧔2㧕ఘㆶဳ଻㒾෸߮㧔3㧕ⶄวဳ଻㒾߇޽ࠆޕ ⃻‛⛎ઃ㧔ߩᒻߢߩක≮ࠨ࡯ࡆࠬឭଏ㧕ߪක≮଻㒾ળ␠߇ᄾ⚂ߒߚක≮ឭଏᯏ㑐ߦࠃߞߡߥߐࠇࠆޕߚߛ ߒ㧘ⵍ଻㒾⠪߇㕖ᄾ⚂ߩක≮ឭଏ⠪ࠍㆬ߱ߎߣࠍᅹߍࠆ߽ߩߢߪߥ޿ޕߘߩ႐วߦߪⵍ଻㒾⠪ߪ⾌↪ߩ৻ ㇱࠍᡰᛄࠊߥߌࠇ߫ߥࠄߥ޿ޕఘㆶဳߩ଻㒾ߩ႐วߦߪ㧘ⵍ଻㒾⠪ߪ⥄ಽߢක≮ឭଏ⠪ࠍㆬ߱ߎߣ߇ߢ߈ ࠆ࠲ࠗࡊ㧔ᄾ⚂ක≮ߥߒ㧕ߩ߶߆㧘଻㒾⠪߇ᄾ⚂ߒߚක≮ᯏ㑐ࠍฃ⸻ߔࠆቢోߥᄾ⚂ක≮㧘߽ߒߊߪ৻ㇱ ᄾ⚂ක≮߇޽ࠆޕⵍ଻㒾⠪ߩ3 ಽߩ 2 ߪ⃻‛⛎ઃဳࠍㆬᛯߒߡ޿ࠆ㧔ޟ2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽޠ㧕ޕ ⵍ଻㒾⠪ߪ఺⽿೙㧔৻ቯ㗵߹ߢߩක≮⾌ࠍ⥄Ꮖ⽶ᜂ㧕ߩ޽ࠆ଻㒾ᄾ⚂߽ㆬᛯߢ߈ࠆޕ఺⽿ߩ਄㒢ߪ100 ࡙ ࡯ࡠ߆ࠄ500 ࡙࡯ࡠ߹ߢߣᄾ⚂ߦࠃߞߡ⇣ߥࠆ߇㧘఺⽿ߦᔕߓߡⵍ଻㒾⠪ߦኻߔࠆቯ㗵଻㒾ᢱߪഀᒁߐࠇ ࠆޕߚߛߒ㧘఺⽿ࠍㆬᛯߔࠆⵍ଻㒾⠪ߪߏߊ௖߆ߦㆊ߉ߥ޿ߣ޿ࠊࠇࠆޕ ⵍ଻㒾⠪ߪᚲᓧߦଐሽߒߚ଻㒾ᢱࠍ⽶ᜂߔࠆޕߎߩ଻㒾ᢱߪޟක≮଻㒾ၮ㊄ޠ㧔2006 ᐕએ೨ߩਛᄩၮ㊄㧕 ߳ᝄࠅㄟ߹ࠇࠆޕⵍ↪⠪ߩ႐ว㧘଻㒾ᢱ㧔ᢱ₸6.5㧑㧕ߪ⾓㊄߆ࠄḮᴰᓽ෼ߐࠇࠆ߇ක≮଻㒾ᴺߪ㓹↪ਥߦ ኻߒߡᒰ⹥଻㒾ᢱ⽶ᜂࠍ⵬ఘߔࠆ㧔⾓㊄ߦ਄ਸ਼ߖߔࠆ㧕⟵ോࠍ⺖ߒߡ޿ࠆޕᓥߞߡ㧘ታ⾰⊛ߦߪᚲᓧଐሽ ଻㒾ᢱߪ㓹↪⠪ߦࠃࠆ᜚಴ߣ޿߃ࠆޕ⥄༡ᬺ⠪߿ᐕ㊄↢ᵴ⠪ߦߪ㓹↪⠪⵬ఘߪߥ޿߇㧘଻㒾ᢱ₸ߪ4.4㧑ߦ シᷫߐࠇߡ޿ࠆޕⵍ↪⠪㧘⥄༡ᬺ⠪ߣ߽ᒰ⹥଻㒾ᢱߩ਄㒢ߪᐕ㑆30,015 ࡙࡯ࡠߢ޽ࠆޕߥ߅㧘଻㒾ᢱߩᓽ ෼ߦߪౝ࿖ᱦ౉ᐡ㧔ᓽ⒢ᯏ㑐㧕߇޽ߚࠆ㧔࿑⴫9㧕9)ޕ ᚲᓧଐሽ଻㒾ᢱߦട߃ߡ㧘18 ᱦએ਄ߩⵍ଻㒾⠪ߪട౉ߔࠆ଻㒾⠪ߦኻߒߡቯ㗵଻㒾ᢱࠍᡰᛄ߁ޕቯ㗵଻ 㒾ᢱߩᐔဋߪ2006 ᐕᤨὐߢ 1,000 ࡙࡯ࡠ㧔1 ࡩ᦬ 92 ࡙࡯ࡠ㧕⒟ᐲߣ⷗ㄟ߹ࠇࠆޕหߓ࠲ࠗࡊߩ଻㒾ᄾ⚂ߢ ޽ࠇ߫ቯ㗵଻㒾ᢱߪဋ৻ߢߥߊߡߪߥࠄߥ޿ޕⵍ଻㒾⠪ߩㆊ෰ߩ∛ᱧ╬ක≮࡝ࠬࠢߢᏅ೎ൻߔࠆߎߣ㧔෸ ߮ട౉ࠍ⸵นߔࠆߎߣ㧕ߪ⹺߼ࠄࠇߡ޿ߥ޿ޕ৻ᐕ㑆㧘ක≮⛎ઃࠍฃߌߥ߆ߞߚⵍ଻㒾⠪ߪ଻㒾ᢱߩㆶઃ 㧔ᐕ㑆ᦨᄢ255 ࡙࡯ࡠ㧕ࠍฃߌࠆߎߣ߇ߢ߈ࠆ㧔No Claim Fund㧕ޕ৻⥸කߩߺߩฃ⸻㧘಴↥ߩߺߩ႐วߢ

_{࠼ࠗ࠷ߢ߽ޟ౏⊛ක≮଻㒾┹੎ᒝൻᴺޠ㧔2007 ᐕ 2 ᦬㧕ߦ߅޿ߡࠝ࡜ࡦ࠳ߩਛᄩၮ㊄ߦ޽ߚࠆක≮ၮ㊄ࠍഃ⸳㧘⽷Ḯࠍ৻ᧄൻߒߡోߡߩⵍ଻} 㒾⠪ߩ଻㒾ᢱ₸ࠍห৻ߦߔࠆߣߣ߽ߦ㧘หၮ㊄ࠍㅢߓߡ∔∛㊄ᐶ㑆ߢ࡝ࠬࠢ᭴ㅧ⺞ᢛࠍⴕ߁ߣߒߡ޿ࠆޕߐࠄߦฦ∔∛㊄ᐶߪട౉⠪߆ࠄ⽷Ḯ ਇ⿷ߦᔕߓߡઃട଻㒾ᢱࠍᓽ෼ߔࠆޕ∔∛㊄ᐶߣ᳃㑆଻㒾ߩਗ┙ߪᱷࠅ㧘ᓟ⠪ߪ࡝ࠬࠢ᭴ㅧ⺞ᢛߩኻ⽎ߦߪߥࠄߥ޿߽ߩߩࠝ࡜ࡦ࠳ဳߩක≮ ೙ᐲߦㄭߠߊᡷ㕟ߣ޿߃ࠆޕ

޽ߞߡ߽଻㒾ᢱㆶઃࠍฃߌࠄࠇࠆޕ߹ߚ㧘ቯ㗵଻㒾ᢱߩ⽶ᜂࠍシᷫߔࠆߚ߼ૐᚲᓧ⠪ะߌߦஜᐽᚻᒰ 㧔Health Care Allowance㧕߇⛎ઃߐࠇߡ޿ࠆޕᚻᒰߪ㧔ታ㗵ߢߪߥߊ㧕ޟᐔဋቯ㗵଻㒾ᢱޠߣⷙ▸⊛⾌↪㧔⽶ ᜂน⢻ߥࠦࠬ࠻㧕ߩᏅ㗵ߦ╬ߒߊ㧘නり਎Ꮺ㧘߆ߟᐕ㑆ߩ㧔☻㧕ᚲᓧ߇25,000 ࡙࡯ࡠએਅߢ޽ࠇ߫ᦨᄢ 400 ࡙࡯ࡠ㧘㈩஧⠪࡮ࡄ࡯࠻࠽࡯߇޿ࠆ਎Ꮺߢᐕ㑆ߩ਎Ꮺ㧔ว▚㧕ᚲᓧ߇40,000 ࡙࡯ࡠએਅߢ޽ࠇ߫ᦨᄢ 1,155 ࡙࡯ࡠߣߥߞߡ޿ࠆޕ଻㒾⠪㑆ߩଔᩰ┹੎ࠍ៊ߥ߁ߎߣߥߊ㧘౏ᐔߦ㈩ᘦߒߚ೙ᐲߣ޿߃ࠆޕ ࿑⴫ 㪐䋺ක≮଻㒾䈱଻㒾ᢱ㩷 ଻ 㒾 ᢱ ₸ 12.55㧑 ․೎ක≮⾌⵬ఘ೙ᐲ ᦨ㜞ᡰᛄ㗵㧔ᐕ㗵㧕 30,631 ࡙࡯ࡠ ⵍ↪⠪╬㧔㓹↪⠪⵬ఘ޽ࠅ㧕 6.5㧑 ଻㒾ᢱ₸ ⥄༡ᬺ⠪╬㧔㓹↪⠪⵬ఘߥߒ㧕 4.4㧑 ᒝ೙ஜᐽ଻㒾೙ᐲ ᦨ㜞ᡰᛄ㗵㧔ᐕ㗵㧕 30,015 ࡙࡯ࡠ ଻㒾ή⺧᳞ႎᅑ㊄ ᐕ 㗵 _࡙࡯ࡠ255 ቯ 㗵 ଻ 㒾 ᢱ ෘ↢⑔␩ࠬࡐ࡯࠷⋭⹜▚㧔ᐕ㗵㧕 1,106 ࡙࡯ࡠ ಴ᚲ㧦ޟ2005 ᐕᐲࠝ࡜ࡦ࠳ක≮଻㒾ળ␠ㅢାޠ    ଻㒾⠪ᯏ⢻ߩᒝൻ߽࿑ࠄࠇߡ޿ࠆޕ∔∛㊄ᐶߪ 93 ᐕએ㒠㧘කᏧߣ୘೎ߦ੤ᷤߔࠆߎߣ߇⹺߼ࠄࠇߡ޿ ߚ߇㧘ኾ㐷කߩ᡽ᴦജߩᒝߐߥߤ߆ࠄታ❣߇߶ߣࠎߤߥ߆ߞߚޕߒ߆ߒ㧘1998 ᐕߩ┹੎ᴺߩᡷᱜߦࠃࠅ㧘 ┹੎ࠍ㒖ኂߔࠆ⚿⸤࡮ଔᩰࠞ࡞࠹࡞╬ߪᒰ੐⠪߇ߘߩ␠ળ⊛೑⋉ࠍ┙⸽ߢ߈ߥ޿㒢ࠅ㧘ߔߴߡ⑌ᱛߐࠇࠆ ߎߣߦߥߞߚޕ㧔98 ᐕએ೨ߪ⚿⸤߇␠ળ⊛೑⋉ߦ෻ߔࠆߎߣࠍ᜼⸽ߔࠆ⽿છߪ᡽ᐭߩ஥ߦ޽ߞߚޕ㧕ߎߩ┹ ੎ᴺߪක≮ឭଏߩ3 ಽߩ 1 ޽߹ࠅߦ㑐ࠊߞߡ޿ࠆޕหᴺߦၮߠ߈౏ᱜขᒁᆔຬળ㧔Competition Authority㧕 ߇ߎࠇ߹ߢᘠⴕߣߒߡⴕࠊࠇߡ޿ߚකᏧࠄ㧔৻⥸ක㧘࠮࡜ࡇࠬ࠻╬㧕ߦࠃࠆଔᩰࠞ࡞࠹࡞ࠍ⑌ᱛߒߚޕ ଻㒾⠪߆ࠄක≮ᯏ㑐㧔∛㒮࡮කᏧ㧕߳ߩᡰᛄ޿ߩ൮᜝ൻ߽࿑ࠄࠇߡ߈ߡ޿ࠆޕ⸻≮ႎ㈽ߩ൮᜝ൻߦߪක ≮ࠨ࡯ࡆࠬߩಽ㘃㧔ᚲቯߩ∔∛ߦኻߔࠆ⸻≮ⴕὑߩᮡḰൻ㧕߇ਇนᰳߢ޽ࠆޕ᡽ᐭߪ2000 ᐕߦ∔∛⸻ᢿ࡮ ⸻≮ⴕὑߦ㑐ߔࠆ⎇ⓥࡊࡠࠫࠚࠢ࠻ࠍ⊒⿷㧘∛㒮ߩᄖ᧪࡮౉㒮ᴦ≮ࠍಽ㘃ߔࠆၮḰߣߒߡDBC㧔∔∛࡮ᴦ ≮ಽ㘃㧕ࠍ㐿⊒ߒߚޕDBC ߩ⒳㘃ߪ 400-600 ߶ߤߢ޽ࠅ㧘05 ᐕ߆ࠄߪ∛㒮⚻⾌ߩ 10㧑ߦߟ޿ߡߪ㧘ߎߩ DBC㧔ߦߣߞߡቯ⟵ߐࠇߚක≮ࠨ࡯ࡆࠬ 100 ⒟ᐲ㧕ߏߣߦଔᩰߠߌࠍⴕ߁ߎߣߦߥߞߡ޿ࠆ㧔Schut and Van de Ven (2005)㧕ޕߎࠇ߹ߢ଻㒾⠪ߪ∛㒮ߣߩ୘೎੤ᷤߪ⹺߼ࠄࠇߡ߅ࠄߕ㧘ߘߩ੍▚ߦߟ޿ߡ∛㒮ߣߩ㓸࿅ ੤ᷤ߳ߩෳട߇⟵ോઃߌࠄࠇߡ޿ߚޕ2006 ᐕࠃࠅ଻㒾⠪ߪ DBC ߦၮߠ߈∛㒮ߣ୘೎ߦᄾ⚂ࠍ੤ࠊߔߎߣ ߇ߢ߈ࠆࠃ߁ߦߥߞߚޕߚߛߒ㧘ะߎ߁5 ᐕ㑆ߪ⒖ⴕᦼ㑆ߣߐࠇ㧘∛㒮੍▚ߩ 90㧑ߪ㧔ᓥ᧪ߩ✚੍▚ᨒ೙

ߦၮߠ߈㧕᡽ᐭߦࠃߞߡ᳿߼ࠄࠇ㧘ᱷࠅߩ10㧑ࠍᒰ੐⠪㑆ߢߩଔᩰ੤ᷤߦᆔߨࠆੑర೙ᐲ߇ߣࠄࠇߡ޿ࠆޕ

㪘㪮㪙㪱 䈱❗ዊ㩷 1968 ᐕߩዉ౉એ᧪㧘⛎ઃ▸࿐ߩ᜛ᄢߣߣ߽ߦ㧘AWBZ ᡰ಴㗵ߪჇടߒ⛯ߌߡ޿ࠆޕ੺⼔㧘㐳ᦼ౉㒮ߥߤ ߦኻߔࠆ࿖᳃ߩ㜞޿࠾࡯࠭߇⢛᥊ߦ޽ࠆߣߒߡ߽㧘ߎߩ߹߹⤘ᒛ߇⛯ߌ߫㧘AWBZ ߩ଻㒾ᢱ߇ 2030 ᐕߦ ߪ25㧑޽߹ࠅߦߥࠆߣߩ⹜▚߽޽ࠆ㧔MHWS(2004)㧕ޕ2000 ᐕએ㒠ߪࠨࠗࡕࡦ࠭⸘↹߆ࠄ৻ォ㧘AWBZ ࠍ 㒢ቯߔࠆᣇะߦ޽ࠆޕ2007 ᐕߦߪ♖␹⑼ᴦ≮㧔1 ᐕએౝ㧕߇ක≮଻㒾೙ᐲ㧔╙ 2 ጀ㧕ߦ⒖ߐࠇࠆ߶߆㧘WMO ᴺ㧔␠ળ⊛ࠨࡐ࡯࠻ߦ㑐ߔࠆᴺᓞ㧕ࠍᣉⴕ㧔2007 ᐕ 1 ᦬㧕ߒߡ࿷ቛࠤࠕࠍ࿾ᣇ⥄ᴦ૕ߦᜂࠊߖࠆߥߤಽᮭ ൻ㧔੺⼔ᡰេߦ߅ߌࠆ࿾ᣇ⥄ᴦ૕ߩ⽿છߩ᜛ల㧕߇ㅴ߼ࠄࠇߡ޿ࠆ㧔MHWS(2004)㧕ޕߚߛߒ㧘੺⼔ᣉ⸳ߪ ᘟᕈ⊛ߥଏ⛎ਇ⿷ߦ޽ࠅ㧘ᓙᯏ࡝ࠬ࠻߽⸃ᶖߒߡ޿ߥ޿ޕ∛㒮ࠍ಴ߚᖚ⠪߇ޟ੺⼔㔍᳃ޠߦߥߞߚ੐଀ߪ ⍮ࠄࠇߡ޿ߥ޿߇㧘ߘߩ ᔨߪ᜞߃ߥ޿㧔ᄢ᫪(2006)㧕ޕ ଻㒾⠪䈻䈱ⷙ೙㩷 ක≮଻㒾ࠍឭଏߔࠆ᳃㑆଻㒾ળ␠ߦኻߒߡߪ㧘ߘߩ⽷ോ࡮ᛩ⾗㧘଻㒾ߩឭଏ㧘଻㒾ᢱߩᓽ෼㧘┹੎╬㧘 ᭽ޘߥዪ㕙ߢⷙ೙߇ሽ࿷ߒߡ޿ࠆޕߘߩⷙ೙ߦߪක≮㑐ㅪߦ㒢ࠄߕ㧘ක≮એᄖߩ଻㒾ળ␠ห᭽㧘᳃㑆଻㒾࡮ ༡೑ડᬺߦኻߔࠆ߽ߩ߽฽߹ࠇࠆޕⷙ೙ᒰዪߣߒߡߪ㧘㧔1㧕ਛᄩ㌁ⴕ㧘㧔2㧕㊄ⲢᏒ႐ⷙ೙ᒰዪ㧘㧔3㧕┹੎ ᡽╷ᒰዪ㧘㧔4㧕ක≮଻㒾⋙ⷞᯏ᭴㧔CTZ㧕㧔ஜᐽෘ↢ࠬࡐ࡯࠷⋭㧕෸߮㧔5㧕ක≮଻㒾ᯏ᭴߇޽ࠆ㧔MHWS(2006)㧕ޕ

଻㒾⠪ߪ᳃㑆଻㒾ળ␠ࠍ⋙〈ߔࠆޟ଻㒾⋙〈ᴺ㧔Insurance Supervision Act㧕1993ޠߩㆡ↪ࠍฃߌࠆޕหᴺ ߪ᳃㑆଻㒾ળ␠߇଻㒾ᄾ⚂ࠍጁⴕߔࠆߩߦᔅⷐߥ⽷ോ਄ߩஜోᕈ߿଻㒾⚻༡ߩ⛮⛯ᕈࠍ⋙〈ߔࠆ߽ߩߢ޽ ࠅ㧘ਛᄩ㌁ⴕ߇ⷙ೙ᒰዪߣߒߡၫⴕߦ޽ߚߞߡ޿ࠆޕ㊄Ⲣⷙ೙ᒰዪߪ㧘ක≮଻㒾ળ␠߇ⵍ଻㒾⠪ߦኻߒߡ ଻㒾ᄾ⚂ߩࠝࡊ࡚ࠪࡦ㧘ቯ㗵଻㒾ᢱߦ㑐ߔࠆᖱႎࠍⵍ଻㒾⠪ߦᱜߒߊ㐿␜ߒߡ޿ࠆ߆ࠍ⋙ⷞߔࠆޕߐࠄߦ หዪߪ଻㒾⠪ߩ⽷ോ▤ℂ࡮ᛩ⾗ߩㆡᱜ߽ክᩏߔࠆޕක≮଻㒾ળ␠޽ࠆ޿ߪක≮ឭଏᯏ㑐ߩ㑆ߢߩ⚿⸤ࠍ㒐 ᱛ࡮៰⊒ߔࠆ㧔ஜోߥ┹੎ࠍ଻ᜬߔࠆ㧕ߩ߇┹੎᡽╷ᒰዪߩᓎഀߢ޽ࠆޕ৻ᣇ㧘CTZ ߪട౉⠪ฃߌ౉ࠇ⟵ ോߩㆩ቞߿ห৻଻㒾ᄾ⚂ߦኻߔࠆ଻㒾ᢱߩㆡᱜᓽ෼㧔Ꮕ೎ൻߩ᦭ή㧕ࠍ⋙ⷞߔࠆޕ߹ߚ㧘CTZ ߪක≮଻㒾 ᴺߢⷙቯߐࠇߚ౏⊛ක≮଻㒾⛎ઃࠍⵍ଻㒾⠪߇ฃߌߡ޿ࠆ߆ߤ߁߆ࠍࡕ࠾࠲࡯ߔࠆ߶߆㧘ᓟㅀߔࠆක≮଻ 㒾ᯏ᭴߆ࠄߩⷐ⺧߇޽ࠇ߫଻㒾⠪ߩᩏኤ߽ⴕ߁ޕߎ߁ߒߚක≮଻㒾Ꮢ႐ߩ⋙〈ߪࠤࠕⷙ೙ᒰዪ㧔Care Authority㧕ߦ⒖ⴕߐࠇࠆߎߣߦߥߞߡ޿ࠆޕޟஜᐽᴺ㧔Health Care Act㧕ޠߦၮߠ޿ߡ⸳┙ߐࠇࠆࠤࠕⷙ೙ᒰ ዪߪAWBZ㧔╙ 1 ጀ㧕ࠍ฽߼ක≮଻㒾ߩㆡᱜߥၫⴕ╬㧘଻㒾⠪ߩ଻㒾ㆇ༡ࠍ⋙ⷞߔࠆᯏ⢻ࠍ᦭ߔࠆߎߣߦ ߥࠆޕᦨᓟߦක≮଻㒾ᯏ᭴ߪ㧘ޟක≮଻㒾ᴺޠߩਅߢ଻㒾Ꮢ႐ߩㆇ༡ో૕ࠍ⋙〈㧘଻㒾ᄾ⚂ߩ᣿⍎ᕈߩଦㅴ㧘 ଻㒾࡮ࠨ࡯ࡆࠬឭଏߦ㑐ࠊࠆᜰ㊎ߩ૞ᚑ㧘ක≮଻㒾ߣAWBZ ߩ㑆ߩᢛวᕈߩ⏕଻㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒ ࠕࡓࠍ㈩ಽߔࠆක≮଻㒾ၮ㊄ߩ▤ℂ෸߮หࡊ࡟ࡒࠕࡓ⒖ォߩታᣉߥߤࠍᜂ߁ޕ 2006 ᐕએ㒠㧘CTZ ߦࠃࠆട౉⠪ฃߌ౉ࠇ⟵ോߪ᳃㑆଻㒾ળ␠ߦㆡ↪ߐࠇߡ߈ߡ޿ࠆޕߒ߆ߒ㧘EU ߢߪ ᳃㑆ડᬺߩ੐ᬺ߳ߩ᡽ᐭߩ⛔೙ࠍ⑌ߓߡ߅ࠅ㧘ߎࠇߦOpen enrollment ߇ᛶ⸅ߔࠆน⢻ᕈ߽ᜰ៰ߐࠇߡ޿ࠆ 㧔Van de Ven ࠛ࡜ࠬࡓࠬᄢቇᢎ᝼⺣㧕ޕ੹࿁ߩᡷ㕟ߦ޽ߚߞߡ㧘ࠝ࡜ࡦ࠳᡽ᐭߪ੐೨ߦ EU ߩ┹੎ᆔຬળߦ ኻߒߡ⏕⹺㧘EU ⷙ೙ߦ⍦⋫ߒߥ޿ߢ޽ࠈ߁ߣ޿߁ᆔຬ㐳ߩ⸒⾰ࠍᓧߡ޿ࠆ߇㧘EU ߩ౏ᑼ⷗⸃ߣ޿߁ࠊߌ ߢߪߥ޿ޕ ଻㒾⠪㑆┹੎䈱ታ㓙㩷 ቯ㗵଻㒾ᢱߪⵍ଻㒾⠪ߩᚲᓧߦߪଐሽߖߕ㧘଻㒾ᄾ⚂࠲ࠗࡊߏߣߦ㊄㗵߇᳿߼ࠄࠇߡ޿ࠆޕ㧔ߚߛߒ㧘

ૐᚲᓧ⠪ߩ⽶ᜂ߳ߩ㈩ᘦߪHealth Care Allowance Act ߩਅߢޟක≮ᚻᒰޠߢ߽ߞߡኻಣߐࠇࠆޕ㧕90 ᐕઍೋ 㗡ߪ㧘∔∛㊄ᐶߦኻߔࠆ੐ᓟ⊛⵬Ⴏߩഀว߇㜞߆ߞߚ㧔93 ᐕߪ 97.5㧑㧕ߎߣ߿ක≮ᯏ㑐ߩㆬ೎߽⊝ήߢ޽

ߞߚߎߣ߆ࠄ଻㒾⠪㑆ߢቯ㗵଻㒾ᢱߦᩰᏅ߇߶ߣࠎߤߥ߆ߞߚޕߒ߆ߒ㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖ ✺ൻ㧔ߘࠇߣวࠊߖߚ੐ᓟ⊛⵬Ⴏߩࠪࠚࠕߩૐਅ㧕߿଻㒾⠪ߩ⚻༡⢻ജߩะ਄ߣߣ߽ߦᩰᏅ߇㗼⪺ߦߥߞ ߡ߈ߡ޿ࠆ㧔࿑⴫10㧕ޕ2006 ᐕߦ߅ߌࠆߎߩቯ㗵଻㒾ᢱߩᦨ㜞㗵㧔ᄾ⚂ක≮ߥߒߩ⵬ఘဳ଻㒾㧕ߪ 1,172 ࡙࡯ࡠߢ޽ࠅ㧘ᦨૐ㗵㧔ᄾ⚂ක≮ઃ߈ߩ⵬ఘဳ଻㒾㧕ߪ990 ࡙࡯ࡠߢ޽ࠆޕ଻㒾ߦࠃࠆଔᩰߩᏅߪ 10㧑એ ਄ߦ㆐ߔࠆޕⵍ଻㒾⠪ߦࠃߞߡㆬᛯߩ⥄↱߇ߥ޿଻㒾໡ຠ㧔⃻‛⛎ઃဳ଻㒾㧕ߪ቟ଔߥ㧘ㆬᛯߩ⥄↱߇ᄙ ޿଻㒾໡ຠ㧔⵬ఘဳ଻㒾㧕ߩ႐วߪ㜞ଔߥޟଔᩰߠߌޠ߇ߥߐࠇߡ߈ߡ޿ࠆ߽ߩߣ⠨߃ࠄࠇࠆޕߚߛߒ㧘 ޽ࠆ଻㒾ળ␠ߩᄾ⚂ක≮ઃ߈ⶄวဳ଻㒾෸߮⵬ఘဳ଻㒾ߪ㧘೎ߩ଻㒾ળ␠ߩ⃻‛⛎ઃဳ଻㒾ࠃࠅ߽቟ଔߥ ႐ว߇޽ࠅ߁ࠆ㧔ޟ2005 ᐕᐲࠝ࡜ࡦ࠳ක≮଻㒾ળ␠ㅢାޠ㧕ޕ ࿑⴫ 㪈㪇㩷 ቯ㗵଻㒾ᢱᩰᏅ䈱᜛ᄢ㩷 0 10 20 30 40 50 60 70 80 90 100 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 ᐕ 䊡䊷䊨 0 5 10 15 20 25 30 35 40 䋦 ଻㒾ᢱᩰᏅ䋨䋽ᦨᄢ䋭ᦨዊ䋩䋨Ꮐゲ䋩 ∔∛㊄ᐶ䈱⽷᡽䊥䉴䉪䋨ฝゲ䋩  ಴ᚲ㧦L. M. Lamers, R. C.J.A. van Vliet and W P.M.M. van de Ven (2003)

 

Schut and Hassink(2002)ߪ 96 ᐕ߆ࠄ 98 ᐕ߹ߢߩࡄࡀ࡞࠺࡯࠲ࠍ↪޿ߡࡊ࡟ࡒࠕࡓߩᒁ߈਄ߍ߇ᒰ⹥଻㒾 ⠪ߩᏒ႐ࠪࠚࠕߦ෸߷ߔࡑࠗ࠽ࠬലᨐߪૐߊ㧘∔∛㊄ᐶ㑆ߢߩଔᩰ┹੎߇㒢ቯ⊛ߢ޽ߞߚߎߣࠍ␜ߒߚޕ ∔∛㊄ᐶࠍᄌ߃ࠆⵍ଻㒾⠪ߩഀวߪᲤᐕ2-3㧑ߦ⇐߹ࠆߣߩႎ๔߽޽ࠆ㧔Lamers et al(2003)㧕ޕ࠼ࠗ࠷ߦ߅ ߌࠆⵍ଻㒾⠪⒖േ߽3-4㧑⒟ᐲߣߐࠇࠆ㧔Buchner and Wasem(2003)㧕ޕ୘ੱߦኻߔࠆචಽߥᖱႎ㧔଻㒾ࡊ࡜ ࡦ࡮ឭଏߐࠇࠆක≮ࠨ࡯ࡆࠬߩౝኈ╬㧕߇ⴕ߈ᷰࠄߥ߆ߞߚߎߣ߇㧘⥄↱ߥ଻㒾⠪ㆬᛯߩᮭ೑߇ⴕ૶ߐࠇ ߥ޿ේ࿃ߩ৻ߟߦ᜼ߍࠄࠇࠆ㧔Van de Ven(1991)㧕ޕߒ߆ߒ㧘2006 ᐕߪⵍ଻㒾⠪ߩ⚂ 18㧑߇೎ߩක≮଻㒾ળ

␠ߦ⒖ߞߚߣߐࠇࠆ㧔࿑⴫11 ෳᾖ㧕ޕห৻଻㒾⠪ߦߣߤ߹ߞߡ߽㧘೎ߩක≮଻㒾ࠍㆬᛯߔࠆߎߣ߽޽ࠅ߁

ࠆޕߎ߁ߒߚౝㇱߢߩ⒖ォߪ5㧑߆ࠄ 10㧑ߦ෸߽߱ߩߣ⷗Ⓧ߽ࠄࠇߡ޿ࠆޕઁߩක≮଻㒾ળ␠߳ߩ⒖ォ෸

ᄾ⚂ࠍᄌᦝߒߚߎߣߦߥࠆޕ೙ᐲᡷ㕟ߦࠃࠆ৻ᤨ⊛ߥ⃻⽎ߣ߽޿߃ࠆ߇㧘ⵍ଻㒾⠪߇ᯏળ㧔ߣᖱႎ㧕߇޽ ࠇ߫㧘ޟ⿷ߦᛩ␿ޠᮭࠍⴕ૶ߔࠆߎߣࠍ␜ߔ੐଀ߢ޽ࠆޕ ࿑⴫ 㪈㪈㩷 㪉㪇㪇㪈 ᐕ䈎䉌 㪉㪇㪇㪍 ᐕ䉁䈪䈱ⵍ଻㒾⠪䈱นേᕈ㩷 ᐕᐲ ᒝ೙ஜᐽ଻㒾ળ␠ߩⵍ଻㒾⠪ ᳃㑆଻㒾ળ␠ߩⵍ଻㒾⠪ 2001 2.6㧑 6.6㧑 2003 2.8㧑 8.6㧑 2004 2.4㧑 ਇ᣿ 2005 4.2㧑 8.7㧑 2006 18㧑 ಴ᚲ㧦ޟ2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽޠ

䋶䋮⚳䉒䉍䈮㩷

ࠊ߇࿖ߢ߽ޟㆬᛯߣ┹੎ޠࠍଦㅴߔߴߊޟ▤ℂ┹੎ޠߩዉ౉߇ឭ⸒ߐࠇߡ޿ࠆ㧔ᐢ੗(1998)㧘(1999)㧕ޕ ␠ળ଻㒾ߦ߅ߌࠆ␠ળㅪᏪ㧔ౣಽ㈩㧕ߣല₸ᕈߩㅊ᳞ߪᔅߕߒ߽⋧෻ߒߥ޿ߎߣߪᒝ⺞ߦ୯ߔࠆޕࠝ࡜ࡦ ࠳ߩࠃ߁ߦ଻㒾⠪ߩᯏ⢻㧔ᮭ㒢㧕ᒝൻߣ଻㒾⠪㑆┹੎ࠍଦߒߚ਄ߢ㧘Ԙᚲᓧଐሽဳ␠ળ଻㒾ᢱߣ࡝ࠬࠢ᭴ ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⚵ߺวࠊߖߢ߽ߞߡ␠ળㅪᏪࠍ⛽ᜬߔࠆ৻ᣇ㧘ԙቯ㗵଻㒾ᢱߦක≮଻㒾߳ߩଔᩰࡔࠞ ࠾࠭ࡓߣߒߡߩᓎഀࠍ߽ߚߖࠆߎߣ߽น⢻ߢ޽ࠆޕቯ㗵଻㒾ᢱߩ৻ㇱࠍ⵬ഥ㧔ᚻᒰ⛎ઃ㧕ߔࠇ߫㧘ૐᚲᓧ ⠪ߦߣߞߡ߽౏ᐔߥ઀⚵ߺߣߥࠆߛࠈ߁ޕ┹੎ේℂߦࠃࠆක≮⾗Ḯߩല₸ൻ㧔ࡒࠢࡠല₸ᕈߩᡷༀ㧕ߪක ≮⾌ࠍ⽷᡽⊛ߦᜬ⛯น⢻ߥ㧔ޟりߩਂޠߦวߞߚ㧕᳓Ḱߦ⇐߼ࠆ㧔ࡑࠢࡠല₸ᕈߩ⏕଻㧕ࡑࠢࡠ✚㗵▤ℂߣ ߽⵬ቢ⊛ߦߥࠅ߁ࠆ㧔૒⮮(2007)㧕ޕ Ꮢ႐ේℂ߳ߩ޽ࠅ߁ࠆᛕ್ߣߒߡߪ㧘୘ੱߪක≮ࠨ࡯ࡆࠬߦ㑐ߔࠆචಽߥᖱႎࠍᜬߚߕ㧘ࠃߞߡ଻㒾⠪ ߿ක≮ᯏ㑐߇னࠅߩᖱႎ㧔޽ࠆ޿ߪࠗࡔ࡯ࠫᚢ⇛㧕ߦᏀฝߐࠇࠆߎߣ߇᜼ߍࠄࠇࠃ߁ޕක≮ᯏ㑐࡮଻㒾⠪ ߦ㑐ߔࠆᖱႎߪࠬ࠲ࡦ࠳࡯࠼ൻߒ㧘Ყセน⢻ߦߔࠆᎿᄦ߇ᔅⷐߢ޽ࠈ߁ޕᖱႎ㐿␜ߩਥ૕ߪ଻㒾⠪㧘ක≮ ᯏ㑐⥄૕ߢ߽ࠃ޿߇㧘ߘߩᖱႎߩᱜ⏕ߐࠍ⺞ᩏ࡮౏⴫ߔࠆ╙3 ⠪ᯏ㑐ߩ⸳┙߇ਇนᰳߢ޽ࠆޕߎߩ╙ 3 ⠪ ᯏ㑐ߦߪᩏኤ㧘ࡍ࠽࡞࠹ࠖ࡯ࠍ⺖ߔᮭ㒢߇ઃਈߐࠇߡߥߊߡߪߥࠄߥ޿ޕ೑ኂᒰ੐⠪㧔଻㒾⠪㧘ක≮ᯏ㑐㧕 ࠄߦࠃࠆ⥄ਥ⊛ߥⷙ೙ߢߪߥߊ㧘ᒝ޿ᮭ㒢ࠍ᦭ߒߚ╙3 ⠪ߩ㑐ਈ߇౏㐿ߐࠇߚᖱႎߩା㗬ᕈࠍ㜞߼ࠆߎߣ ߦ⽸₂ߔࠆߛࠈ߁ޕ߹ߚ㧘଻㒾⠪߿ක≮ᯏ㑐ࠍ⹏ଔߔࠆᩰઃߌᯏ㑐ߩෳ౉ࠍ⹺߼ࠆߎߣ߽ᖱႎ౏㐿ࠍߐࠄ ߦଦㅴߔࠆ߽ߩߣ⠨߃ࠄࠇࠆޕචಽ㧘߆ߟᱜ⏕ߥᖱႎߩਅߢߩߺ୘ੱߪ⽿છ޽ࠆㆬᛯࠍߣࠆߎߣ߇ߢ߈ࠆޕ ଀߃߫㧘☨࿖ߢߪ㧘଻㒾⠪ᯏ⢻ࠍ⊒ើߔࠆ᳃㑆଻㒾㧔HMO ࠍ฽߻㧕ߦኻߒߡ㧘଻㒾⠪࡮଻㒾໡ຠߩ⾰ߩ ⹏ଔ࡮⹺ቯࠍⴕ߁ᯏ㑐㧔National Committee for Quality Assurance㧔NCQA㧕㧕߇ሽ࿷㧘଻㒾⠪ᯏ⢻ߩⴕ߈ߔ߉ ࠍ࠴ࠚ࠶ࠢߒߡ޿ࠆ㧔᧻ේ(2002)㧕ޕ

ක≮ߦ㒢ࠄߕ೙ᐲᡷ㕟ߪ৻ᄛߦߒߡߥࠆ߽ߩߢߪߥ޿ޕࠝ࡜ࡦ࠳ߪ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦ㧔1987 ᐕ㧕߆ࠄ 2006 ᐕᡷ㕟߹ߢ 20 ᐕㄭ޿᦬ᣣࠍⷐߒߚޕߘߩ㑆㧘೙ᐲᡷ㕟ߪẋㅴ⊛㧘߆ߟ⹜ⴕ㍲⺋⊛ߢ޽ߞߚ߇㧘଻㒾 ⠪ᯏ⢻ߩᒝൻߣ┹੎ේℂߩዉ౉ߣ޿߁ၮᧄේೣߦ߱ࠇߪߥ߆ߞߚ㧔࿖᳃⊛࡮⿥ౄᵷ⊛วᗧ߇޽ߞߚ㧕ࠃ߁

ߦᕁࠊࠇࠆޕ␠ળߩ㜞㦂ൻߣ⽷᡽ᖡൻߩਛ㧘ޟ዁᧪਎ઍߦ⽶ᜂࠍవㅍࠅߒߥ޿␠ળ଻㓚೙ᐲࠍ⏕┙ޠߒߟߟ㧘 ᔅⷐ߆ߟㆡಾߥක≮ࠨ࡯ࡆࠬߩឭଏࠍଦㅴߔߴߊක≮೙ᐲߩౣ᭴▽߇ᕆോߦߥߞߡ޿ࠆޕߘߎߢ᳞߼ࠄࠇ ߡ޿ࠆߩߪ႐ᒰߚࠅ⊛ߥ⽷Ḯ⏕଻㧔౏⾌ߩᛩ౉㧕߿⸻≮ႎ㈽ߩࠞ࠶࠻ߢߪߥߊ㧘ක≮೙ᐲߩޟၮᧄේೣޠ ߣ␠ળ⊛ࠦࡦ࠮ࡦࠨࠬߩ⏕┙ߢ޽ࠈ߁ޕ

䋼ෳ⠨ᢥ₂䋾㩷

 ᄢ᫪ᱜඳ(2001)ޟࠝ࡜ࡦ࠳ߩක≮೙ᐲᡷ㕟ߣޟ଻㒾⠪ᯏ⢻ޠޠޡᶏᄖ␠ળ଻㓚⎇ⓥޢNo.136㧘pp.59-71㧘࿖┙ ␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ ᄢ᫪ᱜඳ(2006)ޟࠝ࡜ࡦ࠳ߦ߅ߌࠆක≮ߣ੺⼔ߩᯏ⢻ಽᜂߣㅪ៤ޠޡᶏᄖ␠ળ଻㓚⎇ⓥޢNo.156㧘pp.75-90㧘 ࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ ૒⮮ਥశ(2007)ޟක≮଻㒾೙ᐲᡷ㕟ߩ⺖㗴ޠޡળ⸘ᬌᩏ⎇ⓥޢ╙ 35 ภ㧘pp.7-25 ↰ਛ⠹ᄥ㇢(2003)ޟ࠼ࠗ࠷ߩක≮଻㒾೙ᐲᡷ㕟ޠޡᶏᄖ␠ળ଻㓚⎇ⓥޢNo.145㧘pp.14-25㧘࿖┙␠ળ଻㓚࡮ ੱญ໧㗴⎇ⓥᚲ ↰ਛ⠹ᄥ㇢(2006)ޟ࠼ࠗ࠷ක≮೙ᐲߦߺࠆޟㅪᏪਅߩ┹੎ޠߩࠁߊ߃ޠޡࡈࠖ࠽ࡦࠪࡖ࡞࡟ࡆࡘ࡯ޢ80 ภ㧘 pp.4-32 ᐢ੗⦟ౖ(1998)ޡක≮଻㒾ᡷ㕟ߩ᭴ᗐޢᣣᧄ⚻ᷣᣂ⡞␠ ᐢ੗⦟ౖ✬(1999)ޡක≮ᡷ㕟ߣࡑࡀࠗࠫ࠼࡮ࠤࠕޢ᧲ᵗ⚻ᷣᣂႎ␠ ᑝἑ⌀ℂሶ(2000)ޟࠝ࡜ࡦ࠳ߩ㐳ᦼක≮࡮੺⼔଻㒾ޠޡᶏᄖ␠ળ଻㓚⎇ⓥޢNo.131㧘pp.47-55㧘࿖┙␠ળ଻ 㓚࡮ੱญ໧㗴⎇ⓥᚲ ᧻ේ↱⟤(2002)ޟක≮ឭଏ૕೙ߣ଻㒾⠪ᯏ⢻ޠޡක≮ߣ␠ળޢvol. 12(1)㧘pp.27-35

Buchner, F. and J. Wasem (2003) “Needs for further improvement: risk adjustment in the German health insurance system,” Health Policy 65(1) pp.21-35.

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Pott-Buter, H.A. (2000) “Dimensions in Health Care: an overview of the health care system in the Netherlands,” ޡᶏ ᄖ␠ળ଻㓚⎇ⓥޢNo.131㧘pp.66-82㧘࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ

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䋼ෳ⠨⾗ᢱ䋨䉥䊤䊮䉻ળ⸘ᬌᩏ㒮ឭଏ⾗ᢱ䋩䋾㩷

ޟ2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽޠ ޟ2005 ᐕᐲࠝ࡜ࡦ࠳ක≮଻㒾ળ␠ㅢାޠ

ޟක≮ߦ㑐ߔࠆᬌ⸽:2005 ᐕᐲᐕႎޠVWS ᡽╷㗔ၞᢥᦠ CVZ (2005) Personal Budget: Purchase your own care in 8 steps.

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MHWS (Ministry of Health, Welfare and Sport) (2006) Health Insurance in the Netherlands; The new health