An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS).
An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS).
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DOI：
10.1016/s0140-6736(14)60075-1
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发表时间：
2014-12-13
期刊：
影响因子：
--
通讯作者：
Vega J
中科院分区：
文献类型：
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作者：
Marten R;McIntyre D;Travassos C;Shishkin S;Longde W;Reddy S;Vega J
巴西、俄罗斯、印度、中国和南非（金砖国家）几乎占世界人口的一半，所有五个国家政府最近都承诺在国家、区域和全球范围内努力确保实现全民健康覆盖（UHC）。这项分析审查了各国为实现全民健康覆盖所作的努力。由于健康指标范围广泛，预期寿命（从53岁到73岁不等）和5岁以下儿童死亡率（从每1000例活产死亡10.3到44.6不等），对每个金砖国家进展情况的审查表明，每个国家在实现全民健康覆盖之前都还有一段路要走。金砖国家在实现全民健康覆盖方面面临着巨大的、往往是类似的挑战。根据对每个国家的审查，最紧迫的问题是：筹集不足的公共开支;管理公私混合的保健系统;确保公平;满足对更多人力资源的需求;管理不断变化的人口和疾病负担;解决健康的社会决定因素。公共资金的增加可以用来展示金砖国家卫生部门如何加快实现全民健康覆盖的进展。尽管所有金砖国家都增加了卫生资源投入，但增长最多的是中国，这可能是中国经济快速增长的结果。然而，经济增长率第二高的金砖国家印度在公共卫生资金方面的改善最少。未来的研究，以了解这些国家的卫生部门的这种不同的优先级可能是有用的。同样，可以探讨战略采购在与强大的私营部门合作中的作用、联邦结构的影响以及作为全民健康覆盖基础的初级卫生保健投资的影响。这些问题可以作为金砖国家集中努力分享想法和战略的基础。
Brazil, Russia, India, China, and South Africa (BRICS) represent almost half the world's population, and all five national governments recently committed to work nationally, regionally, and globally to ensure that universal health coverage (UHC) is achieved. This analysis reviews national efforts to achieve UHC. With a broad range of health indicators, life expectancy (ranging from 53 years to 73 years), and mortality rate in children younger than 5 years (ranging from 10·3 to 44·6 deaths per 1000 livebirths), a review of progress in each of the BRICS countries shows that each has some way to go before achieving UHC. The BRICS countries show substantial, and often similar, challenges in moving towards UHC. On the basis of a review of each country, the most pressing problems are: raising insufficient public spending; stewarding mixed private and public health systems; ensuring equity; meeting the demands for more human resources; managing changing demographics and disease burdens; and addressing the social determinants of health. Increases in public funding can be used to show how BRICS health ministries could accelerate progress to achieve UHC. Although all the BRICS countries have devoted increased resources to health, the biggest increase has been in China, which was probably facilitated by China's rapid economic growth. However, the BRICS country with the second highest economic growth, India, has had the least improvement in public funding for health. Future research to understand such different levels of prioritisation of the health sector in these countries could be useful. Similarly, the role of strategic purchasing in working with powerful private sectors, the effect of federal structures, and the implications of investment in primary health care as a foundation for UHC could be explored. These issues could serve as the basis on which BRICS countries focus their efforts to share ideas and strategies.