Financing for universal health coverage in small island states: evidence from the Fiji Islands.
Financing for universal health coverage in small island states: evidence from the Fiji Islands.
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DOI：
10.1136/bmjgh-2016-000200
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发表时间：
2017
影响因子：
8.1
通讯作者：
Wiseman V
中科院分区：
文献类型：
--
作者：
Asante AD;Irava W;Limwattananon S;Hayen A;Martins J;Guinness L;Ataguba JE;Price J;Jan S;Mills A;Wiseman V
全民健康覆盖对全球减贫和卫生系统公平至关重要。许多低收入和中等收入国家，包括太平洋小岛屿国家，已承诺实现全民健康覆盖并改革其卫生筹资系统，以更好地与全民健康覆盖目标保持一致。这项研究首次提供了关于太平洋小岛屿国家斐济卫生筹资系统公平性的全面证据。这些国家的卫生系统在国际文献中鲜有报道。该研究采用效益和筹资发生率分析来评估公共和私营部门卫生筹资效益和负担的分布情况。对2000户家庭进行横断面调查所得的初级数据用于评估医疗保健福利，2008-2009年斐济家庭收入和支出调查所得的次级数据用于评估卫生筹资捐款。这些数据由社会经济群体进行分析，以确定这些群体的相对收益和融资发生率。斐济医疗保健福利的分配稍微有利于穷人——大约61%的护理站公共支出和26%的政府医院住院护理支出用于向最贫穷的20%人口提供服务。筹资系统是显著进步的，较富裕的群体承担较高份额的卫生筹资负担。斐济的卫生保健系统在筹资方面实现了一定程度的纵向公平，穷人从政府卫生支出中获得的福利份额较高，而承担的筹资负担份额较富裕群体低。
Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008–2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. The distribution of healthcare benefits in Fiji slightly favours the poor—around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups.