The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries
The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries
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DOI：
10.1080/23288604.2016.1166306
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发表时间：
2016-01-01
影响因子：
4.1
通讯作者：
Nandakumar, Allyala
中科院分区：
文献类型：
--
作者：
Bowser, Diana;Gupta, Jaya;Nandakumar, Allyala
改善孕产妇和儿童健康的需求方和供给方卫生融资方案正在更加频繁地实施；然而，在宏观层面上估计它们对孕产妇、婴儿和儿童死亡率的影响的证据有限。该研究的目的是确定四种特定类型的需求侧和供给侧卫生融资项目对全球水平和国家收入类别的婴儿、儿童和孕产妇死亡率的影响。以下四个需求方和供给方卫生融资项目被纳入分析：有条件现金转移支付项目、代金券项目、社区医疗保险和按绩效付费计划。使用1995-2010年147个国家的面板数据，估计了一个固定效应模型，以衡量这四个需求侧和供给侧卫生融资方案对婴儿、五岁以下儿童和孕产妇死亡率的影响。该模型对所有国家和三个国家收入类别进行了估计：低收入、中低收入和中高收入。随着时间的推移，需求侧和供给侧卫生筹资规划的实施有所增加，数据集中147个国家中有45个到2010年至少实施了其中一项规划。结果表明，在对所有国家进行审查时，社区医疗保险的婴儿和五岁以下儿童死亡率显著下降。在对三种国家收入分类进行审查时，需求方面和供应方面的卫生筹资也会产生影响，根据国家收入分类，代金券和按绩效付费对降低婴儿、五岁以下儿童和孕产妇死亡率的影响各不相同。具有广泛人口覆盖面的健康保险计划，如基于社区的健康保险，可对婴儿和五岁以下儿童的死亡率产生重大影响。需求侧和供给侧的卫生融资项目，如按绩效付费和代金券项目，对婴儿、五岁以下儿童和孕产妇死亡率的影响因国家收入水平而异。
Demand- and supply-side health financing programs that improve maternal and child health are being implemented more frequently; however, there is limited evidence estimating their impact on maternal, infant, and child mortality at the macro level. The purpose of the study was to determine the impact of four specific types of demand- and supply-side health financing programs on infant, child, and maternal mortality at the global level and by county income categories. The following four demand- and supply-side health financing programs were chosen for inclusion in the analysis: conditional cash transfer programs, voucher programs, community-based health insurance, and pay-for-performance schemes. A fixed effects model was estimated, using panel data for 147 countries over the period 1995-2010, to measure the impact of these four demand- and supply-side health financing programs on infant, under-five, and maternal mortality. The model was estimated for all countries and for three country income categories: low, lower-middle, and upper-middle income. The implementation of demand- and supply-side health financing programs has increased over time, with 45 out of 147 countries in the data set implementing at least one of these programs by 2010. The results show that there is a significant decline in infant and under-five mortality from community-based health insurance when examined across all countries. There is also an impact from demand- and supply-side health financing when examined across the three country income classifications, with vouchers and pay-for-performance showing a varying impact on reduced infant, under-five, and maternal mortality depending on the country income classification. Health insurance schemes with a broad population reach, such as community-based health insurance, can have a large impact on infant and under-five mortality. Demand- and supply-side health financing programs, such as pay-for-performance and voucher programs, have a varying impact on infant, under-five, and maternal mortality depending on the income level of the country.