Debate: can we achieve universal health coverage without a focus on disability?
Debate: can we achieve universal health coverage without a focus on disability?
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DOI：
10.1186/s12913-018-3547-2
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发表时间：
2018-09-26
影响因子：
2.8
通讯作者：
Hanefeld J
中科院分区：
文献类型：
--
作者：
Kuper H;Hanefeld J
实现全民健康覆盖（UHC）是全球卫生议程的一个关键目标，也是可持续发展目标的一个重要目标。人们越来越认识到，一些群体可能在实现全民健康覆盖的努力中落后，包括全球10亿残疾人。辩论的一个基本问题是-全民健康覆盖能否在不包括残疾人的情况下实现？残疾人更有可能健康状况不佳。因此，他们对一般医疗服务，以及与其潜在缺陷有关的康复和专科服务的需求会更大。残疾人在获得医疗保健方面也经常面临更多困难，在寻求医疗保健时需要支付更高的费用，并且经常报告说，他们获得的服务质量比其他人差。由于这些不同的挑战，残疾人在全民健康覆盖的三个方面面临着具体和额外的困难：覆盖范围，获得所需的服务，以及合理的成本。因此，关注残疾人对于实现全民健康覆盖至关重要，特别是因为他们占全球人口的15%。为了确保全民健康覆盖的实现包容并满足残疾人的需求，卫生系统需要进行调整。建议采取双轨办法，这意味着重点是将残疾人纳入主流服务，并针对他们提供所需的具体服务。还必须努力提高服务质量（例如通过培训保健工作人员），加强对残疾人的费用保护（例如通过社会保障）。改变全民健康覆盖战略以更具包容性的一个关键挑战是缺乏关于需要什么和有效什么的证据，迫切需要对这一主题进行更多的研究。如果不关注残疾人，就很难实现全民健康覆盖。为改善残疾人的覆盖面而进行的改革可能会使更广泛的群体受益，包括老年人、少数民族和短期功能障碍者。因此，包容残疾人的战略将改善卫生系统的公平性，并确保我们在实现全民健康覆盖时“不让任何人掉队”。
The achievement of Universal Health Coverage (UHC) is a key aim of the global health agenda, and an important target of the Sustainable Development Goals. There is increasing recognition that some groups may fall behind in efforts to achieve UHC, including the 1 billion people globally living with disabilities. A fundamental question for debate is – can UHC be achieved without the inclusion of people with disabilities? People with disabilities are more likely to experience poor health. They will therefore have greater need for general healthcare services, as well as rehabilitation and specialist services, related to their underlying impairment. People with disabilities also frequently face additional difficulties in accessing healthcare, incur greater costs when seeking healthcare and often report experiencing worse quality services than others. As a consequence of these different challenges, people with disabilities face specific and added difficulties across three dimensions of UHC: coverage, access to services needed, and at reasonable cost. A focus on people with disabilities is therefore essential to achieving UHC, particularly since they constitute 15% of the global population. To ensure the realisation of UHC is inclusive of and addresses the needs of people with disabilities, health systems need to adapt. A twin-tracked approach is recommended, which means that there is a focus on including people with disabilities in mainstream services, as well as targeting them with specific services needed. There also must be efforts to improve the quality of services (e.g. through healthcare staff training) and enhance cost protection for people with disabilities (e.g. through social protection). A key challenge to changing UHC strategies to be more inclusive is the lack of evidence on what is needed and works, and more research is needed urgently on this topic. It will be difficult to achieve UHC without a focus on people with disabilities. Changes made to improve coverage for people with disabilities will likely benefit a wider group, including older people, ethnic minorities, and people with short-term functional difficulties. Disability-inclusive strategies will therefore improve health system equity and ensure that we “Leave no one behind” as we move towards UHC.
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