Health-system reform and universal health coverage in Latin America
Health-system reform and universal health coverage in Latin America
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DOI：
10.1016/s0140-6736(14)61646-9
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发表时间：
2015-03-28
期刊：
影响因子：
168.9
通讯作者：
Wagstaff, Adam
中科院分区：
文献类型：
--
作者：
Atun, Rifat;Monteiro de Andrade, Luiz Odorico;Wagstaff, Adam
从20世纪80年代末开始，许多拉丁美洲国家开始进行社会部门改革，以减轻贫困，减少社会经济不平等，改善健康结果，并提供金融风险保护。特别是从20世纪90年代开始，旨在加强卫生系统以减少卫生获取和成果方面的不平等的改革侧重于扩大全民健康覆盖，特别是针对贫困公民。在拉丁美洲，卫生系统改革产生了一种独特的全民健康覆盖方法，以公平、团结和集体行动克服社会不平等的原则为基础。在大多数被研究的国家，政府的资金支持了供应方干预措施的引入，以扩大对未参保公民的保险覆盖范围——通过确定和扩大福利方案——并扩大卫生服务的提供。巴西和古巴等国引入了税收资助的全民卫生系统。这些变化与需求方干预措施相结合，旨在减轻贫困（针对健康的许多社会决定因素）和改善处境最不利人口获得服务的机会。因此，加强卫生系统以实现全民健康覆盖的显著特点以及拉丁美洲的经验教训对推进全民健康覆盖的国家具有重要意义。
Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens-with defined and enlarged benefits packages-and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.