Progress towards universal health coverage in BRICS: translating economic growth into better health
Progress towards universal health coverage in BRICS: translating economic growth into better health
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DOI：
10.2471/blt.13.127951
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发表时间：
2014-06-01
影响因子：
11.1
通讯作者：
McIntyre, Diane
中科院分区：
文献类型：
--
作者：
Rao, Krishna D.;Petrosyan, Varduhi;McIntyre, Diane
巴西、俄罗斯联邦、印度、中国和南非--被称为金砖国家--代表了世界上增长最快的一些大型经济体，占世界人口的近40%。在过去二十年中，金砖国家进行了卫生系统改革，以在全民健康覆盖方面取得进展。本文讨论了这些改革的三个关键方面：政府在卫生融资中的作用;改革背后的根本动机;以及非金砖国家吸取的经验教训的价值。尽管各国政府在改革中发挥了突出作用，但私人融资构成了金砖国家卫生支出的主要份额。中国和印度依赖直接支出，巴西和南非则有大量私人保险。巴西的卫生改革是一场使健康成为一项宪法权利的政治运动的结果，而中国、印度、俄罗斯联邦和南非的改革则是为了改善公共系统的业绩和减少在获得服务方面的不平等。实现全民健康覆盖的进程一直缓慢。在中国和印度，改革没有充分解决自付问题。国家和国家以下各级实体之间的谈判往往具有挑战性，但巴西通过宪法规定的责任划分，得以在联邦和州实体之间实现良好的协调。在俄罗斯联邦，协调不力导致资源分散汇集和使用效率低下。在混合保健系统中，必须利用公共和私营部门的资源。
Brazil, the Russian Federation, India, China and South Africa - the countries known as BRICS - represent some of the world's fastest growing large economies and nearly 40% of the world's population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, Poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.