Report of the WHO Commission on Macroeconomics and Health: a summary and critique.
Report of the WHO Commission on Macroeconomics and Health: a summary and critique.
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世界卫生组织宏观经济与健康委员会的报告：总结和批评。
DOI：
10.1016/s0140-6736(03)12491-9
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Waitzkin,Howard
中科院分区：
文献类型：
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作者：
Waitzkin,Howard
宏观经济观点在最贫穷的流行疾病感染国，减轻流行疾病感染的负担，如艾滋病、结核病和疟疾，将提高劳动力生产率，促进投资，并促进经济发展。健康状况不佳是贫穷的一个重要决定因素；改善健康是促进贫穷国家经济发展和减少贫困的一项关键战略。世界上低收入和中等收入国家应与高收入国家合作，扩大世界上穷人获得基本保健服务的机会，包括侧重于具体干预措施“ q为实现这一建议，高收入国家应”承诺大幅增加财政援助，高收入国家还“决心，不应将缺乏捐助者资金作为限制向世界最贫穷人民提供保健服务能力的因素”。财政和改革“将搁置决定改革还是捐助者融资必须优先的先有鸡还是先有蛋的问题”。捐助国和受援国将承认“在每个阶段都需要资金和改革”。政府改革必须伴随着拟议的新财政捐款贴近客户（CTC）有利的干预措施涉及保健中心、小型卫生站和外联服务，而不是系统；q公共服务和预算的问责制和透明度将指导这些努力提供者q CTC系统“将涉及国家和非国家卫生服务提供者的混合，由国家担保融资”q在这种模式下，政府可以拥有和经营服务单位。或者它“可以与营利性和非营利性提供者签订服务合同”q各种提供者将创造“竞争和公共系统失败时的安全阀”q竞争性的公私合营系统将提高效率，而公共融资将提供“稳定性和可预测性”q公共融资将为穷人提供一揽子基本服务。虽然收入较高的人会在私营部门购买服务，但预付社区预付在某种程度上将取代私人自付费用的筹资计划q卫生组织以前与世界银行协调的出版物，例如卫生组织的《2000年世界卫生报告》，2 .赞成预付，认为这是增加卫生保健系统筹资公平性的一种方式q .预付的理由是，自付费用给穷人造成了不成比例的负担，因此构成了一种倒退的财政结构q .预付将资助“基本治疗保健服务”，超出了那些被界定为由公共部门资助的基本一揽子服务的一部分
Macroeconomic view Reducing the burden of endemic infections—eg, AIDS, tuberculosis, and malaria—in the poorest of endemic infections countries would increase workforce productivity, facilitate investment, and enhance economic development q Poor health is an important determinant of poverty; improving health is a key strategy for economic development and reduced poverty in poor countries Key recommendations “... the world’s low-and middle-income countries, in partnership with high-income countries, should scale up the access of the world’s poor to essential health services, including a focus on specific interventions” q To accomplish this recommendation, the high-income countries should “commit vastly increased financial assistance, in the form of grants” rather than loans that would increase the “overhang” of debt q The high income countries also “would resolve that the lack of donor funds should not be the factor that limits the capacity to provide health services to the world’s poorest peoples” Finance and reform The “chicken-and-egg problem of deciding whether reform or donor financing must come first would be put aside” q Instead, donors and recipients would acknowledge that “finance and reform are needed at each stage” q Governmental reform must accompany the proposed new financial contributions Close-to-client (CTC) Favoured interventions involve health centres, small health posts, and outreach services, rather than system: public technically advanced services in hospitals that use expensive technology funding for private q Accountability and transparency in public services and budgeting would guide these efforts providers q The CTC system “would involve a mix of state and nonstate health service providers, with financing guaranteed by the state” q In this model the government may own and operate service units, or it “may contract for services with forprofit and not-for-profit providers” q A variety of providers would create “competition and a safety valve in case of failure of the public system” q The competitive, private-public system would increase efficiency, whereas public financing would offer “stability and predictability” q Public financing would pay for a package of essential services for the poor, while people with higher incomes would purchase services in the private sector Prepaid community Prepayment to some extent would replace private, out-of-pocket spending financing schemes q Previous WHO publications coordinated with the World Bank, such as WHO’s World Health Report 2000, 2 have favoured prepayment as a way to increase the fairness of financing health-care systems q The rationale for prepayment holds that out-of-pocket payments disproportionately burden the poor and therefore comprise a regressive financial structure q Prepayment would finance “basic curative health services” beyond those defined as part of the essential package to be funded by the public sector