Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
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DOI：
10.1016/s2468-2667(18)30213-5
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发表时间：
2019-01-01
影响因子：
50
通讯作者：
Weaver, Marcia R.
中科院分区：
文献类型：
--
作者：
Moses, Mark W.;Pedroza, Paola;Weaver, Marcia R.
背景 为了为实现全民健康覆盖 (UHC) 的计划提供信息，我们估算了门诊和住院的利用率和单位成本，对利用率进行了分解分析，并估算了满足 UHC 利用率标准所需的额外服务和资金。 方法 我们整理了来自 130 个国家的 1175 个国家年的门诊患者数据和来自 128 个国家的 2068 个国家年的住院数据。我们使用贝叶斯元回归工具 DisMod-MR，按性别、年龄、地点和年份对人均年访问量和入院人数进行了元回归分析。我们分解了 1990 年至 2016 年服务总数的变化。我们使用 795 个国民健康账户的数据来估计门诊和住院服务在按地点和年份划分的总卫生支出中所占的份额，并以支出除以利用率来估计单位成本。我们确定了每个残疾调整生命年的利用标准，并估计了所需的额外服务和资金。 结果 2016 年，全球年龄标准化门诊患者利用率为人均 5.42 次就诊（95% 不确定性区间 [UI] 4.88-5.99），住院患者利用率为人均 0.10 次入院 (0.09-0.11)。全球范围内，2016年提供了393.5亿人次（95% UI 35.38-43.58）人次访问量和7.1亿人次（0.65-0.77）入场人次。1990年以来访问量增长58.65%中，人口增长占42.95%，人口老龄化占8.09%，较高利用率占7.63%；入院人数增长67.96%的结果是，44.33%来自人口增长，9.99%来自人口老龄化，13.55%来自利用率增加。 2016 年的单位成本估算（以 2017 年国际元 [I$] 计算）为参观费用为 2 至 478 卢比，入场费用为 87 至 12543 卢比。 2016 年，低收入和中低收入国家新增 82 亿（6.24-9.95）人次就诊和 2.8 亿（0.25-0.30）入院人数的年度费用为 5,031.2 亿印尼盾（404.35-605.98）或 1,581 亿美元（126.58-189.67）。 全民健康覆盖计划解读可以基于当前卫生系统的利用率和单位成本，并以门诊就诊和住院患者的利用率标准为指导，以最低的成本实现最高的个人卫生服务覆盖率。版权所有 (C) 2018 作者。由爱思唯尔有限公司出版
Background To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation.Methods We collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed.Findings In 2016, the global age-standardised outpatient utilisation rate was 5.42 visits (95% uncertainty interval [UI] 4.88-5.99) per capita and the inpatient utilisation rate was 0.10 admissions (0.09-0.11) per capita. Globally, 39.35 billion (95% UI 35.38-43.58) visits and 0.71 billion (0.65-0.77) admissions were provided in 2016. Of the 58.65% increase in visits since 1990, population growth accounted for 42.95%, population ageing for 8.09%, and higher utilisation rates for 7.63%; results for the 67.96% increase in admissions were 44.33% from population growth, 9.99% from population ageing, and 13.55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to 1$22543 for admissions. The annual cost of 8.20 billion (6.24-9.95) additional visits and 0.28 billion (0.25-0.30) admissions in low-income and lower-middle income countries in 2016 was I$503.12 billion (404.35-605.98) or US$158.10 billion (126.58-189.67).Interpretation UHC plans can be based on utilisation and unit costs of current health systems and guided by standards ofutilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.