The role of institutional design and organizational practice for health financing performance and universal coverage
The role of institutional design and organizational practice for health financing performance and universal coverage
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DOI：
10.1016/j.healthpol.2010.09.013
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发表时间：
2011-03-01
期刊：
影响因子：
3.3
通讯作者：
Carrin, Guy
中科院分区：
文献类型：
--
作者：
Mathauer, Inke;Carrin, Guy
许多低收入和中等收入国家严重依赖自付费用的医疗保健支出。这些国家面临的挑战是如何修改其卫生筹资体系以实现全民覆盖。本文提出了一个分析框架，用于对卫生筹资体系及其绩效进行系统审查，在此基础上确定适当的变革，以促进全民覆盖。该框架的显着特点是注重卫生筹资的制度设计和组织实践，而卫生筹资绩效取决于卫生筹资的制度设计和组织实践。制度设计被理解为正式规则，即与卫生筹资有关的法律和监管规定；组织实践是指组织行为者实施和遵守这些规则的方式。卫生筹资绩效可具体化为九个通用卫生筹资绩效指标。绩效不足可能是由制度设计和组织实践中的六种瓶颈造成的。据此，提出了六类改进措施来解决这些瓶颈。卫生筹资体系的制度设计和组织实践可以积极发展、修改或加强。通过了解卫生筹资系统内的激励环境，可以预测拟议变革的潜在影响。 (C) 2010 Elsevier Ireland Ltd. 保留所有权利。
Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage.The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators.Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks.The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated. (C) 2010 Elsevier Ireland Ltd. All rights reserved.