Palmer Natasha, Mueller Dirk H, Gilson Lucy, Mills Anne, Haines Andy
London School of Hygiene and Tropical Medicine, London, UK.
Lancet. 2004;364(9442):1365-70. doi: 10.1016/S0140-6736(04)17195-X.
In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.
在本文中，我们概述了自1995年以来关于各种融资策略对低收入国家卫生服务可及性或健康结果影响的研究。现有有限的证据总体表明，使用者付费会抑制服务利用。预付款或保险计划有改善可及性的潜力，但范围非常有限。有条件现金支付在提高干预措施的接受度方面显示出前景，但也可能产生不良激励。关于使用者付费的报告大多来自非洲，以及拉丁美洲关于有条件现金转移的证据，都表明了研究开展背景的重要性。这一领域需要提高研究质量。为卫生融资举措的评估提供更大规模的前期资金，对于确保建立一个与该问题对实现发展目标的重要性相匹配的证据基础是必要的。
