Gotsadze George, Zoidze Akaki, Vasadze Otar
Curatio International Foundation, 37 D Chavchavadze Ave, 0179 Tbilisi, Georgia.
Soc Sci Med. 2005 Feb;60(4):809-21. doi: 10.1016/j.socscimed.2004.06.017.
The transition resulting from the break-up of the Soviet Union significantly affected the health care systems and population health status in the newly independent States. The available body of evidence suggests that contraction of public resources resulting from economic slowdown has led to the proliferation of out-of-pocket payments and private spending becoming a major source of finance to health service provision to the population. Emerging financial access barriers impede adequate utilization of health care services. Most transition countries embarked on reforming health systems and health care financing in order to tackle this problem. However, little evidence is available about the impact of these reforms on improved access and health outcomes. This paper aims to contribute to the assessment of the impact of health sector reforms in Georgia. It mainly focuses on changes in the patterns of health services utilization in rural areas of the country as a function of implemented changes in health care financing on a primary health care (PHC) level. Our findings are based on a household survey which was carried out during summer 2002. Conclusions derived from the findings could be of interest to policy makers in transitional countries. The paper argues that health financing reforms on the PHC level initiated by the Government of Georgia, aimed at decreasing financial access barriers for the population in the countryside, have rendered initial positive results and improved access to essential PHC services. However, to sustain and enhance this attainments the government should ensure equity, improve the targeting mechanisms for the poor and mobilize additional public and private funds for financing primary care in the country.
苏联解体所带来的转变对新独立国家的医疗保健系统和人口健康状况产生了重大影响。现有证据表明,经济放缓导致公共资源缩减,进而使得自费支付激增,私人支出成为为民众提供医疗服务的主要资金来源。新出现的财务获取障碍阻碍了医疗保健服务的充分利用。大多数转型国家着手进行卫生系统和医疗保健融资改革,以解决这一问题。然而,关于这些改革对改善医疗服务可及性和健康结果的影响,几乎没有相关证据。本文旨在为评估格鲁吉亚卫生部门改革的影响做出贡献。它主要关注该国农村地区医疗服务利用模式的变化,这是初级卫生保健(PHC)层面医疗保健融资实施变化的一个函数。我们的研究结果基于2002年夏季进行的一项家庭调查。研究结果得出的结论可能会引起转型国家政策制定者的兴趣。本文认为,格鲁吉亚政府发起的初级卫生保健层面的卫生融资改革,旨在减少农村人口的财务获取障碍,已经取得了初步积极成果,并改善了基本初级卫生保健服务的可及性。然而,为了维持和加强这一成果,政府应确保公平,改进针对贫困人口的靶向机制,并筹集更多公共和私人资金用于该国的初级保健融资。
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