Department of Sociology and Christ Church, University of Oxford, Oxford, England.
Am J Public Health. 2011 Jan;101(1):165-72. doi: 10.2105/AJPH.2009.184895.
We assessed the determinants of health care funding allocations among South Africa's provinces and their effects on health care from 1996 through 2007.
We performed multivariate regression of funding allocation data against measures of disease burden and health system infrastructure by province.
Disease burden was increasingly negatively correlated with funding allocations and explained less than one quarter of the variation in allocations among provinces. Nearly three quarters of the variation in allocations was explained by preexisting hospital infrastructure and health care workers. The density of private hospitals in the preceding year was associated with greater government allocations (b(private) = 0.12; 95% confidence interval [CI] = 0.08, 0.15), but public hospital density in the preceding year was not (b(public) = 0.05; 95% CI = -0.02, 0.11). Greater allocations were associated with a higher number of doctors (b = 0.54; 95% CI = 0.34, 0.75) but fewer nurses (b = -0.37; 95% CI = -0.72,-0.25) in the same year.
Regions with a greater capacity to spend funds received more funding and created more infrastructure than those with greater health needs. Historical infrastructure inequalities may have created an infrastructure-inequality trap, in which the distribution of funds to those with greater "absorptive capacity" exacerbates inequalities.
我们评估了南非各省之间医疗保健资金分配的决定因素及其对 1996 年至 2007 年期间医疗保健的影响。
我们对资金分配数据与各省疾病负担和卫生系统基础设施指标进行了多元回归分析。
疾病负担与资金分配呈负相关，且解释了各省之间资金分配差异的不到四分之一。资金分配差异的近四分之三是由先前存在的医院基础设施和卫生保健工作者解释的。前一年私立医院的密度与政府拨款的增加有关（b(private) = 0.12；95%置信区间[CI] = 0.08，0.15），但前一年公立医院密度无显著相关（b(public) = 0.05；95% CI = -0.02，0.11）。当年拨款较多与医生人数较多（b = 0.54；95% CI = 0.34，0.75）相关，但护士人数较少（b = -0.37；95% CI = -0.72，-0.25）。
有更多资金支出能力的地区比有更大卫生需求的地区获得了更多的资金并建立了更多的基础设施。历史基础设施不平等可能造成了基础设施不平等陷阱，即向具有更大“吸收能力”的地区分配资金加剧了不平等。
