Department of Health Systems Financing, World Health Organization, Geneva, Switzerland.
Trop Med Int Health. 2012 Jan;17(1):23-35. doi: 10.1111/j.1365-3156.2011.02894.x. Epub 2011 Oct 18.
To document the patterns of health service utilization and health payments at public and private facilities across countries.
We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared.
Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider.
The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation.
记录各国公共和私人医疗机构的卫生服务利用和卫生支出模式。
我们使用了来自 39 个低收入和中低收入国家的世界卫生调查数据，以考察公私部门之间的差异。比较了门诊和住院服务在公共和私人设施的利用情况、公共和私人设施的自付费用（OOP）以及交通费用。
公共和私人部门的利用和支出差异很大。在大多数国家，公共设施在门诊和住院服务方面都占主导地位。但是，尽管私人设施的使用在富人中更为普遍，但穷人也在相当程度上使用这些设施，而且在研究中的几乎所有国家都是如此。大多数 OOP 是在公共提供者处为住院服务支付的。平均而言，门诊服务并非如此。除了私人设施的住院服务外，药品占所有服务 OOP 的最大份额，而在私人设施的门诊服务中，咨询费占 OOP 的最大份额。交通费用相当可观。价格竞争肯定不是指导提供者选择的唯一因素。
结果支持政府继续有策略地与私营部门合作。然而，它们也突出表明，不能将各国的情况一概而论。如果政府仅仅关注咨询费，那么它们可能需要重新考虑在公共提供者处取消简单的用户费用策略。使卫生服务更容易获得的政策需要考虑一个全面的福利套餐，其中包括与护理相关的更广泛的费用，如药品和交通支出。
