Center for Global Development, 2055 L St NW, Fifth Floor, Washington, DC 20036, USA.
Center for Global Development, 2055 L St NW, Fifth Floor, Washington, DC 20036, USA.
Soc Sci Med. 2014 Mar;105:112-21. doi: 10.1016/j.socscimed.2014.01.014. Epub 2014 Jan 22.
Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 per cent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.
人均健康支出上升和用于卫生服务的自付支出比例下降。我们将这些趋势描述为“健康融资转型”，以提供一个理解健康市场和公共政策的概念框架。我们使用了来自 126 个国家的 1995 年至 2009 年的数据，通过水平和一阶差分回归，考察了健康支出及其构成变化的各种解释。我们估计健康支出的收入弹性约为 0.7，与最近的可比研究一致。我们的分析还显示，健康支出呈现出显著的上升趋势——每年约增长 1%——这与技术和医疗实践的变化、成本压力以及为医疗保健提供资金和管理的机构有关。自付支出占总健康支出的比例与收入无关，但受国家筹集一般收入能力的影响。这些结果支持健康融资转型的存在，并描述了公共政策如何影响这些趋势。
