经济激励措施与孕产妇健康:我们从这里何去何从?

Financial incentives and maternal health: where do we go from here?

作者信息

Morgan Lindsay, Stanton Mary Ellen, Higgs Elizabeth S, Balster Robert L, Bellows Ben W, Brandes Neal, Comfort Alison B, Eichler Rena, Glassman Amanda, Hatt Laurel E, Conlon Claudia M, Koblinsky Marge

出版信息

J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):8-22.

DOI:
Abstract

Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives--performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers--summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

摘要

许多低收入和中等收入国家正在应用包含经济激励措施的卫生筹资战略,改善孕产妇和新生儿健康往往是其核心目标。然而,对这类项目及其对孕产妇健康影响的综述却很少。2012年4月24日至25日召开了美国政府关于通过经济激励措施加强孕产妇保健服务提供和利用的证据峰会,以填补这一空白。本文是评估经济激励措施(基于绩效的激励措施、保险、免费用药项目、有条件现金转移支付和代金券)效果系列文章的最后一篇,总结了相关证据,并讨论了背景、项目设计与实施、成本效益和可持续性等问题。我们提出了在设计和实施旨在改善孕产妇健康的经济激励项目时需考虑的关键领域,并强调了证据方面的差距,这些差距可能受益于更多研究。尽管各项研究的方法严谨性有所不同,但总体证据表明,经济激励措施可提高对孕产妇保健服务的需求并改善其供应。缺乏确凿证据证明激励措施与改善健康结果之间存在联系;然而,证据表明经济激励措施可增加孕产妇保健服务的数量和质量,并解决阻碍妇女获得以及提供者提供优质、挽救生命的孕产妇保健服务的卫生系统和经济障碍。

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