Wagstaff Adam, Dmytraczenko Tania, Almeida Gisele, Buisman Leander, Hoang-Vu Eozenou Patrick, Bredenkamp Caryn, Cercone James A, Diaz Yadira, Maceira Daniel, Molina Silvia, Paraje Guillermo, Ruiz Fernando, Sarti Flavia, Scott John, Valdivia Martin, Werneck Heitor
Adam Wagstaff (
Tania Dmytraczenko is a senior economist in the health, nutrition, and population global practice at the World Bank.
Health Aff (Millwood). 2015 Oct;34(10):1704-12. doi: 10.1377/hlthaff.2014.1453.
Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens' rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already "reached" universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone--irrespective of their ability to pay--gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed.
评估全民健康覆盖进展情况的两个常用指标，一是评估公民获得医疗保健的权利，二是统计参加财务保护计划、免受高额医疗费用影响的人数。依据这些指标，拉丁美洲的大多数国家已“实现”全民健康覆盖。然而，这两个指标均未表明一个国家是否在当前普遍认可的意义上实现了全民健康覆盖，即每个人——无论支付能力如何——都能获得所需的医疗服务，且不会承受过度的经济困难。我们运用了世界银行和世界卫生组织提出的一个框架来监测这一定义下的进展情况，进而构建了一个全民健康覆盖成就的综合指数。我们采用该方法，利用了1990年至2013年期间针对拉丁美洲所有20个国家开展的112次家庭调查的数据。没有一个国家获得完美的全民健康覆盖分数，但一些国家（包括那些卫生系统整合程度更高的国家）表现优于其他国家。在所分析的时间段内，除一个国家外，所有国家的全民健康覆盖总体情况都有所改善。
