Pesec Madeline, Ratcliffe Hannah L, Karlage Ami, Hirschhorn Lisa R, Gawande Atul, Bitton Asaf
Madeline Pesec (
Hannah L. Ratcliffe is a primary health care research specialist at Ariadne Labs.
Health Aff (Millwood). 2017 Mar 1;36(3):531-538. doi: 10.1377/hlthaff.2016.1319.
Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.
长期以来,哥斯达黎加在提供初级卫生保健方面一直被视为中低收入国家的典范。1994年,该国采用了一种基本综合医疗团队模式对其初级卫生保健系统进行了改革。尽管这一模式取得了成功,但总体上却很少有人对其进行研究。本案例研究详细描述了哥斯达黎加创新性地实施四项关键服务提供改革的情况,并解释了这些改革如何支持初级卫生保健的四项基本功能:首诊服务、协调、连续性和综合性。当世界各国为实现可持续发展目标而追求高质量的全民健康覆盖时,哥斯达黎加的经验为所需的初级卫生保健改革类型以及成功实施这些改革的潜在机制提供了宝贵的经验教训。