Ottersen Trygve, Moon Suerie, Røttingen John-Arne
1Oslo Group on Global Health Policy,Department of Community Medicine and Global Health and Centre for Global Health,University of Oslo,Oslo,Norway.
4Harvard T.H. Chan School of Public Health,Harvard University,Boston, MA,USA.
Health Econ Policy Law. 2017 Apr;12(2):265-284. doi: 10.1017/S1744133116000499.
Recent developments have transformed the role and characteristics of middle-income countries (MICs). Many stakeholders now question the appropriate role of MICs in the system of development assistance for health (DAH), and key funders have already recast their approach to these countries. The pressing question is whether MICs should be recipients, funders, both or neither. The answer has deep implications for individual countries and their citizens, and for the DAH system as a whole. We clarify the fundamental issues involved and emphasise a special feature of many MICs: mid-level gross national income per capita (GNIpc) combined with substantial health needs and large inequalities. We discuss the trade-off between concerns for capacity and need, and illustrate a capacity-based approach to setting the level of a GNIpc eligibility threshold. We also discuss how needs-based exceptions and incentive-preserving instruments can complement such a threshold. Against this background, we outline options for the future roles of MICs in various circumstances. We conclude that major players in the DAH system have reason to reconsider the criteria for allocating DAH among countries and the norms for which countries should contribute and how much.
近期的发展改变了中等收入国家（MICs）的角色和特征。如今，许多利益相关者质疑中等收入国家在卫生发展援助（DAH）体系中的适当角色，主要资助方也已重新调整对这些国家的援助方式。紧迫的问题是，中等收入国家应是援助接受方、资助方、既是接受方又是资助方，还是两者都不是。答案对各个国家及其公民，乃至整个卫生发展援助体系都有着深远影响。我们阐明了其中涉及的基本问题，并强调了许多中等收入国家的一个特点：人均国民总收入（GNIpc）处于中等水平，同时存在大量的卫生需求和严重的不平等现象。我们讨论了在关注能力与需求之间的权衡，并举例说明了一种基于能力的方法来设定人均国民总收入资格门槛水平。我们还讨论了基于需求的例外情况和保持激励措施的手段如何补充这样一个门槛。在此背景下，我们概述了中等收入国家在不同情况下未来角色的选择。我们的结论是，卫生发展援助体系中的主要参与者有理由重新考虑在各国之间分配卫生发展援助的标准，以及各国应做出贡献的规范和额度。
