Gupta Indrani, Mondal Swadhin
Institute of Economic Growth, Delhi, India.
Institute for Studies in Industrial Development, New Delhi, India.
WHO South East Asia J Public Health. 2014 Jul-Dec;3(3):273-284. doi: 10.4103/2224-3151.206750.
The paper examines the issues around mobilization of resources for the 11 countries of the South-East Asia Region of the World Health Organization (WHO), by analysing their macroeconomic situation, health spending, fiscal space and other determinants of health. With the exception of a few, most of these countries have made fair progress on their own Millennium Development Goal (MDG) targets of maternal mortality ratio and mortality rate in children aged under 5 years. However, the achieved targets have been very modest - with the exception of Thailand and Sri Lanka - indicating the continued need for additional efforts to improve these indicators. The paper discusses the need for investment, by looking at evidence on economic growth, the availability of fiscal space, and improvements in "macroeconomic-plus" factors like poverty, female literacy, governance and efficiency of the health sector. The analysis indicates that, overall, the countries of the WHO South-East Asia Region are collectively in a position to make the transition from low public spending to moderate or even high health spending, which is required, in turn, for transition from lowcoverage-high out-of-pocket spending (OOPS) to highcoverage-low OOPS. However, explicit prioritization for health within the overall government budget for low spenders would require political will and champions who can argue the case of the health sector. Additional innovative avenues of raising resources, such as earmarked taxes or a health levy can be considered in countries with good macroeconomic fundamentals. With the exception of Thailand, this is applicable for all the countries of the region. However, countries with adverse macroeconomic-plus factors, as well as inefficient health systems, need to be alert to the possibility of overinvesting - and thereby wasting - resources for modest health gains, making the challenge of increasing health sector spending alongside competing demands for spending on other areas of the social sector difficult.
本文通过分析世界卫生组织（WHO）东南亚区域11个国家的宏观经济状况、卫生支出、财政空间及其他卫生决定因素，探讨了这些国家资源筹集方面的问题。除少数国家外，这些国家在实现本国千年发展目标（MDG）的孕产妇死亡率和5岁以下儿童死亡率目标方面均取得了一定进展。然而，除泰国和斯里兰卡外，所实现的目标非常有限，这表明仍需继续加大努力以改善这些指标。本文通过审视经济增长、财政空间可用性以及贫困、女性识字率、治理和卫生部门效率等“宏观经济+”因素的改善情况等证据，讨论了投资的必要性。分析表明，总体而言，WHO东南亚区域各国总体上有能力从低公共支出向适度甚至高卫生支出转变，而这反过来又是从低覆盖率-高自付费用支出向高覆盖率-低自付费用支出转变所必需的。然而，对于低支出国家而言，要在政府总体预算中明确优先考虑卫生领域，需要政治意愿以及能够为卫生部门据理力争的支持者。对于宏观经济基本面良好的国家，可以考虑诸如专项税收或卫生税等其他创新的资源筹集途径。除泰国外——该区域所有国家均适用。然而，宏观经济+因素不利且卫生系统效率低下的国家需要警惕过度投资——进而浪费——资源却仅获得有限卫生收益的可能性，这使得在社会部门其他领域支出需求竞争的情况下增加卫生部门支出面临挑战。
