Yamey Gavin, Beyeler Naomi, Wadge Hester, Jamison Dean
Duke Global Health Institute, Duke University. Durham, Carolina del Norte, EUA.
Global Health Sciences, University of California San Francisco. San Francisco, EUA.
Salud Publica Mex. 2017 May-Jun;59(3):321-342. doi: 10.21149/8675.
Developing country governments and aid agencies face difficult decisions on how best to allocate their finite resources. Investments in many different sectors -including education, water and sanitation, transportation, and health- can all reap social and economic benefits. This report focuses specifically on the health sector. It presents compelling evidence of the value of scaling-up health investments. The economic case for increasing these investments in health has never been stronger. Having made progress in reducing maternal and child mortality, and deaths from infectious diseases, it is essential that policymakers do not become complacent. These gains will be quickly reversed without sustained health investments. Scaled-up investments will be needed to tackle the emerging non-communicable disease (NCD) burden and to achieve universal health coverage (UHC). The value of investment in health far beyond its performance is reflected in economic prosperity through gross domestic product (GDP). People put a high monetary value on the additional years of life that health investments can bring -an inherent value to being alive for longer, unrelated to productivity. Policymakers need to do more to ensure that spending on health reflects people's priorities. To make sure services are accessible to all, governments have a clear role to play in financing health. Without public financing, there will be some who cannot afford the care they need, and they will be forced to choose sickness -perhaps even death- and financial ruin; a devastating choice that already pushes 150 million people into poverty every year. In low-income countries (LICs) and middle-income countries (MICs), public financing should be used to achieve universal coverage with a package of highly cost-effective interventions ('best buys'). Governments failing to protect the health and wealth of their people in this way will be unable to reap the benefits of long-term economic prosperity and growth. Public financing has the benefit of being more efficient and better at controlling costs than private financing and is the only sustainable way to reach UHC. In addition, people put a high economic value on the protection against financial risk that public financing provides. This report addresses three key questions: 1) What is the economic rationale for investing in health?; 2) what is the best way to finance health?, and 3) which interventions should be prioritized?
发展中国家政府和援助机构在如何以最佳方式分配其有限资源方面面临艰难抉择。对包括教育、水与环境卫生、交通和卫生等许多不同部门的投资都能带来社会和经济效益。本报告特别关注卫生部门。它提供了扩大卫生投资价值的有力证据。增加这些卫生投资的经济理由从未如此充分。在降低孕产妇和儿童死亡率以及传染病死亡人数方面取得进展后,政策制定者绝不能自满。如果没有持续的卫生投资,这些成果将很快逆转。需要扩大投资来应对新出现的非传染性疾病负担并实现全民健康覆盖。对卫生的投资价值远不止于其表现,它通过国内生产总值(GDP)反映在经济繁荣中。人们对卫生投资所能带来的额外寿命年数给予了很高的货币价值——这是长寿本身的固有价值,与生产力无关。政策制定者需要采取更多措施,确保卫生支出反映人们的优先事项。为确保所有人都能获得服务,政府在为卫生筹资方面可发挥明确作用。没有公共筹资,就会有人负担不起所需的医疗服务,他们将被迫在疾病(甚至可能是死亡)和经济破产之间做出选择;这是一个每年已使1.5亿人陷入贫困的毁灭性选择。在低收入国家和中等收入国家,公共筹资应用于通过一系列高成本效益的干预措施(“最佳选择”)实现全民覆盖。不以这种方式保护其人民健康和财富的政府将无法收获长期经济繁荣和增长的益处。公共筹资比私人筹资更有效且更善于控制成本,是实现全民健康覆盖的唯一可持续方式。此外,人们对公共筹资提供的防范财务风险的保障给予很高的经济价值。本报告探讨了三个关键问题:1)投资卫生的经济理由是什么?;2)为卫生筹资的最佳方式是什么?以及3)应优先考虑哪些干预措施?