公共卫生领域的新问题:对加纳医疗保健支出、政策及成果的一种视角分析
Emerging issues in public health: a perspective on Ghana's healthcare expenditure, policies and outcomes.
作者信息
Adua Eric, Frimpong Kwasi, Li Xia, Wang Wei
机构信息
School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027 Australia.
School of Natural Sciences, Edith Cowan University, Perth, WA 6027 Australia.
出版信息
EPMA J. 2017 Aug 18;8(3):197-206. doi: 10.1007/s13167-017-0109-3. eCollection 2017 Sep.
Ghana's healthcare expenditure has increased over the past two decades. Increased healthcare expenditures are required to enhance the acquisition of better hospital resources that may improve healthcare. This study presents an overview of healthcare expenditures and health outcomes (i.e. infant mortality, under-5 mortality and life expectancy) from 1995 to 2014 in Ghana. Infant and under-5 mortalities have declined by 50 and 25%, respectively, as of 2014, while life expectancy has increased from 60.7 to 64.8 years. Private spending on health, especially out-of-pocket payments, declined but is higher than the World Health Organization's recommended financial threshold. Non-communicable diseases (NCDs) are rising with healthcare costs leading to catastrophically high healthcare expenditures in the future. While government's investments on healthcare have yielded positive results, the improvement in the health outcomes cannot be attributed to increased health expenditure alone. Therefore, this paper outlines policies on maternal health, national health insurance and healthcare reforms that have influenced health outcomes. In parallel, the paper highlights challenges of the Ghana health system of which the major ones are (1) inadequate financial investments in health and (2) limited health workforce and facilities. These challenges can be ameliorated by (1) establishing new health institutions and expanding existed ones; (2) providing incentives to discourage the exodus of health workers; (3) introduction of the concept of predictive, preventive and personalized medicine (PPPM) for treating NCDs; and (4) alternative insurance schemes for vulnerable groups. This, coupled with the will of the government to curb misappropriation of funds, will be important to achieving better health outcomes.
在过去二十年中,加纳的医疗保健支出有所增加。需要增加医疗保健支出,以获取更好的医院资源,从而改善医疗保健状况。本研究概述了1995年至2014年加纳的医疗保健支出和健康结果(即婴儿死亡率、五岁以下儿童死亡率和预期寿命)。截至2014年,婴儿死亡率和五岁以下儿童死亡率分别下降了50%和25%,而预期寿命则从60.7岁提高到了64.8岁。卫生方面的私人支出,尤其是自付费用有所下降,但仍高于世界卫生组织建议的财务阈值。非传染性疾病(NCDs)正在增加,医疗成本不断上升,这将导致未来灾难性的高额医疗保健支出。虽然政府在医疗保健方面的投资取得了积极成果,但健康结果的改善不能仅仅归因于医疗支出的增加。因此,本文概述了影响健康结果的孕产妇健康、国家医疗保险和医疗改革政策。与此同时,本文强调了加纳卫生系统面临的挑战,其中主要挑战包括:(1)对卫生的财政投资不足;(2)卫生人力和设施有限。这些挑战可以通过以下方式得到缓解:(1)建立新的卫生机构并扩大现有机构;(2)提供激励措施,以阻止卫生工作者外流;()引入预测、预防和个性化医学(PPPM)概念来治疗非传染性疾病;(4)为弱势群体提供替代保险计划。再加上政府遏制资金挪用的意愿,这对于实现更好的健康结果至关重要。