Baltussen R, Jansen M P, Bijlmakers L, Tromp N, Yamin A E, Norheim O F
Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
Royal Tropical Institute, Amsterdam, Noord-Holland, The Netherlands.
BMJ Glob Health. 2017 Aug 22;2(3):e000342. doi: 10.1136/bmjgh-2017-000342. eCollection 2017.
Progressive realisation is invoked as the guiding principle for countries on their own path to universal health coverage (UHC). It refers to the governmental obligations to immediately and progressively move towards the full realisation of UHC. This paper provides procedural guidance for countries, that is, how they can best organise their processes and evidence collection to make decisions on what services to provide first under progressive realisation. We thereby use 'evidence-informed deliberative processes', a generic value assessment framework to guide decision making on the choice of health services. We apply this to the concept of progressive realisation of UHC. We reason that countries face two important choices to achieve UHC. First, they need to define which services they consider as high priority, on the basis of their social values, including cost-effectiveness, priority to the worse off and financial risk protection. Second, they need to make tough choices whether they should first include more priority services, first expand coverage of existing priority services or first reduce co-payments of existing priority services. Evidence informed deliberative processes can facilitate these choices for UHC, and are also essential to the progressive realisation of the right to health. The framework informs health authorities on how they can best organise their processes in terms of composition of an appraisal committee including stakeholders, of decision-making criteria, collection of evidence and development of recommendations, including their communication. In conclusion, this paper fills in an important gap in the literature by providing procedural guidance for countries to progressively realise UHC.
逐步实现被视为各国在实现全民健康覆盖（UHC）道路上的指导原则。它指的是政府有义务立即并逐步朝着全面实现全民健康覆盖迈进。本文为各国提供程序指导，即各国如何能最佳地组织其流程和证据收集，以便就逐步实现过程中首先应提供哪些服务做出决策。因此，我们使用“循证协商过程”，这是一个通用的价值评估框架，用于指导关于卫生服务选择的决策。我们将其应用于全民健康覆盖逐步实现的概念。我们认为，各国在实现全民健康覆盖方面面临两个重要选择。首先，它们需要根据社会价值观，包括成本效益、对弱势群体的优先考虑和财务风险保护，确定哪些服务被视为高度优先。其次，它们需要做出艰难抉择，是首先纳入更多优先服务、首先扩大现有优先服务的覆盖范围，还是首先降低现有优先服务的自付费用。循证协商过程可以促进这些全民健康覆盖的选择，并对逐步实现健康权也至关重要。该框架告知卫生当局如何在评估委员会的组成（包括利益相关者）、决策标准、证据收集以及建议的制定（包括其传达）方面最佳地组织其流程。总之，本文通过为各国逐步实现全民健康覆盖提供程序指导，填补了文献中的一个重要空白。
