Voorhoeve Alex, Tan-Torres Edejer Tessa, Kapiriri Lydia, Norheim Ole Frithjof, Snowden James, Basenya Olivier, Bayarsaikhan Dorjsuren, Chentaf Ikram, Eyal Nir, Folsom Amanda, Halina Tun Hussein Rozita, Morales Cristian, Ostmann Florian, Ottersen Trygve, Prakongsai Phusit, Saenz Carla, Saleh Karima, Sommanustweechai Angkana, Wikler Daniel, Zakariah Afisah
a Department of Philosophy, Logic, and Scientific Method, London School of Economics , London , UK.
b Department for Bioethics at the National Institutes of Health , Bethesda , MD , USA.
Health Syst Reform. 2017 Oct 2;3(4):301-312. doi: 10.1080/23288604.2017.1324938. Epub 2017 Aug 31.
Abstract-Progress toward universal health coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the World Health Organization (WHO) Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.
摘要——实现全民健康覆盖（UHC）的进展需要做出艰难的权衡。在本期刊中，世界卫生组织（WHO）总干事陈冯富珍博士认可了WHO公平与全民健康覆盖协商小组提出的做出此类决策的原则。这些原则包括使人群健康最大化、优先考虑最贫困人群以及保护人们免受与健康相关的经济风险。但在具体案例中应如何应用这些原则，以及当这些原则的要求相互冲突时应如何进行权衡呢？协商小组的一些成员和一群不同的卫生政策专业人员撰写的本文探讨了这些问题。文章考虑了实际政策困境的三种典型版本。这些案例中的每一个都涉及到全民健康覆盖进展的三个关键维度之一：首先覆盖哪些服务、优先为哪些人群提供覆盖以及如何从自费支出转向通过资金统筹进行预付。我们的案例经过简化以突出常见的权衡。尽管我们提出了具体建议，但我们的主要目的是展示在全民健康覆盖道路上在相互竞争的利益之间达成公平平衡所涉及的推理的形式和实质。
