Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Water, Research and Training Center (WRTC), Yangon, Myanmar.
PLoS One. 2019 Jun 14;14(6):e0217278. doi: 10.1371/journal.pone.0217278. eCollection 2019.
We systematically review the health-financing mechanisms, revenue rising, pooling, purchasing, and benefits, in the Association of Southeast Asian Nations (ASEAN) and the People's Republic of China, and their impact on universal health coverage (UHC) goals in terms of universal financial protection, utilization/equity and quality. Two kinds of sources are reviewed: 1) academic articles, and 2) countries' health system reports. We synthesize the findings from ASEAN countries and China reporting on studies that are in the scope of our objective, and studies that focus on the system (macro level) rather than treatment/technology specific studies (micro level).The results of our review suggest that the main sources of revenues are direct/indirect taxes and out of pocket payments in all ASEAN countries and China except for Brunei where natural resource revenues are the main source of revenue collection. Brunei, Indonesia, Philippines, Malaysia, and Viet Nam have a single pool for revenue collection constituting a national health insurance. Cambodia, China, Lao, Singapore, and Thailand have implemented multiple pooling systems while Myanmar has no formal arrangement. Capitation, Fee-for-Service, DRGs, Fee schedules, Salary, and Global budget are the methods of purchasing in the studied countries. Each country has its own definition of the basic benefit package which includes the services that are perceived as essential for the population health. Although many studies provide evidence of an increase in financial protection after reforming the health-financing mechanisms in the studied countries, inequity in financial protection continue to exist. Overall, the utilization of health care among the poor has increased as a consequence of the implementation of government subsidized health insurance schemes which target the poor in most of the studied countries. Inappropriate policies and provider payment mechanisms impact on the quality of health care provision. We conclude that the most important factors to attain UHC are to prioritize and include vulnerable groups into the health insurance scheme. Government subsidization for this kind of groups is found to be an effective method to achieve this goal. The higher the percentage of government expenditure on health, the greater the financial protection is. At the same time, there is a need to weigh the financial stability of the health-financing system. A unified health insurance system providing the same benefit package for all, is the most efficient way to attain equitable access to health care. Capacity building for both administrative and health service providers is crucial for sustainable and good quality health care.
我们系统地回顾了东南亚国家联盟(东盟)和中华人民共和国的卫生筹资机制、收入增长、资金统筹、采购和效益,以及它们在全民健康覆盖(UHC)目标方面对普遍财务保护、利用/公平性和质量的影响。我们审查了两种来源:1)学术文章,2)国家卫生系统报告。我们综合了东盟国家和中国报告的符合我们目标范围的研究结果,以及侧重于系统(宏观层面)而非治疗/技术特定研究(微观层面)的研究结果。我们的审查结果表明,除了文莱,所有东盟国家和中国的主要收入来源都是直接/间接税和自付费用,而文莱的主要收入来源是自然资源收入。文莱、印度尼西亚、菲律宾、马来西亚和越南有一个单一的资金池,构成国家健康保险。柬埔寨、中国、老挝、新加坡和泰国实行了多种资金统筹制度,而缅甸则没有正式安排。人头付费、按服务收费、按疾病诊断相关分组、按费用表、工资和总额预算是这些国家的采购方法。每个国家都有自己的基本福利包定义,其中包括被认为对人口健康至关重要的服务。尽管许多研究提供了证据表明,在改革卫生筹资机制后,这些国家的财务保护有所增加,但财务保护的不公平性仍然存在。总体而言,由于实施了针对贫困人群的政府补贴医疗保险计划,贫困人群的卫生保健利用增加了。在大多数研究国家中,不适当的政策和提供者支付机制对卫生保健提供的质量产生了影响。我们的结论是,实现全民健康覆盖的最重要因素是将弱势群体纳入医疗保险计划,并给予优先考虑。为这类人群提供政府补贴被认为是实现这一目标的有效方法。政府卫生支出占比越高,财务保护程度就越高。同时,需要权衡卫生筹资系统的财务稳定性。为所有人提供相同福利包的统一医疗保险系统是实现公平获得卫生保健的最有效途径。行政和卫生服务提供者的能力建设对于可持续和高质量的卫生保健至关重要。