Bump Jesse B
Department of International Health ; Georgetown University ; Washington , DC , USA.
Health Syst Reform. 2015 Jan 2;1(1):28-38. doi: 10.4161/23288604.2014.991211.
-Over the last several years the once-obscure idea of Universal Health Coverage (UHC) has blossomed into a movement embraced by leading authorities in global health. Both the World Bank and the World Health Organization have designated UHC as a core objective, but many details of this concept have yet to be specified, including the political economy process by which countries can increase financial protection to move toward UHC. Using an analysis of historical literature, this paper examines the development of the two common mechanisms for providing financial risk protection: national social health insurance as developed in Germany, and general tax revenue as used by the United Kingdom to launch the National Health Service. Because of the prominence of organized labor groups in demanding increased financial protection in these two cases, the paper then considers a comparison case from the Progressive Era in the United States where labor groups were far less engaged. Based on the categories used in the historical literature, I develop a framework for comparing the cases in six areas: related legal and cultural heritage; macro-historical conditions; demand for increased social protection; politics of expanding government role in health; financing and delivery systems; and UHC-related outcomes. The paper concludes with some reflections from this analysis for low- and middle-income countries attempting to move toward UHC.
在过去几年里，曾经鲜为人知的全民健康覆盖（UHC）理念已发展成为一场受到全球卫生领域权威机构支持的运动。世界银行和世界卫生组织都已将全民健康覆盖指定为核心目标，但这一概念的许多细节仍有待明确，包括各国为增加财政保护以迈向全民健康覆盖的政治经济进程。通过对历史文献的分析，本文考察了提供金融风险保护的两种常见机制的发展：德国发展起来的国家社会医疗保险，以及英国用于启动国民医疗服务体系的一般税收收入。由于在这两个案例中，有组织的劳工团体在要求增加财政保护方面发挥了突出作用，本文随后考虑了美国进步时代的一个对比案例，在该案例中，劳工团体的参与度要低得多。基于历史文献中使用的类别，我构建了一个框架，用于在六个领域对这些案例进行比较：相关的法律和文化遗产；宏观历史条件；对增加社会保护的需求；扩大政府在卫生领域作用的政治情况；融资和提供系统；以及与全民健康覆盖相关的结果。本文最后对试图迈向全民健康覆盖的低收入和中等收入国家进行了一些分析思考。
