School of Nursing and Health Studies, University of Washington, Bothell, USA.
Global Health. 2019 Nov 28;15(Suppl 1):71. doi: 10.1186/s12992-019-0519-1.
The use of crowdfunding platforms to cover the costs of healthcare is growing rapidly within low-, middle-, and high-income countries as a new funding modality in global health. The popularity of such "medical crowdfunding" is fueled by health disparities and gaps in health coverage and social safety-net systems. Crowdfunding in its current manifestations can be seen as an antithesis to universal health coverage. But research on medical crowdfunding, particularly in global health contexts, has been sparse, and accessing robust data is difficult. To map and document how medical crowdfunding is shaped by, and shapes, health disparities, this article offers an exploratory conceptual and empirical analysis of medical crowdfunding platforms and practices around the world. Data are drawn from a mixed-methods analysis of medical crowdfunding campaigns, as well as an ongoing ethnographic study of crowdfunding platforms and the people who use them.
Drawing on empirical data and case examples, this article describes three main ways that crowdfunding is impacting health equity and health politics around the world: 1) as a technological determinant of health, wherein data ownership, algorithms and platform politics influence health inequities; 2) as a commercial determinant of health, wherein corporate influence reshapes healthcare markets and health data; 3) and as a determinant of health politics, affecting how citizens view health rights and the future of health coverage.
Rather than viewing crowdfunding as a social media fad or a purely beneficial technology, researchers and publics must recognize it as a complex innovation that is reshaping health systems, influencing health disparities, and shifting political norms, even as it introduces new ways of connecting and caring for those in the midst of health crises. More analysis, and better access to data, is needed to inform policy and address crowdfunding as a source of health disparities.
众筹平台作为全球卫生领域的一种新的筹资模式，在中低收入国家迅速普及，用于支付医疗费用。这种“医疗众筹”的流行是由卫生差异以及卫生覆盖和社会安全网系统的差距所推动的。目前的众筹模式可以被视为全民健康覆盖的对立面。但是，关于医疗众筹的研究，特别是在全球卫生背景下，一直很少，而且难以获取可靠的数据。为了绘制和记录医疗众筹如何受到卫生差异的影响，以及如何塑造卫生差异，本文对全球各地的医疗众筹平台和实践进行了探索性的概念和实证分析。数据来自对医疗众筹活动的混合方法分析，以及对众筹平台和使用这些平台的人的持续民族志研究。
本文利用实证数据和案例，描述了众筹在全球范围内影响健康公平和健康政治的三种主要方式：1）作为健康的技术决定因素，其中数据所有权、算法和平台政治影响健康不平等；2）作为健康的商业决定因素，其中企业影响力重塑医疗保健市场和健康数据；3）作为健康政治的决定因素，影响公民如何看待健康权利和健康保障的未来。
研究人员和公众不应将众筹视为社交媒体的一时风尚或纯粹有益的技术，而必须认识到它是一种复杂的创新，正在重塑卫生系统，影响健康差异，并改变政治规范，即使它为处于健康危机中的人们提供了新的联系和关怀方式。需要进行更多的分析，并更好地获取数据，以告知政策并解决众筹作为健康差异的一个来源。
