James Macinko (
Flavia Cristina Drumond Andrade is an associate professor in the School of Social Work at the University of Illinois at Urbana-Champaign, in Urbana, Illinois.
Health Aff (Millwood). 2020 Nov;39(11):1951-1960. doi: 10.1377/hlthaff.2019.01570.
Countries around the world have committed to achieving universal health coverage as part of the Sustainable Development Goals agreed upon by all United Nations members, intended to be achieved by 2030. But important population groups such as older adults are rarely examined as part of Sustainable Development Goals monitoring and evaluation efforts. This study uses recent (2014-16) high-quality, individual-level data from several aging cohorts representing more than 100,000 adults ages fifty and older in twenty-three high- and middle-income countries. After individual characteristics and health needs were controlled for, national rates varied up to tenfold for poor access (no doctor visit) and threefold for potential overutilization (fifteen or more doctor visits and multiple hospitalizations) in the past year. Catastrophic expenditures (25 percent or more of household income spent out of pocket on health care) averaged 9 percent, with the highest rates observed in middle-income countries and among sicker populations in some high-income countries. Strengthening universal health coverage for older adults will require greater tailoring and targeting of benefits to meet this population's health needs while protecting them from catastrophic health expenditures.
全球各国承诺实现全民健康覆盖，这是联合国所有成员国商定的可持续发展目标的一部分，目标是在 2030 年实现。但是，老年人等重要人群在可持续发展目标监测和评估工作中很少被作为目标群体进行考察。本研究使用了来自 23 个高收入和中等收入国家的多个老龄化队列的最近（2014-16 年）高质量个人层面数据，这些队列代表了超过 10 万名 50 岁及以上的成年人。在控制了个人特征和健康需求后，各国的不良就诊（没有看医生）比例差异最大可达十倍，潜在过度就诊（过去一年就诊十五次或以上并多次住院）比例差异最大可达三倍。灾难性支出（用于医疗保健的家庭收入的 25%以上）平均为 9%，在中等收入国家和一些高收入国家的较不健康人群中观察到的比率最高。加强老年人的全民健康覆盖，需要更好地调整和有针对性地提供福利，以满足这部分人群的健康需求，同时保护他们免受灾难性的医疗支出。
