Centre for Health Economics, University of York, York, England.
Department of Health Sciences, University of York, York, England.
Lancet. 2021 Feb 27;397(10276):828-838. doi: 10.1016/S0140-6736(21)00243-9.
An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.
在几乎所有低收入和中等收入国家都存在一种逆向医疗保健规律，即社会弱势群体的医疗服务需求更大，但获得的服务更少、质量更低。相比之下，在高收入国家则存在一种不成比例的医疗保健规律，即社会弱势群体获得更多的医疗保健服务，但质量更差，数量也不足以满足他们的额外需求。这两种规律不仅是由财政障碍和碎片化的医疗保险制度造成的，还与寻求医疗保健服务和共同投资方面的社会不平等以及医疗保健的成本和效益有关。投资于更多的综合全民健康覆盖和更强的初级保健，并根据需求提供服务，可以改善人口健康状况，减少健康不平等。然而，卫生政策目标之间有时存在权衡取舍。医疗保健技术、政策和资源的配置应该对其公平影响进行分配分析，以确保始终关注减少健康不平等的目标。
