Department of Sociology, Boston University, Boston, MA, USA.
Health Resources in Action, Health Equity Research Lab, Cambridge Health Alliance, Boston, MA, USA.
Glob Public Health. 2022 Aug-Sep;17(9):1809-1826. doi: 10.1080/17441692.2021.1981973. Epub 2021 Sep 23.
How does the private sector structure the trajectory of a country's universal healthcare programme? Social scientists have long pointed to the importance of path dependence in shaping health reform. Yet, rarely have middle-income countries' experience with the private sector under Universal Health Coverage (UHC) been examined from comparative perspective. In this paper, we explore the changing landscape of the health sector in Brazil and Thailand before UHC reform and after. We find path-dependent processes at work that have pushed two countries that both adopted UHC reforms in divergent directions. In Brazil, a comparatively large and entrenched private sector that existed before reform has grown over time, and a sizable private health insurance industry has exerted powerful influence on health policy, weakening the public sector. In Thailand, constraints on private health insurance growth and sustained investment in public health infrastructure and governance have helped check the growth of private sector influence, although battles over health policy still remain contentious. The experiences of these countries offer lessons for policymakers seeking to achieve and maintain robust UHC programmes in other contexts.
私营部门如何构建国家全民医保计划的轨迹？社会科学家早就指出，路径依赖对塑造卫生改革很重要。然而，从中等收入国家在全民医保（UHC）下的私营部门经验很少从比较的角度进行研究。在本文中，我们探讨了巴西和泰国在 UHC 改革之前和之后的卫生部门不断变化的格局。我们发现了起作用的路径依赖过程，这些过程将两个都采取 UHC 改革的国家推向了不同的方向。在巴西，改革前就已经存在的相对较大且根深蒂固的私营部门随着时间的推移而增长，规模可观的私营医疗保险行业对卫生政策产生了强大影响，削弱了公共部门。在泰国，对私营医疗保险增长的限制以及对公共卫生基础设施和治理的持续投资，有助于控制私营部门影响力的增长，尽管卫生政策的争论仍然存在争议。这些国家的经验为其他背景下寻求实现和维持强大的 UHC 计划的政策制定者提供了教训。
