World Bank Group, Washington, District of Columbia, USA.
Public Health Foundation of India, New Delhi, India.
J Glob Health. 2021 Nov 20;11:16002. doi: 10.7189/jogh.11.16001. eCollection 2021.
Public financing is necessary for realizing universal health coverage (UHC), a policy commitment that emphasizes that everyone should have access to health services they need, of sufficient quality to be effective, and that the use of these services does not expose individuals to financial hardship. As countries undergo their health financing transitions, moving away from external and out-of-pocket (OOP) financing toward domestically-sourced public financing, finding ways to increase public financing in an efficient, equitable, and sustainable manner is front and center in the policy dialogue around UHC. This paper focuses on one aspect of the health financing transition that has generally received less attention: that UHC is also intrinsically about a policy direction that emphasizes at its core redistribution of resources from the well-off to the poor. Differences in the level and organization of public financing for health for a given level of national income also reflect differences in social and political preferences for redistribution and equity across countries. Hence, navigation of a country's health financing transition in ways that accelerates progress towards UHC also implies that public resources are targeted and expended in ways to improve effective service coverage and reduce OOP spending . To leverage a country's health financing transition for UHC, mechanisms should be introduced for: (i) ensuring that benefit entitlements are explicit and intertemporally commensurate with levels of public financing; (ii) fragmentation in pooling mechanisms is reduced to facilitate cross-subsidization without jeopardizing equity; (iii) levels of OOP and complementary sources of financing are nudged towards the well-off until core levels of public financing are adequate to provide similar levels of coverage for all; and (v) that purchasing of services is done in ways that helps reduce geographic- and income-related inequities in access and supply of quality health services. This implies careful policy choices need to be made, ones that require looking beyond the simplistic dichotomy between OOP and public sources of financing for UHC at the aggregate level to more nuanced and disaggregated assessments of the organization, use, and net fiscal incidence of financing and expenditures.
公共融资对于实现全民健康覆盖（UHC）是必要的，这一政策承诺强调每个人都应该能够获得他们所需的医疗服务，这些服务的质量要足以产生效果，并且使用这些服务不会使个人陷入经济困境。随着各国进行卫生融资转型，从外部和自费（OOP）融资转向国内公共融资，以高效、公平和可持续的方式增加公共融资成为 UHC 政策对话的核心。本文关注卫生融资转型的一个方面，这个方面通常受到的关注较少：即 UHC 也从根本上涉及到一种政策方向，该方向强调从富裕人群向贫困人群重新分配资源。在给定的国民收入水平下，卫生领域公共融资的水平和组织差异也反映了各国在再分配和公平方面的社会和政治偏好的差异。因此，以加速实现 UHC 的方式引导一个国家的卫生融资转型，也意味着公共资源应被定向和支出，以改善有效服务覆盖范围并减少自费支出。为了利用一个国家的卫生融资转型实现 UHC，可以引入以下机制：（i）确保受益权益明确，并与公共融资水平保持跨期一致；（ii）减少汇集机制的碎片化，以便在不损害公平的情况下进行交叉补贴；（iii）将自费和补充融资来源的水平推向富裕人群，直到核心公共融资水平足以为所有人提供类似的覆盖水平；以及（v）以有助于减少地理和收入相关的服务获取和供应质量不公平的方式进行服务采购。这意味着需要做出谨慎的政策选择，这些选择需要超越简单地将 OOP 和公共融资来源之间的二分法应用于 UHC 的总体水平，而要对融资和支出的组织、使用和净财政影响进行更细致和分解的评估。
