将全民健康覆盖扩大到非正式工人:东南亚低收入和中等收入国家卫生融资计划的系统评价。

Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia.

机构信息

Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden.

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia.

出版信息

PLoS One. 2023 Jul 11;18(7):e0288269. doi: 10.1371/journal.pone.0288269. eCollection 2023.

Abstract

Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments' commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.

摘要

实现全民健康覆盖 (UHC) 是大多数中低收入国家的优先事项,反映了政府对改善人口健康的承诺。然而,许多国家高度的非正规就业给实现全民健康覆盖带来了挑战,政府难以扩大非正规工人的获得途径和财务保障。东南亚是一个非正规就业比例很高的地区。我们专注于该地区,系统地回顾和综合了已发表的关于实施卫生融资计划以扩大非正规工人全民健康覆盖的证据。我们遵循 PRISMA 指南,系统地搜索了同行评议文章和灰色文献中的报告。我们使用 Joanna Briggs 研究所的系统评价清单评估研究质量。我们使用基于分析卫生融资计划的通用概念框架的主题分析来综合提取的数据,并根据这些计划在财务保护、人口覆盖和服务获取方面对全民健康覆盖进展的影响对其进行分类。研究结果表明,各国采取了各种方法将全民健康覆盖扩大到非正规工人,并实施了具有不同收入筹集、汇集和采购规定的计划。卫生融资计划的人口覆盖率不同;那些对全民健康覆盖有明确政治承诺并采取普遍主义方法的计划达到了非正规工人的最高覆盖率。财务保护指标的结果喜忧参半,但总体上表明自付支出、灾难性卫生支出和贫困发生率呈下降趋势。出版物普遍报告通过引入的卫生融资计划提高了利用率。总体而言,这项审查支持了现有的证据基础,即主要依赖一般收入并对非正规工人提供全额补贴和强制性覆盖是改革的有前途的方向。重要的是,该论文通过提供一个相关的最新资源,为致力于逐步实现全民健康覆盖的国家提供了一个扩展的现有研究,该资源映射了加速全民健康覆盖目标进展的循证方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d08/10335706/7b78a75c0023/pone.0288269.g001.jpg

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