Yaghoubi Maryam, Vahedi Idehlo Masoud, Mehdizadeh Parisa, Meskarpour Amiri Mohammad
Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Independent Researcher, Tehran, Iran.
Health Econ Rev. 2023 Aug 1;13(1):41. doi: 10.1186/s13561-023-00450-x.
Expanding fiscal space for health can be defined as providing additional budgetary resources for health, which is highly important during biological crises. This study aimed to provide a model for financing the treatment costs during biological crises using the development of the fiscal space approach.
This study employed a descriptive mixed-method design, consisting of three stages. In the first stage, a systematic review of relevant literature was conducted using multiple databases, including Scopus, PubMed, and Google Scholar. A total of 45 studies that met the inclusion criteria were selected. In the second stage, a panel of 14 experts identified five primary and 32 secondary strategies using an open questionnaire. Any additional strategies not identified during the literature review were added if a consensus was reached by experts. In the final stage, the Best Worst Method (BWM) was used to prioritize the identified strategies and sub-strategies based on their feasibility, effectiveness, quick yield, and fairness.
Five strategies and fifty sub-strategies were identified. The most important strategies were the increase in health sector-specific resources (0.3889), increase in efficiency of health expenditures (0.2778), structural reforms (0.1111), health sector-specific grants and foreign aid (0.1667), and conducive macroeconomic conditions (0.05556). The most important sub-strategies were establishing and increasing earmarked taxes for the health sector (0.0140), expanding Universal Health Coverage (UHC) plans (0.0103), attracting the participation of non-governmental organizations (NGOs) and charitable organizations in the health sector (0.0096), integrating basic social insurance funds (0.0934), and tax exemptions for economic activists in the health sector (0.009303) during the crisis.
This study identified five main strategies and 50 sub-strategies for financing the treatment costs during biological crises. The most important strategies were increasing health sector-specific resources, improving efficiency of health expenditures, and implementing structural reforms. To finance health expenditures, harmful and luxury goods taxes can be increased and allocated to the health sector during crises. UHC plans should be improved and expanded, and the capacity of NGOs and charitable organizations should be better utilized during crises.
扩大卫生领域的财政空间可定义为为卫生提供额外的预算资源，这在生物危机期间至关重要。本研究旨在利用财政空间方法的发展，提供一个在生物危机期间为治疗费用融资的模型。
本研究采用描述性混合方法设计，包括三个阶段。在第一阶段，使用多个数据库（包括Scopus、PubMed和谷歌学术）对相关文献进行系统综述。共筛选出45项符合纳入标准的研究。在第二阶段，一个由14名专家组成的小组通过开放式问卷确定了5项主要策略和32项次要策略。如果专家们达成共识，将添加文献综述中未发现的任何其他策略。在最后阶段，使用最佳最差方法（BWM）根据已确定策略和子策略的可行性、有效性、快速收益和公平性对其进行优先级排序。
确定了5项策略和50项子策略。最重要的策略是增加卫生部门特定资源（0.3889）、提高卫生支出效率（0.2778）、进行结构改革（0.1111）、卫生部门特定赠款和外国援助（0.1667）以及有利的宏观经济条件（0.05556）。最重要的子策略是在危机期间设立并增加卫生部门的专项税收（0.0140）、扩大全民健康覆盖（UHC）计划（0.0103）、吸引非政府组织（NGO）和慈善组织参与卫生部门（0.0096）、整合基本社会保险基金（0.0934）以及对卫生部门的经济活动参与者免税（0.009303）。
本研究确定了在生物危机期间为治疗费用融资的5项主要策略和50项子策略。最重要的策略是增加卫生部门特定资源、提高卫生支出效率和实施结构改革。为资助卫生支出，可在危机期间提高有害品和奢侈品税并分配给卫生部门。应改进和扩大UHC计划，并在危机期间更好地利用非政府组织和慈善组织的能力。
