1995 年至 2015 年间 49 个地区的卫生保健系统资源足迹及其可及性和质量：投入产出分析。
Health-care systems' resource footprints and their access and quality in 49 regions between 1995 and 2015: an input-output analysis.
机构信息
Institut de Sciences de la Terre (ISTerre), CNRS-University of Grenoble, Grenoble, France; The Shift Project, Paris, France.
The Shift Project, Paris, France; Université Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U 1309, Rennes, France.
出版信息
Lancet Planet Health. 2023 Sep;7(9):e747-e758. doi: 10.1016/S2542-5196(23)00169-9.
BACKGROUND
Strategies to reduce the environmental impact of health care are often limited to greenhouse gas emissions. To broaden their scope, our aim was to determine the evolution of the resource footprints, dependency, and efficiency of health-care systems and to determine the relationship between this evolution and their Healthcare Access and Quality (HAQ) index.
METHODS
We carried out an input-output analysis of 49 health-care systems from 1995 to 2015. We harmonised the EXIOBASE v3.8.2 database-providing data for 49 world regions-to the World Health Organization Health Expenditures Database. We then performed a panel data analysis to understand the relationship between Healthcare Access and Quality index and energy footprint per capita of health-care systems. EXIOBASE3 does not provide measurement errors so it was not possible to propagate the uncertainties as can be done with other input-output databases.
FINDINGS
Health-care systems' footprint increased over the past two decades, reaching 7% of global non-metallic minerals footprint, 4% of global metal ores footprint, and 5% of global fossil fuels footprint in 2013. This increase was mostly due to China, rising from 7% of the non-metallic minerals footprint in 1995 to 45% in 2013. 80% of the health-care systems studied were dependent at more than 50% on fossil fuel imports. The energy footprint per capita was correlated exponentially with the HAQ index but some countries performed much better than others at a given energy footprint. Health-care systems have not become more efficient between 2002 and 2015.
INTERPRETATION
Health-care systems' resources footprint are exponentially linked to their HAQ. Both prevention and efficiency measures will be needed to change this relationship. If it is not enough, high-income countries will have to choose between further reducing the resource consumption of their health-care systems or shifting the efforts to other sectors, health being considered an incompressible need. We call for the creation of a HAQE (health-care access, quality, and efficiency) index that would add resource efficiency to access and quality when ranking health-care systems.
FUNDING
The Shift Project.
背景
降低医疗保健环境影响的策略通常仅限于温室气体排放。为了扩大其范围，我们的目标是确定医疗保健系统的资源足迹、依存度和效率的演变，并确定这种演变与医疗保健可及性和质量（HAQ）指数之间的关系。
方法
我们对 1995 年至 2015 年期间的 49 个医疗保健系统进行了投入产出分析。我们将 EXIOBASE v3.8.2 数据库（为 49 个世界区域提供数据）与世界卫生组织卫生支出数据库进行了协调。然后，我们进行了面板数据分析，以了解医疗保健可及性和质量指数与医疗保健系统人均能源足迹之间的关系。EXIOBASE3 不提供测量误差，因此无法像其他投入产出数据库那样传播不确定性。
结果
在过去的二十年中，医疗保健系统的足迹增加了，到 2013 年，占全球非金属矿物足迹的 7%、全球金属矿石足迹的 4%和全球化石燃料足迹的 5%。这种增长主要是由于中国，其非金属矿物足迹从 1995 年的 7%上升到 2013 年的 45%。在所研究的 80%的医疗保健系统中，对化石燃料进口的依存度超过 50%。人均能源足迹与 HAQ 指数呈指数相关，但在给定的能源足迹下，一些国家的表现明显好于其他国家。2002 年至 2015 年间，医疗保健系统的效率并没有提高。
解释
医疗保健系统的资源足迹与 HAQ 呈指数相关。要改变这种关系，需要采取预防和提高效率的措施。如果这还不够，高收入国家将不得不选择进一步降低医疗保健系统的资源消耗，或者将精力转移到其他部门，因为健康被认为是一种不可压缩的需求。我们呼吁创建一个 HAQE（医疗保健可及性、质量和效率）指数，该指数在对医疗保健系统进行排名时，将资源效率纳入可及性和质量。
资助
转移项目。
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