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医疗保健融资政策工具对卫生系统效率的影响:来自撒哈拉以南非洲的证据。

Effects of healthcare financing policy tools on health system efficiency: Evidence from sub-Saharan Africa.

作者信息

Arhin Kwadwo, Oteng-Abayie Eric Fosu, Novignon Jacob

机构信息

Ghana Institute of Management and Public Administration, Department of Economics, Accra, Ghana.

Kwame Nkrumah University of Science and Technology, Department of Economics, Kumasi, Ghana.

出版信息

Heliyon. 2023 Oct 10;9(10):e20573. doi: 10.1016/j.heliyon.2023.e20573. eCollection 2023 Oct.

Abstract

BACKGROUND

Evidence shows high levels of catastrophic and impoverishing healthcare expenditure among households in sub-Saharan Africa (SSA). The way healthcare is financed has an impact on how well a health system performs its functions and achieves its objectives. This study aims to examine the effect of healthcare financing policy tools on health system efficiency.

METHOD

The study classifies 46 sub-Saharan African (SSA) countries into four groups of health systems sharing similar healthcare financing strategies. A two-stage and one-stage stochastic frontier analysis (SFA) and Tobit regression techniques were employed to assess the impact of healthcare financing policy variables on health system efficiency. Data from the selected 46 SSA countries from 2000 to 2019 was investigated.

RESULTS

The results revealed that prepayment healthcare financing arrangements, social health insurance, mixed- and external-financing healthcare systems significantly enhance health system efficiency. Reliance on a single source for financing healthcare, particularly private out-of-pocket payment reduces health system efficiency.

CONCLUSION

For policy-making purposes, health care systems financed through a mix of financing arrangements comprising social health insurance, private, and public funding improve health system efficiency in delivering better health outcomes as opposed to depending on one major source of financing, particularly, private out-of-pocket payments.

摘要

背景

有证据表明,撒哈拉以南非洲(SSA)家庭的灾难性和致贫性医疗支出水平很高。医疗保健的筹资方式会影响卫生系统履行其职能和实现其目标的程度。本研究旨在探讨医疗保健筹资政策工具对卫生系统效率的影响。

方法

该研究将46个撒哈拉以南非洲(SSA)国家分为四组具有相似医疗保健筹资策略的卫生系统。采用两阶段和单阶段随机前沿分析(SFA)以及Tobit回归技术来评估医疗保健筹资政策变量对卫生系统效率的影响。对2000年至2019年选定的46个SSA国家的数据进行了调查。

结果

结果显示,预付制医疗保健筹资安排、社会医疗保险、混合融资和外部融资的医疗系统显著提高了卫生系统效率。依赖单一的医疗保健融资来源,尤其是私人自付费用,会降低卫生系统效率。

结论

出于政策制定目的,通过包括社会医疗保险、私人和公共资金在内的多种融资安排组合来融资的医疗保健系统,在提供更好的健康结果方面提高了卫生系统效率,这与依赖单一主要融资来源,特别是私人自付费用形成对比。

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