Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Duke NUS Graduate Medical School, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Lancet Glob Health. 2023 Dec;11(12):e1964-e1977. doi: 10.1016/S2214-109X(23)00448-5.
The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC).
In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing.
Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement.
Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC.
Bill & Melinda Gates Foundation.
COVID-19 大流行是一场卫生紧急事件，需要迅速调动财政资源，以支持国家应对。有效利用卫生筹资机制和政策，或缺乏这些机制和政策，都会影响大流行对人口，特别是弱势群体和个人的影响。我们提供了在大流行期间 15 个国家采用的卫生筹资政策概述和说明性示例，制定了具有弹性的卫生筹资框架，并利用这场大流行来支持向全民健康覆盖（UHC）迈进。
在这项案例研究中，我们审查了 15 个国家的国家卫生筹资政策应对措施，这些国家是有目的地选择的，代表了所有世卫组织区域，具有不同的收入水平、UHC 指数得分和卫生系统类型。我们对同行评议文章、政策文件、技术报告以及关于为应对大流行而采取的政策措施的公开数据进行了系统文献回顾，并通过与 61 名卫生系统和卫生筹资专家的深入访谈补充了所获得的数据。我们对数据进行了主题分析，并将关键主题组织成一个有弹性的卫生筹资概念框架。
卫生应急有弹性的卫生筹资有两个主要阶段：（1）吸收和恢复，在此期间，卫生系统需要吸收大流行带来的最初和后续冲击，并从中恢复稳定；（2）维持，在此期间，卫生系统需要扩大和维持卫生方面的财政空间，以实现全民健康覆盖，同时建立有弹性的卫生筹资结构，使卫生系统更好地为未来的卫生应急做好准备。我们观察到，这五个关键的融资政策在各国都得到了实施，即：利用预算外资金迅速作出初步反应、重新调配现有资金、建立有效的资金拨付机制，以确保资金迅速流向预期人员和广大民众、动员私营部门以减轻公共部门的差距、扩大服务覆盖范围，以加强弱势群体的保护。需要在每个阶段进行问责和监测，以确保资金的高效和问责制流动，这可以通过强有力的治理和协调、信息技术和社区参与来实现。
我们的研究结果表明，卫生系统需要利用 COVID-19 大流行作为一个机会窗口，使卫生筹资政策更加稳健，并需要在政治上承诺支持有效的公共融资机制，为未来的紧急情况做好准备，并作为实现全民健康覆盖的一个杠杆。
比尔及梅琳达·盖茨基金会。
