Omidvar Tehrani Shadi, Perkins Douglas D, Mihaylov Nikolay L
Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA.
Faculty of Public Health, Medical University of Varna, Varna, Bulgaria.
Sociol Health Illn. 2025 Feb;47(2):e13865. doi: 10.1111/1467-9566.13865. Epub 2024 Nov 25.
The quality and access to healthcare systems depend on community health resources, infrastructure, and funding; however, a significant disparity in these resources persists globally. The effectiveness of national health systems depends on a balanced approach to health spending, access to facilities and a skilled local health workforce. What accounts for country-level differences in those critical community and societal health resources? We proposed and tested a model that leverages political and socioeconomic factors to predict various health resources and services in countries. Data, including community health training, research, and support, universal health coverage, healthcare infrastructure, and per capita health expenditure, were collected and analysed by statistical methods, like bivariate correlations and hierarchical multiple linear regressions from 105 countries. Countries with more grassroots activism, fiscal decentralisation, freedom, and globalisation and less perceived corruption and inequality had more community and societal health resources. In multivariate analyses, stronger community health training and research is associated with the globalisation index, freedom score, government fiscal decentralisation, and income inequality. The strongest predictor of health insurance coverage and hospital beds was the country's population education index, and of nurses and midwives-per-capita and health expenditures-per-capita was GDP-per-capita. These insights could guide policymaking to reduce global health inequalities.
医疗保健系统的质量和可及性取决于社区卫生资源、基础设施和资金；然而，全球范围内这些资源存在显著差异。国家卫生系统的有效性取决于对卫生支出、设施可及性和熟练的当地卫生人力采取平衡的方法。那些关键的社区和社会卫生资源在国家层面上的差异是由什么造成的？我们提出并测试了一个利用政治和社会经济因素来预测各国各种卫生资源和服务的模型。通过双变量相关性和分层多元线性回归等统计方法，收集并分析了来自105个国家的数据，包括社区卫生培训、研究和支持、全民健康覆盖、医疗基础设施以及人均卫生支出。基层行动主义更强、财政分权、自由度和全球化程度更高，且感知到的腐败和不平等更少的国家，拥有更多的社区和社会卫生资源。在多变量分析中，更强的社区卫生培训和研究与全球化指数、自由度得分、政府财政分权以及收入不平等相关。医疗保险覆盖范围和医院床位的最强预测因素是该国的人口教育指数，而人均护士和助产士数量以及人均卫生支出的最强预测因素是人均国内生产总值。这些见解可为减少全球卫生不平等的政策制定提供指导。
