Paganini J M
Instituto Universitario para la Salud, Facultad de Ciencias Médicas, La Plata, Argentina.
Rev Panam Salud Publica. 1998 Nov;4(5):305-10. doi: 10.1590/s1020-49891998001100003.
Since the 1970s the Member States of the World Health Organization have pledged themselves to the goal of "health for all" and to broadening the coverage, quality, and efficiency of the health care services they provide. In spite of that commitment, there has been little progress in the conceptual understanding and development of indicators to help evaluate the characteristics of the populations with and without coverage, as well as in knowing the relationship between coverage and the characteristics of health care services. Most of the countries of Latin America and the Caribbean are in the process of reforming their health care sectors, and they could benefit from new insight in these areas. To help build that knowledge, this study looked at the population without health care services in the countries of Latin America and the Caribbean, using four indicators: vaccination for poliomyelitis, tuberculosis (BCG) vaccination, prenatal care for pregnant women, and childbirths attended by a health professional. In 1995, out of a total population of 474 million in Latin America and the Caribbean, the number without coverage was a minimum of 40 million, calculated using the indicator of BCG vaccination coverage. Using the indicator for prenatal care, the number of persons without health care coverage was 137 million. By analyzing these four indicators in each country, it is possible to develop health services profiles that would suggest different health sector reform policies. The study also analyzed some characteristics of the structure and coverage of the health systems in 46 countries and territories and their correlation with indicators of result or impact. Five indicators of health care resources were used, along with ten indicators of coverage and seven indicators of result or level of health achieved. A statistically significant association (P = 0.05) was found between the coverage of prenatal care and professionally attended childbirths and the results as measured by rates of infant mortality and maternal mortality.
自20世纪70年代以来，世界卫生组织各成员国承诺致力于实现“全民健康”目标，并扩大其提供的医疗服务的覆盖范围、提高质量和效率。尽管有这一承诺，但在帮助评估有医保和无医保人群特征的指标的概念理解和制定方面，以及在了解医保覆盖范围与医疗服务特征之间的关系方面，进展甚微。拉丁美洲和加勒比地区的大多数国家正在对其医疗部门进行改革，它们可以从这些领域的新见解中受益。为了帮助积累这方面的知识，本研究考察了拉丁美洲和加勒比地区各国未获得医疗服务的人群，使用了四个指标：脊髓灰质炎疫苗接种、卡介苗接种、孕妇产前护理以及有卫生专业人员接生的分娩情况。1995年，拉丁美洲和加勒比地区总人口为4.74亿，根据卡介苗接种覆盖率指标计算，未获医保覆盖的人数至少为4000万。按照产前护理指标计算，未获得医保覆盖的人数为1.37亿。通过分析每个国家的这四个指标，有可能制定出表明不同医疗部门改革政策的卫生服务概况。该研究还分析了46个国家和地区卫生系统的结构和覆盖范围的一些特征及其与结果或影响指标的相关性。使用了五个医疗资源指标、十个覆盖指标以及七个结果或健康水平指标。研究发现，产前护理覆盖率和专业人员接生的分娩情况与以婴儿死亡率和孕产妇死亡率衡量的结果之间存在统计学上的显著关联（P = 0.05）。
