PDF(Pubmed)
Abstract：
Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.
摘要：
各国政府在卫生筹资系统方面的努力和改革旨在实现全民健康覆盖。家庭在医疗保健方面的支出在实现这一目标方面发挥着非常重要的作用。这项系统审查的目的是评估国际汽联在不同地区测量的自付医疗支出不平等，在2030年实现UHC的背景下。在PubMed中进行了全面系统的搜索，Scopus,和WebofScience数据库，以确定2016年至2022年间以英语发布的原始定量和混合方法研究。初步确定共336篇文章,在筛选过程之后，系统评价包括15篇文章，删除不符合纳入标准的重复项和文章后。尽管整体回归，保险制度普遍改善了人口覆盖率，减少了就业人口自付医疗支出的不平等，但是区域研究强调了在微观层面审查局势的重要性。该研究的结果提供了进一步的证据支持这样的观点，即医疗保健融资系统较少依赖公共资金和直接税融资，而更多地依赖私人支付与灾难性医疗支出的更高患病率相关，并在医疗保健融资方面表现出更多的回归模式。强调需要采取政策干预措施来解决这些不平等问题。由于财政脆弱人群经历的不平等，各国政府在实现全民健康覆盖方面面临重大挑战，包括药品的高额自付费用，非正式指控，以及医疗保健融资管理方面的地区差异。
