■实现全民健康覆盖(UHC)是可持续发展目标(SDGs)共同的重要目标。由于UHC水平受区域经济和资源配置等因素的影响,中国迫切需要地方证据。这项研究旨在监测2016年至2021年各省的进展,从而为制定特定地区的战略提供信息。
■基于世界卫生组织提出的UHC监测框架,构建了UHC指数,包括服务覆盖维度(16个指标)和财务保护维度(4个指标)。在这项观察性研究中,来自中国大陆25个省(自治区,直辖市)的常规收集的健康数据来自统计年鉴,相关文献,具有全国代表性的调查。指数是用几何平均值计算的。使用不平等的斜率指数(SII)和不平等的相对指数(RII)来量化各省之间的社会经济不平等。
■从2016年到2021年,中国在实现UHC方面取得了值得称赞的进展,指数从2016年的56.94升至2021年的63.03。大多数省份在服务覆盖率方面表现更好。西部省份总体进展较快,这归因于财政保护的大幅增加。尽管差距很大,2021年,UHC指数从上海的77.94到福建的54.61,整个25个省份的UHC整体公平性都有所提升。SII从17.78(95%置信区间(CI)=11.64,23.93)降至12.25(95%CI=5.86,18.63),RII从1.38(95%CI=1.29,1.46)降至1.22(95%CI=1.16,1.29)。然而,非传染性疾病(NCD)领域的指数得分和公平性都出现了下降,强调需要优先关注。
■在可持续发展目标和“健康中国2030”倡议的背景下,中国在UHC方面取得了值得称赞的进展,省际公平有所改善。然而,实质性差异持续存在。UHC的公平实现需要优先考虑在欠发达地区增强服务能力和财政保护,特别是通过解决全科医生劳动力短缺和减少灾难性支付。发达地区应通过针对关键风险因素的有效干预措施,重点预防非传染性疾病。这项研究为其他国家采用全面的监测框架提供了启示,确定国家以下差异,并推出有针对性的政策举措。
UNASSIGNED: Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies.
UNASSIGNED: Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII).
UNASSIGNED: From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention.
UNASSIGNED: In the context of SDGs and the \'Healthy China 2030\' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.