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Financiación pública de la salud en los países en desarrollo: un análisis sistemático transnacional
Chunling Lu1, Matthew T Schneider, Paul Gubbins
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Lancet (London, England)
|April 13, 2010
Resumen
El gasto gubernamental en salud aumentó a nivel mundial, pero la asistencia al desarrollo para la salud (DAH) a los gobiernos redujo el gasto nacional en salud. DAH a los sectores no gubernamentales, sin embargo, impulsó el gasto nacional en salud, destacando la necesidad de estrategias de asignación de ayuda cuidadosas.
Área de la Ciencia:
- Salud Global La salud global.
- Economía de la salud Economía de la salud
- Política de salud pública Política de salud pública.
Sus antecedentes:
- El gasto gubernamental en salud es un indicador clave del compromiso nacional y la sostenibilidad del programa.
- El análisis de los gastos gubernamentales de salud en los países en desarrollo es crucial para comprender las tendencias de financiación de la salud.
- Los factores que influyen en la financiación de la salud pública incluyen el PIB, el tamaño del gobierno, la prevalencia del VIH, el alivio de la deuda y la asistencia al desarrollo para la salud (DAH).
Objetivo del estudio:
- Analizar sistemáticamente las fuentes de datos para el gasto público en salud en los países en desarrollo.
- Describir las tendencias en la financiación de la salud pública a partir de fuentes nacionales.
- Evaluar la relación entre el gasto nacional en salud y el PIB, el tamaño del gobierno, la prevalencia del VIH, el alivio de la deuda y la DAH.
Principales métodos:
- Análisis sistemático del gasto público en salud como agente (GHE-A) utilizando diversas fuentes de datos.
- Evaluación de la calidad de las fuentes e imputación múltiple para los datos completos de GHE-A.
- Métodos de regresión de panel para estimar las asociaciones entre el gasto nacional en salud y los principales indicadores económicos y de salud.
Principales resultados:
- La financiación de la salud pública de fuentes nacionales casi se duplicó a nivel mundial entre 1995 y 2006.
- Si bien el gasto nacional en salud aumentó en general, algunos países de África subsahariana experimentaron disminuciones en las cuotas de gasto en salud.
- La asistencia al desarrollo para la salud (AAD) dirigida a los gobiernos impactó negativamente en el gasto nacional en salud, mientras que la AAD a los sectores no gubernamentales tuvo un efecto positivo.
Conclusiones:
- Las recomendaciones incluyen un monitoreo estandarizado de los gastos de salud y objetivos colaborativos para las cuotas de gasto en salud.
- Es esencial invertir en la capacidad de los países en desarrollo para gestionar la DAH.
- Debe considerarse una evaluación cuidadosa de la DAH a los sectores no gubernamentales y mecanismos de ayuda alternativos como los subsidios a los precios globales.
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