発展途上国における保健の公共資金: 跨国的な体系的分析
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
まとめ
保健に対する政府支出は世界的に増加したが,政府への保健開発援助 (DAH) は国内保健支出を削減した. しかし,非政府部門へのDAHは,国内保健支出を増加させ,援助の配分戦略に注意を払う必要があることを強調しました.
科学分野:
- グローバル・ヘルス グローバル・ヘルス
- 健康経済学 医療経済学
- 公共衛生政策 公共衛生政策
背景:
- 政府の医療支出は,国家的なコミットメントとプログラムの持続可能性の重要な指標です.
- 発展途上国における政府医療費の分析は,医療財政の動向を理解する上で極めて重要です.
- 公衆衛生の資金調達に影響を及ぼす要因には,GDP,政府規模,HIV感染率,債務解消,および健康のための開発援助 (DAH) が含まれる.
研究 の 目的:
- 開発途上国における政府保健支出に関するデータソースを体系的に分析する.
- 国内からの公衆衛生資金調達の動向を記述する.
- 国内保健費とGDP,政府規模,HIV感染率,債務解消,DAHとの関係を評価する.
主な方法:
- 多様なデータソースを使用して,エージェントとしての健康 (GHE-A) に対する政府支出の体系的分析.
- ソースの品質評価と,完全なGHE-Aデータに対する複数の帰算.
- 国内医療支出と主要な経済および健康指標の関連性を推定するためのパネル回帰方法.
主要な成果:
- 国内からの公衆衛生の資金調達は,1995年から2006年にかけて,世界的にほぼ倍増した.
- 国内保健費の支出は全体的に増加したが,サハラ以南のアフリカのいくつかの国では,保健費の割合が減少した.
- 政府に向けられた保健開発援助 (DAH) は,国内保健支出に負の影響を及ぼしたが,非政府セクターへのDAHは,積極的な影響を及ぼした.
結論:
- 推奨事項には,医療費の標準化されたモニタリングと,医療費のシェアに関する共同目標が含まれています.
- 開発途上国のDAH管理能力への投資は不可欠です.
- 非政府セクターへのDAHの注意深い評価と,グローバル価格補助金などの代替援助メカニズムを検討すべきである.
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