分权化和公平的服务提供:在卫生部门治理改革下获得和满意度
Alan Zarychta1, Bertha Bermudez Tapia2, Elisabeth Dowling Root3
1Crown Family School of Social Work, Policy, and Practice, University of Chicago, United States.
Social science & medicine (1982)
|November 11, 2025
概括
洪都拉斯的去中心化改善了农村社区的医疗保健准入和满意度,减少了基于财富的差距. 根据管理机构的改进情况有所不同,非政府组织和协会显示出最大的好处.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
背景情况:
- 全球南方地区的行政改革往往旨在加强农村卫生服务的提供.
- 分权化,将权力转移与基于绩效的管理结合起来,是关键的战略.
- 洪都拉斯的卫生部门改革涉及到将其三分之一的市政当局的服务提供分散.
研究的目的:
- 评估去中心化对公平提供医疗服务的影响.
- 分析对医疗保健获取和患者满意度的影响.
- 调查家庭财富,性别,教育和种族作为调节者的作用.
主要方法:
- 分析了来自65个匹配市 (23个集中,42个分散) 的约9000个家庭的数据.
- 测量个人和设施层面的护理障碍.
- 评估对咨询和整体卫生系统的满意度.
主要成果:
- 与集中管理相比,去中心化与较少的设施级访问障碍和更高的满意度有关.
- 在去中心化下,医疗保健获取方面的基于财富的差异减少了.
- 协会和市政府的获取改善最为显著;对非政府组织和协会的满意度提高最多.
结论:
- 分权化可以提高医疗服务的输出,结果和公平性.
- 在公平的医疗服务提供中观察到的改善挑战了以前的研究结果.
- 分权化的有效性取决于管理当地卫生服务的中介组织类型.
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