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Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress

机译：促进普遍的金融保护：来自七个低收入和中等收入国家的证据表明促进或阻碍进展的因素

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Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC.These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds.The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies.This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC.
机译：尽管全民健康覆盖（UHC）是全球卫生政策的优先事项，但在中低收入国家（LMIC）中进行UHC改革的证据仍然有限。本文概述了本专题系列案例研究的主要见解，这些案例研究是在过渡到UHC的非常不同的阶段在七个中低收入国家（哥斯达黎加，乔治亚州，印度，马拉维，尼日利亚，坦桑尼亚和泰国）进行的。当试图通过减少自付费用来改善财务保护时，通过税收筹资和有时是强制性保险缴费来增加预付款资金的重要性。如果正在努力将金融保护范围扩大到正规部门就业以外的人群，这将增加税收筹资特别重要，这将使人们对该群体推行缴费型保险计划的价值产生疑问。在某些中低收入国家中，公务员保险计划的优先次序首先受到关注，这也引发了对有限资金的最适当使用的质疑。与普遍主义改革相比，这些国家的多样化改革为针对穷人的政策经验提供了一些见解。方法。在UHC方面取得最大进展的国家，例如哥斯达黎加和泰国，做出了明确的承诺，要确保为所有人提供经济保护和尽快获得所需的护理，而采用针对性的国家不一定是这种情况。改革。在采用普遍主义而非针对性方法的国家中，资金池中的分散性也趋于减少。除了限制交叉补贴外，资金池的分散还导致一揽子福利待遇的差异，导致各群体无法获得所需的护理和财务保护；一旦这种差异根深蒂固，就很难克服。能力限制，尤其是在采购组织中，是LMIC中普遍存在的问题。案例研究还强调了高层政治领导者在推行UHC政策和公民支持以维持这些政策方面的关键作用。本系列证明了促进在中低收入国家之间分享UHC改革经验的价值。它还确定了未来在中低收入国家中进行医疗保健融资研究的关键领域，这些领域将支持在实现UHC方面取得进展。

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