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Health Financing Systems, Health Equity and Universal Health Coverage in Arab Countries

机译：阿拉伯国家的卫生筹资系统，卫生公平和全民健康覆盖

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摘要

This article provides an overview of health financing structures in Arab countries in the context of their preparedness for universal health coverage. Current arrangements have left large swathes of the population shouldering high financial burdens and facing hardships when using healthcare, with significant impoverishing and deterrent effects. Health protection schemes are most comprehensive for those who can afford healthcare; they are mainly based on contributions and formal employment and thus fail to cater for the poor and the rural and informal sectors. Financing systems also lack the operational bases and institutional prerequisites for effective resource pooling and risk sharing, with segmentation and fragmentation worsening horizontal and vertical inequities. The neglect of public health systems has reinforced inequities by widening the gap between needs and provision, and by emphasizing the ability to pay as a basis for accessing quality care. In a context of informality and poverty, focusing reforms on health insurance is not a panacea. Rather, moving towards universal health coverage and reducing health inequities will require changes in the level of political tolerance for social injustice, and a paradigm shift to a more equity-based political economy which views health as an investment and an entitlement.
机译：本文概述了阿拉伯国家为全民健康覆盖做好准备的情况下的卫生筹资结构。当前的安排使大批人口在使用医疗保健时肩负着沉重的经济负担并面临困境，产生了显着的贫困和威慑作用。对于可以负担得起医疗保健费用的人，健康保护计划最为全面；它们主要是基于缴款和正规就业，因此无法满足穷人以及农村和非正规部门的需求。筹资系统还缺乏有效资源汇集和风险分担的业务基础和体制先决条件，而细分和支离破碎加剧了横向和纵向不平等。对公共卫生系统的忽视通过扩大需求和提供之间的差距，并强调支付能力作为获得优质医疗服务的基础，加剧了不平等现象。在非正式和贫困的情况下，将改革重点放在健康保险上不是万能的。相反，要实现全民健康覆盖并减少卫生不平等，就需要改变对社会不公正现象的政治容忍度，并需要向以公平为基础的政治经济学范式转变，这种政治经济学将卫生视为一项投资和一项应享权利。

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  • 来源
    《Development and change》 |2017年第1期|146-179|共34页
  • 作者

    Alami Randa;

  • 作者单位

    Sch Oriental & African Studies, Dept Econ, Russell Sq, London WC1H 0XG, England|Oxford Inst Energy Studies, Oxford, England;

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