评论
打印
Today, I am pleased to announce that with our Japanese partners we are releasing a synthesis of case study findings from 11 countries that have achieved, or are committed to achieving, universal health coverage.
今天，我很高兴地宣布，我们同日本合作伙伴共同发布了已经实现或者致力于实现全面健康覆盖的11个国家案例的综合研究成果。
These 11 countries are diverse – geographically, culturally, and economically. But all of these countries are demonstrating how these programs can improve the health and welfare of their citizens and promote inclusive and sustainable economic growth.
这11个国家在地理上、文化上和经济上千差万别。但所有这些国家都显示出这些计划如何能够改善国民的健康与福祉，并促进包容性和可持续的经济增长。
The good news is that many low- and middle-income countries are introducing fundamental reforms and achieving remarkable progress.
好消息是，许多低收入国家和中等收入国家正在出台根本性的改革，并取得了显著进展。
So what are the main lessons from these 11 countries? Here are five:
那么，这11个国家的重要经验启示是什么呢？一共有五条：
One, strong national and local political leadership and long-term commitment are required to achieve and sustain universal health coverage;
第一，强有力的国家和地方政治领导力和长期的承诺是实现和维持全民健康覆盖的必要条件；
Two, short-term wins are critical to secure public support for reforms as in the case of Turkey where hospitals were outlawed from retaining patients unable to pay for care;
第二，短期成功对于获得公众对改革的支持具有关键意义，比如土耳其对不让付不起医疗费的患者离开的医院予以取缔；
Three, economic growth, by itself, is insufficient to ensure equitable coverage—so countries must enact policies that redistribute resources and reduce disparities in access to affordable, quality care;
第三，经济增长本身不足以确保公平覆盖，所以各国必须颁布政策重新分配资源和缩小在获得可负担的优质医疗保健服务方面的差距；
Four, strengthening the quality and availability of health services depends not only on highly skilled professionals but also on community and mid-level workers who constitute the backbone of primary health care.
第四，加强卫生保健服务的质量与可获性不仅取决于技术高超的专业人员，还取决于构成初级卫生保健骨干力量的社区和中层工作者；
And finally, five, countries need to invest in a robust and resilient primary care system to improve access and manage health care costs.
第五，国家需要投资建立一个强大坚韧的初级卫生保健体系，以改善医疗保健服务获取和管理医疗卫生费用。
Not surprisingly, all of these cases also demonstrate that as countries move toward universal coverage, they will confront competing demands and continuing trade-offs. Countries face choices that can either enhance or erode coverage. The countries which have been most successful in expanding coverage have been in a mode of continuous learning – from what is happening both inside and outside their borders – and adapting their approaches based on the best available knowledge and evidence.
毫不奇怪，所有这些案例也表明，随着全民健康覆盖的进程，国家将会面临相互竞争的需求，需要不断做出权衡取舍。国家面临在增强或削弱健康覆盖两者之间做出抉择。在扩大健康覆盖方面最成功的国家始终处于一种不断学习的模式——借鉴国内外的发展经验，并根据可获得的最佳知识与实证不断调整他们的模式。
A promising message from these case studies is that even low-income countries with low levels of health coverage can still aim for universal health coverage. Countries can start by building their institutional capacity, learn from the experiences of other countries, and adapt innovative approaches that can catalyze the expansion of coverage.
从这些案例研究中产生的一个令人鼓舞的信息是，即使健康覆盖水平偏低的低收入国家仍可以全民健康覆盖为目标。国家可以从自身的机构能力建设出发，借鉴别国的经验，采取创新方式促进覆盖面的扩大。
These are the cross-cutting lessons. Now let’s take a closer look at a few of these countries:
这些都是跨领域的经验启示。现在我们来仔细看看其中几个国家的案例：
In Turkey, an economic crisis in the early 2000s prompted major government reforms and laid the groundwork for the 2003 Turkey Health Transformation Program. Turkey cleaned up government deficits and created leaner and more efficient state bureaucracies—and also opened doors for reform in the health sector by breaking old interest group politics. Outcomes are impressive: Today, more than 95 percent of the Turkish population is covered by formal health insurance. The Program now provides a high level of financial protection and equity while ensuring high and rising levels of patient satisfaction. Furthermore, infant mortality rates have declined from 28.5 per 1,000 live births in 2003 to 10.1 per 1,000 live births in 2010, and the maternal mortality ratio fell from 61 deaths per 100,000 live births in 2000 to 16.4 deaths per 100,000 live births in 2010. Turkey’s example proves that financial constraints—even a major financial crisis—can catalyze the expansion of coverage. The Bank Group has been pleased to partner with the Turkish government to support this effort.
在土耳其，21世纪初爆发的经济危机促使政府进行了重大改革，为2003年土耳其的卫生改革计划奠定了基础。土耳其清理了政府赤字，建立了更加精简高效的政府机构，同时也破除了老的利益集团政治，敞开了卫生部门的改革大门。其结果令人印象深刻：如今，正规医疗保险覆盖面达到土耳其人口的95 ％以上。该计划现在提供高水平的财政保障与公平，同时确保患者满意度高且不断上升。婴儿死亡率从2003年每千名活产儿死亡28.5名， 2010年下降到每千名活产儿死亡10.1名。孕产妇死亡率从2000年的每10万活产死亡61人，2010年下降到每10万活产死亡16.4人。土耳其的案例证明，财政拮据甚至重大的金融危机都可能促进健康覆盖面扩大。世行集团一直很高兴与土耳其政府合作支持这一努力。
Thailand has focused on strengthening its health workforce, with the Thai Network of Rural Doctors leading the push for reforms. In addition to increasing the number of doctors and nurses, the government raised basic salaries and introduced incentives to attract and retain health workers. As a result of the health workforce scale-up and other factors, popular utilization of essential health services has improved. Since the Universal Coverage Scheme was introduced there has been a declining trend in the incidence of catastrophic health expenditures, defined as out-of-pocket payments for health care exceeding 10 percent of total household consumption expenditure. The incidence dropped from 6.8 percent in 1996 to 2.8 percent in 2008 among the poorest people in the program. The impact on province-specific incidence of impoverishment has been even more impressive: in the poorest rural northeast region of Thailand, the number of impoverished households dropped from 3.4 percent in 1996 to less than 1.3 percent in 2006-2009.
泰国一直专注于加强卫生队伍建设，以泰国乡村医生网络为首推进改革。除了增加医护人员人数外，政府提高了基本工资，并推出优惠措施吸引和留住卫生工作者。由于卫生人力资源规模化及其他因素的影响，民众对基本卫生服务的使用率得到提高。自实行全民健康覆盖计划以来，灾难性卫生支出——即自付医疗费用超过家庭总消费支出的10％——的发生率呈下降趋势，在计划覆盖的最贫困人口中从1996年的6.8 ％到2008年降低到2.8％。对分省的致贫率的影响更为显著：在泰国最贫穷的东北农村地区，因病致贫的家庭比例从1996年的3.4％在2006-2009年期间下降到1.3％以下。
Ethiopia launched its Health Extension Program in 2003 to promote universal coverage of primary care. The program delivers 16 clearly defined packages of health services for free. At the center of the program is the network of health extension workers – all women, 10th grade high school graduates recruited from their communities, trained for one year and redeployed back into their communities. More than 35,000 health extension workers have been trained and deployed thus far, and their services are now in high demand from other sectors as well – such as adult literacy or sharing of sustainable agriculture techniques. The challenge is to continue to enhance the skills and performance of these frontline workers and to protect their time to ensure they can provide communities with the quality health services they need. The latest Ethiopia Demographic and Health Survey data show that between 2005 and 2010, child mortality fell from 123 per thousand to 88 per thousand, a 28 percent decline. Over the same time period, Ethiopia also reports impressive reductions in both stunting among children and anemia among women; and contraceptive use nearly doubled, contributing to a reduction in total fertility rate.
埃塞俄比亚在2003年推出健康推广计划以促进初级卫生保健服务的普遍覆盖。该计划免费提供16项明确规定的医疗服务包。该方案的核心是建立卫生保健推广工作者网络——均为女性，从社区招募的 10年级高中毕业生，经过一年培训，然后重新安置回到社区。截至目前共培训和安置卫生保健工作者35,000多人。现在其他部门对他们的服务需求也很大，比如成人扫盲或推广可持续农业技术。目前的挑战是如何继续提高这些一线工作者的技能和绩效，保障他们的时间，以确保能为社区提供所需要的优质医疗保健服务。最新埃塞俄比亚人口与健康调查数据显示， 从2005年至2010年期间，儿童死亡率下降了28％ 。在同一时段，埃塞俄比亚的儿童发育不良率和妇女贫血率也出现显著下降；避孕药具使用率增加了近一倍，导致总生育率呈现下降。
And in Peru, the government is leveraging its sovereign wealth funds to jumpstart ambitious reforms aimed at realizing universal health coverage. The Bank Group is partnering with the Ministry of Health to develop a national set of indicators that will allow them to measure, monitor, and evaluate the expansion of coverage, and take into account the epidemiological transition that the country is facing.
秘鲁政府正在利用主权财富基金推动以实现全民健康覆盖为目标的雄心勃勃的改革。世行集团正在与卫生部合作制定一套国家指标，用于衡量、监测和评价覆盖面扩大进度，也考虑到该国所面临的流行病学转型的情况。
