2019全球疾病负担全民健康覆盖协作组根据204个国家和地区1990-2019年卫生服务有效覆盖指数来评估全民健康覆盖率。2020年8月27日，《柳叶刀》杂志发表了该成果。
实现全民健康覆盖（UHC）包括所有人在不遭受经济困难的情况下，获得高质量的所需卫生服务。联合国可持续发展目标（SDGs）和世界卫生组织第十三个工作总规划（GPW13）的议程强调，努力实现UHC是国家和全球机构的政策重点。评估卫生系统层面的有效覆盖范围对于了解健康服务是否符合各国健康状况，以及是否可为所有年龄段的人群带来足够优质的健康收益至关重要。
根据《2019年全球疾病、伤害和危险因素负担研究》，研究组评估了1990-2019年UHC在204个国家和地区的有效覆盖率。在全球范围内，UHC有效覆盖指数从1990年的45.8提高到2019年的60.3，但2019年各个国家/地区范围的UHC有效覆盖率仍然从日本和冰岛的超过95到索马里和中非共和国的低于25不等。
自2010年以来，撒哈拉以南非洲的UHC有效覆盖指数加速增长；相比之下，相对于1990-2010年，大多数其他疾病负担较重的地区在2010-2019年的增长速度都放慢了。尽管非传染性疾病占2019年潜在健康增长的比例更大，但许多国家非传染性疾病的有效覆盖率指标相对于传染性疾病和母婴健康来说表现落后，这表明许多卫生系统无法跟上不断增长的非传染性疾病负担和相关的人口健康需求。
2019年，UHC有效覆盖指数与人均综合医疗支出相关，尽管各发展阶段国家的UHC有效覆盖率远低于其健康支出的潜在水平。将健康支出转化为UHC有效覆盖率最大效率化，各国需要达到人均1398美元的综合健康支出，才能使UHC有效覆盖指数达到80。2018-2023年，预计将有3.889亿的人口当量将被UHC有效覆盖，远远低于GPW13在此期间再增加10亿人UHC获益的目标。当前预测表明，预计2023年仍有31亿人口当量仍缺乏UHC的有效覆盖，其中近三分之一的人口居住在南亚。
研究结果表明，除非在非传染性疾病方面采取协调一致的行动，且各国能够更好地将健康支出转化为UHC指数提高，否则全球加快UHC服务覆盖范围的目标不可能实现。
附：英文原文
Title: Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Author: Rafael Lozano, Nancy Fullman, John Everett Mumford, Megan Knight, Celine M Barthelemy, Cristiana Abbafati, Hedayat Abbastabar, Foad Abd-Allah, Mohammad Abdollahi, Aidin Abedi, Hassan Abolhassani, Akine Eshete Abosetugn, Lucas Guimares Abreu, Michael R M Abrigo, Abdulaziz Khalid Abu Haimed, Abdelrahman I Abushouk, Maryam Adabi, Oladimeji M Adebayo, Victor Adekanmbi, Jaimie Adelson, Olatunji O Adetokunboh, Davoud Adham, Shailesh M Advani, Ashkan Afshin, Gina Agarwal, Pradyumna Agasthi, Seyed Mohammad Kazem Aghamir, Anurag Agrawal, Tauseef Ahmad, Rufus Olusola Akinyemi, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Samuel B Albertson, Yihun Mulugeta Alemu, Robert Kaba Alhassan, Muhammad Ali, Saqib Ali, Vahid Alipour, Syed Mohamed Aljunid, Franois Alla, Majid Abdulrahman Hamad Almadi, Ali Almasi, Amir Almasi-Hashiani, Nihad A Almasri, Hesham M Al-Mekhlafi, Abdulaziz M Almulhim, Jordi Alonso, Rajaa M Al-Raddadi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Saeed Amini, Mostafa Amini-Rarani, Fatemeh Amiri, Arianna Maever L Amit, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, Catalina Liliana Andrei, Sofia Androudi, Fereshteh Ansari, Alireza Ansari-Moghaddam, Carl Abelardo T Antonio, Catherine M Antony, Ernoiz Antriyandarti, Davood Anvari, Razique Anwer, Jalal Arabloo, Morteza Arab-Zozani, Aleksandr Y Aravkin, Olatunde Aremu, Johan rnlv, Malke Asaad, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Charlie Ashbaugh, Seyyed Shamsadin Athari, Maha Mohd Wahbi Atout, Marcel Ausloos, Leticia Avila-Burgos, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Getie Lake Aynalem, Muluken Altaye Ayza, Samad Azari, Peter S Azzopardi, Darshan B B, Ebrahim Babaee, Ashish D Badiye, Mohammad Amin Bahrami, Atif Amin Baig, Mohammad Hossein Bakhshaei, Ahad Bakhtiari, Shankar M Bakkannavar, Arun Balachandran, Shelly Balassyano, Maciej Banach, Srikanta K Banerjee, Palash Chandra Banik, Agegnehu Bante Bante, Simachew Animen Bante, Suzanne Lyn Barker-Collo, Till Winfried Brnighausen, Lope H Barrero, Quique Bassat, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Bayisa Abdissa Baye, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Tariku Tesfaye Tesfaye Bekuma, Michelle L Bell, Isabela M Bensenor, Adam E Berman, Eduardo Bernabe, Robert S Bernstein, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Pankaj Bhardwaj, Anusha Ganapati Bhat, Krittika Bhattacharyya, Suraj Bhattarai, Zulfiqar A Bhutta, Ali Bijani, Boris Bikbov, Ver Bilano, Antonio Biondi, Binyam Minuye Birihane, Moses John Bockarie, Somayeh Bohlouli, Hunduma Amensisa Bojia, Srinivasa Rao Rao Bolla, Archith Boloor, Oliver J Brady, Dejana Braithwaite, Paul Svitil Briant, Andrew M Briggs, Nikolay Ivanovich Briko, Sharath Burugina Nagaraja, Reinhard Busse, Zahid A Butt, Florentino Luciano Caetano dos Santos, Lucero Cahuana-Hurtado, Luis Alberto Cámera
Issue&Volume: 2020-08-27
Abstract: Background
Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.
Methods
Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023.
Findings
Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia.
Interpretation
The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC.
DOI: 10.1016/S0140-6736(20)30750-9
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30750-9/fulltext
LANCET：《柳叶刀》，创刊于1823年。隶属于爱思唯尔出版社，最新IF：202.731
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