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Cost-effective public health interventions are not reaching developing country populations who need them. Programmes to deliver these interventions are too often patchy, low quality, inequitable, and short-lived. We review the challenges of going to scale, building on known, effective interventions to achieve universal coverage. One challenge is to choose interventions consistent with the epidemiological profile of the population. A second is to plan for context-specific delivery mechanisms effective in going to scale, and to avoid uniform approaches. A third is to develop innovative delivery mechanisms that move incrementally along the vertical-to-horizontal axis as health systems gain capacity in service delivery. The availability of sufficient funds is essential, but constraints to reaching universal coverage go well beyond financial issues. Accurate estimates of resource requirements need a full understanding of the factors that limit intervention delivery. Sound decisions need to be made about the choice of delivery mechanisms, the sequence of action, and the pace at which services can be expanded. Strong health systems are required, and the time frames and funding cycles of national and international agencies are often unrealistically short. 相似文献
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Kalipso Chalkidou Robert Marten Derek Cutler Tony Culyer Richard Smith Yot Teerawattananon Francoise Cluzeau Ryan Li Richard Sullivan Yanzhong Huang Victoria Fan Amanda Glassman Yu Dezhi Martha Gyansa-Lutterodt Sam McPherson Carlos Gadelha Thiagarajan Sundararaman Neil Squires Nils Daulaire Rajeev Sadanandan Konuma Shiro Alexandre Lemgruber 《Lancet》2014
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Ikegami N Yoo BK Hashimoto H Matsumoto M Ogata H Babazono A Watanabe R Shibuya K Yang BM Reich MR Kobayashi Y 《Lancet》2011,378(9796):1106-1115
Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans. 相似文献
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Determining the effective coverage of maternal and child health services in Kenya,using demographic and health survey data sets: tracking progress towards universal health coverage 下载免费PDF全文
Peter K. Nguhiu Edwine W. Barasa Jane Chuma 《Tropical medicine & international health : TM & IH》2017,22(4):442-453
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Nevin WS 《Archives of internal medicine》2001,161(15):1915-6; author reply 1916-7
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National health plans: some economic and financial aspects 总被引:1,自引:0,他引:1
B S Bloom 《Annals of internal medicine》1973,78(6):954-958