不同国家健康保障制度筹资机制变革因素的描述性系统评价

目的归纳和描述不同类型健康保障制度国家卫生筹资机制变革的推动或阻碍因素。方法由主题专家和检索人员讨论并试验后确定检索词，共检索19个电子数据库，2个卫生机构网站，2个灰色文献数据库和搜索引擎Google。纳入所有国家水平上实施卫生筹资机制变革的文章。用预先设计的数据提取表收集文章内容，根据设计的理论框架对提取的信息进行分析和描述。结果本系统评价共纳入59篇文献，经济的发展为各国卫生筹资变革提供了条件，卫生体制出现的问题可以直接导致变革的发生，而政治因素是大多数国家的推动因素，其中韩国是由于民主政治体制下上台政党推动了变革，泰国和德国是由于首相上台而实施的变革，意大利和法国则是由于卫生费用支出过大和卫生系统不公平而导致的变革。结论已实现全民健康保障的国家为发展中国家卫生筹资变革提供借鉴，在实行变革之前要充分了解和分析政治、经济和社会等影响因素，充分利用推动因素和避免阻碍因素。

Factors Determining the Health Financing Systems: A Descriptive Systematic Review

Objectives To describe the factors determining choice of health financing systems. Methods Search words chosen by both health policy experts and the review search coordinators after discussion and pilot. 19 electronic databases, 2 international health institutes websites, 2 grey literature databases, and search engine Google were included in the databases. Any literature about health financing reforms on country level was included. Pre-designed data extraction form was used for collecting the information. The data was analyzed and described by pre-designed analytic framework. Result A total of 59 studies were included in this review. The driving forces included political, economic, social, and health systems factors. Development level of economy was the most crucial factor for transformation of health financing systems. The health system could directly led to the transition between different health systems, both Italy and France transform their financing system from social health insurance to national health system. The key persons such as premier of Thailand and Germany, leader of political and social organization in Israel and Korea are the driving forces of health financing reforms. Conclusion Developing countries can learn from the countries which have achieved universal coverage through health financing reform. Underlying factors influencing formulation of a health financing system need to be considered before taking actions in reforming the current system. Efforts in transforming the health financing systems need to be made from political, economic, and health systems sides.