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Germany: Health system review. 德国:卫生系统审查。
Q1 Medicine Pub Date : 2014-01-01
Reinhard Busse, Miriam Blümel

This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities.

对德国卫生系统的分析回顾了最近在组织和治理、卫生融资、卫生保健提供、卫生改革和卫生系统绩效方面的发展。在德国的医疗保健系统中,决策权传统上由国家(联邦)和州(州)两级共享,大部分权力下放给自治机构。它为广泛的福利提供了全民覆盖。自2009年以来,通过法定或私人医疗保险,所有公民和永久居民都必须获得医疗保险。2014年初,共有7000万人或85%的人口在132个疾病基金之一中享受法定健康保险。另有11%的人享受替代性私人医疗保险。该系统的特点是自由选择提供者和不受限制地获得所有级别的护理。德国卫生保健提供系统的一个关键特征是公共卫生服务、门诊护理和住院(住院)护理之间明确的制度分离。越来越多的人认为这是变革的障碍,因此正在提供综合护理,目的是改善流动医生和医院之间的合作。德国在医疗保健方面投入了大量资源:2012年占国内生产总值的11.4%,是欧盟最高水平之一。在国际上,德国的医疗保健系统有一个慷慨的福利篮子,是最高水平的能力之一,以及相对较低的费用分摊。然而,德国的医疗保健系统在一些领域仍然需要改进,比如医疗质量。此外,法定和私人医疗保险的划分仍然是德国医疗保健系统面临的最大挑战之一,因为它导致了不平等。
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引用次数: 0
Malta: Health system review. 马耳他:卫生系统审查。
Q1 Medicine Pub Date : 2014-01-01
Natasha Azzopardi Muscat, Neville Calleja, Antoinette Calleja, Jonathan Cylus

This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community.

对马耳他卫生系统的分析回顾了其组织和治理、卫生筹资、卫生保健提供、卫生改革和卫生系统绩效方面的发展。马耳他的保健系统由公共部门和私营部门组成,前者在服务点免费,并为所有公民提供全面的一揽子保健服务,后者占保健总支出的三分之一,并提供大部分初级保健。马耳他公民的预期寿命是欧洲最高的之一。然而,非传染性疾病是一个主要问题,肥胖在成人和儿童中日益普遍。卫生系统面临重大挑战,包括人口稳步老龄化,这影响了公共财政的可持续性。其他供应限制来自财政和基础设施的限制。尽管如此,在确保提供方便、高质量、安全和可持续的医疗保健系统方面,存在着强有力的政治承诺。这就要求进行战略投资,支持对现有程序的修订,同时将护理的重点从医院转移到社区。
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引用次数: 0
Uzbekistan: health system review. 乌兹别克斯坦:卫生系统审查。
Q1 Medicine Pub Date : 2014-01-01
Mohir Ahmedov, Ravshan Azimov, Zulkhumor Mutalova, Shahin Huseynov, Elena Tsoyi, Bernd Rechel

Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention.

乌兹别克斯坦是一个中亚国家,1991年苏联解体后独立。从那时起,它开始了几项重大的卫生改革,涉及卫生保健提供、治理和筹资,目的是在确保公平获取的同时提高效率。农村地区的初级保健已改为两级制度,而城市地区的专科综合诊所正在转变为覆盖所有城市人口群体的普通综合诊所。二级保健的资金来源是过去的支出和投入(并越来越多地通过用户收费自筹资金),而初级保健的资金来源则越来越多地以人头为基础。此外,还在努力提高分配效率,用于改革后的初级保健制度的资源份额正在缓慢增加。卫生保健的提供在很大程度上仍为公共所有,但卫生保健总支出的近一半来自私人来源,主要是自付费用。有一揽子基本福利,其中包括初级保健、紧急保健以及对某些疾病和人口类别的护理。然而,二级保健和门诊药品不包括在大多数人口的一揽子福利中,对私人保健支出的依赖导致不平等和家庭灾难性支出。虽然公共支出的份额正在缓慢增加,但财政保护仍然是一个令人关切的领域。护理质量是另一个日益受到重视的领域。
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引用次数: 0
Croatia: health system review. 克罗地亚:卫生系统审查。
Q1 Medicine Pub Date : 2014-01-01
Aleksandar Džakula, Anna Sagan, Nika Pavić, Karmen Lonćčarek, Katarina Sekelj-Kauzlarić

Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity; psychiatric care in the community is not well developed; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to

克罗地亚是巴尔干半岛上的一个中欧小国,人口约430万,国内生产总值(GDP)为欧盟(EU)平均水平的62%(以购买力平价表示;PPP)。2013年7月1日,克罗地亚成为欧盟第28个成员国。克罗地亚出生时的预期寿命一直在稳步增长(在1991年至1995年独立战争之后的几年里略有下降),但仍低于欧盟的平均水平。近年来,人口中超重和肥胖的流行率有所上升,缺乏身体活动的趋势令人担忧。1993年成立的克罗地亚健康保险基金(CHIF)是强制性健康保险(MHI)系统中唯一的保险机构,该系统向全体人口提供全民健康保险。二级卫生保健设施的所有权在国家和县之间分配。公立医院的财政状况很弱,最近的改革旨在改善这种状况。2009年引入特许权(由县政府组织招标提供特定初级保健服务的公私伙伴关系),使县政府能够在初级保健的组织、协调和管理方面发挥更积极的作用;大多数初级保健实践已经私有化。与西欧相比,克罗地亚政府用于保健的国内生产总值比例仍然相对较低,人均保健支出也是如此。尽管公共支出占卫生总支出(the)的比例一直在下降,但82%左右的比例仍然相对较高,即使以欧洲标准衡量也是如此。社保基金收入的主要来源是强制性医疗保险缴款,占社保基金总收入的76%,尽管只有约三分之一的人口(在职工人)有义务全额缴纳医疗保险缴款。虽然MHI计划的广度和范围很广,但患者必须支付许多商品和服务的费用,自2003年以来,免费保健服务的权利已经有系统地减少,但弱势群体可以豁免。可以改善保健部门的资本和人力资源配置:例如,老年人和体弱者之家的运作接近最大能力;社区精神科护理不发达;某些类别的医疗专业人员短缺,包括地域不平衡。关于克罗地亚保健改革政策进程的研究很少。然而,改革似乎往往缺乏可供公众分析和审视的战略基础和预测,缺乏对改革成果的评估。考虑到可用资源的数量,卫生保健系统的总体表现似乎还不错。然而,缺乏适当评估的数据。
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引用次数: 0
Norway: health system review. 挪威:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Ånen Ringard, Anna Sagan, Ingrid Sperre Saunes, Anne Karin Lindahl

Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies intended to empower patients and users. The past few years have seen efforts to improve coordination between health care providers, as well as an increased attention towards quality of care and patient safety issues. Overall, comparing mortality rates amenable to medical intervention suggests that Norway is among the better performing European countries. Despite having one of the highest densities of physicians in Europe, though, Norway still struggles to ensure geographical and social equity in access to health care.

挪威有500万居民,分布在近40万平方公里的土地上,是欧洲人口最稀少的国家之一。自上世纪70年代初开始生产石油以来,该国经历了几十年的高速增长,现在是世界上人均最富有的国家之一。总体而言,挪威人口健康状况良好;预期寿命为81.53岁,高于欧盟平均水平80.14岁,总体预期寿命与健康寿命之间的差距约为欧盟平均水平的一半。医疗保健系统是半分散的。专科保健由国家负责(由四个地区卫生当局管理),市政当局负责初级保健。虽然卫生保健支出仅占挪威国内生产总值的9.4%(在世卫组织欧洲区域排名第16位),但鉴于挪威人均国内生产总值非常高,其人均卫生支出高于大多数国家。公共来源占卫生总支出的85%以上;大多数私人保健资金来自家庭自掏腰包。包括医生和护士在内的大多数卫生人员群体的从业人员数量在过去几十年中一直在增加,与其他欧盟国家相比,每10万居民的卫生保健人员数量很高。然而,长时间等待选择性护理仍然是一个问题,并引起患者的不满。在过去的四十年里,医疗改革的重点发生了变化。在1970年代,重点是平等和增加获得保健服务的地理机会;在1980年代,改革旨在控制费用和下放保健服务;上世纪90年代的重点是提高效率。自千年开始以来,重点一直放在保健服务的提供和组织的结构性改革以及旨在赋予病人和使用者权力的政策上。在过去几年中,为改善保健提供者之间的协调作出了努力,并对护理质量和患者安全问题给予了更多关注。总的来说,比较可接受医疗干预的死亡率表明,挪威是表现较好的欧洲国家之一。尽管挪威是欧洲医生密度最高的国家之一,但它仍在努力确保获得医疗保健的地域和社会公平。
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引用次数: 0
Austria: health system review. 奥地利:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Maria M Hofmarcher, Wilm Quentin

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry. One of the key weaknesses of the health-care system is in the prevention of illness. Spending on preventive medicine, at 2% of total health spending, is significantly lower than the EU15 and OECD average (both 3%), and also shows a below-average rate of growth. It remains to be seen whether the focus on health promotion and prevention of the 'framework health goals' approved in 2012 will be translated into concrete measures, whether clear responsibilities for implementation can be assigned, and whether sufficient funding will be made available. This would be likely to improve the health of the Austrian population and would help to reduce costs associated with preventable diseases.

对奥地利卫生系统的分析回顾了最近在组织和治理、卫生融资、卫生保健提供、卫生改革和卫生系统绩效方面的发展。奥地利卫生系统为广泛的福利和高质量的护理提供全民覆盖。自由选择提供者和不受限制地获得所有护理级别(全科医生、专科医生和医院)是该系统的特点。不出所料,人口满意度远高于欧盟平均水平。自2005年以来,与收入有关的卫生不平等有所增加,尽管与其他国家相比仍然相对较低。医疗保健系统是由国家的联邦结构和将责任委托给自治利益相关者的传统形成的。一方面,这使得分散的规划和治理能够适应当地的规范和偏好。另一方面,它也导致责任分散,并经常导致协调不足。为此,几年来一直努力在联邦和区域一级实现对保健系统的更多联合规划、管理和筹资。与任何卫生系统一样,仍然存在一些挑战。无论是绝对值还是占GDP的百分比,医疗保健系统的成本都远高于欧盟15国的平均水平。医疗保健服务存在严重的结构性失衡,医院部门规模过大,可用于门诊护理和预防医学的资源不足。与此同时,在治疗服务(医院床位和专科医生)和预防性服务(如预防性健康检查、门诊康复、社会心理和心理治疗护理和护理)的利用方面存在明显的区域差异。在使用医疗服务,如预防性健康检查、免疫接种或牙科方面,存在明显的社会不平等。卫生保健系统的主要弱点之一是在疾病预防方面。预防医学支出占卫生总支出的2%,大大低于欧盟15国和经合组织的平均水平(均为3%),而且增长率也低于平均水平。还有待观察的是,2012年批准的“框架健康目标”对促进和预防健康的重点是否会转化为具体措施,是否能够分配明确的执行责任,以及是否能够提供足够的资金。这可能会改善奥地利人口的健康状况,并有助于减少与可预防疾病有关的费用。
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引用次数: 0
Lithuania: health system review. 立陶宛:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Liubove Murauskiene, Raimonda Janoniene, Marija Veniute, Ewout van Ginneken, Marina Karanikolos

This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality.

这份对立陶宛卫生系统的分析回顾了自2000年以来在组织和治理、卫生筹资、卫生保健提供、卫生改革和卫生系统绩效方面的发展。立陶宛的卫生系统是一个混合系统,主要由国家健康保险基金通过强制性健康保险计划提供资金,并由国家为非经济活动人口提供的大量捐款补充,约占其预算的一半。卫生部门的公共资金自2004年以来逐步增加,2010年占国内生产总值的5.2%。尽管立陶宛的卫生系统受到了最近经济危机的考验,但立陶宛的反周期国家健康保险缴费政策(确保不从事经济活动的人口得到覆盖)帮助卫生系统度过了危机,立陶宛成功地利用危机作为杠杆降低了药品价格。然而,公共卫生支出削减的未来影响令人担忧。此外,自付费用仍然很高(特别是药品费用),可能威胁到弱势群体获得保健服务的机会。许多挑战依然存在。初级保健系统需要加强,以便更多的病人得到治疗,而不是转诊给专科医生,这也需要病人改变态度。需要增加资源分配的透明度和问责制,包括资本投资的融资和付款人与提供者的关系。最后,人口健康虽然有所改善,但仍然令人关切,通过减少可控制和可预防的死亡率负担,可以取得重大进展。
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引用次数: 0
Canada: Health system review. 加拿大:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Gregory Marchildon

Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.

加拿大是一个拥有3300万人口的高收入国家。尽管2008年开始的经济衰退,它的经济表现一直稳定。加拿大人的预期寿命持续上升,与大多数经合组织国家相比,加拿大人的预期寿命较高;然而,婴儿和产妇死亡率往往比澳大利亚、法国和瑞典等国更糟。卫生总支出的约70%来自联邦、省和地区政府的一般税收收入。大部分公共卫生收入用于提供全民医疗保险(医疗上必要的住院和医生服务,在服务点对居民免费)和补贴门诊处方药和长期护理的费用。医疗保健费用的增长速度继续快于经济和政府收入的增长速度,这在很大程度上是由处方药支出推动的。然而,在过去五年中,药品支出的增长率与医院支出相匹配,并被医生支出超过,这主要是由于提供者报酬的增加。保健服务的管理、组织和提供高度分散,各省和地区负责管理医疗保险和规划保健服务。在过去十年中,没有重大的泛加拿大卫生改革倡议,但个别省份和地区已将重点放在重组或微调其区域卫生系统上,并改善初级、急性和慢性护理的质量、及时性和患者体验。医疗保险制度有效地为加拿大人提供了医疗和医生费用方面的经济保障。然而,医疗保险覆盖的服务范围狭窄,在覆盖范围方面产生了重大差距,公平获取可能是这些领域的一项挑战。
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引用次数: 0
Belarus: health system review. 白俄罗斯:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Erica Richardson, Irina Malakhova, Irina Novik, Andrei Famenka

This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success.

对白俄罗斯卫生系统的分析回顾了自2008年以来在组织和治理、卫生融资、医疗保健提供、卫生改革和卫生系统绩效方面的发展。尽管自独立以来发生了相当大的变化,但白俄罗斯仍然致力于普遍获得保健服务的原则,主要通过国有设施在使用点免费提供保健服务,这些设施在领土上按等级组织。保健政策的特点是渐进式的变化,而不是彻底的改革,尽管在一些地区实行了人头供资,并且一直在努力加强初级保健的作用。医院部门费用高和公共卫生薄弱等问题表明,有必要推进改革方案。今后改革的重点是加强预防服务和提高专家服务的质量和效率。实现这一目标的主要挑战包括减少医院的过剩能力,加强保健管理,使用循证治疗和诊断程序,以及制定更有效的筹资机制。让所有利益攸关方参与制定进一步的改革规划并在他们之间达成共识将是改革成功的关键。
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引用次数: 0
Estonia: health system review. 爱沙尼亚:卫生系统审查。
Q1 Medicine Pub Date : 2013-01-01
Taavi Lai, Triin Habicht, Kristiina Kahur, Marge Reinap, Raul Kiivet, Ewout van Ginneken

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.

对爱沙尼亚卫生系统的分析回顾了组织和治理、卫生筹资、卫生保健提供、卫生改革和卫生系统绩效方面的最新发展。毫无疑问,主要问题是2008年的金融危机。尽管爱沙尼亚相当成功地应对了经济衰退,对该体系的总体满意度仍然很高,但很难预测紧缩方案的长期影响。后者包括削减福利和价格,增加某些服务的费用分摊,延长等候时间,减少专门护理。在保健成果方面,在预期寿命和婴儿死亡率方面取得了重要进展,预期寿命已接近欧洲联盟(欧盟)的平均水平。有必要改善吸烟和饮酒,它们与大多数可避免的疾病有关。虽然人口的健康行为正在改善,但群体之间存在巨大差距,肥胖率,特别是年轻人的肥胖率正在上升。在保健方面,自付费用的负担仍由弱势群体承担。此外,医院数量、医院床位和平均住院时间已降至欧盟平均水平,但床位入住率仍低于欧盟平均水平,效率有待提高。展望未来,许多危机前的挑战依然存在。这些措施包括确保卫生保健筹资的可持续性,保证足够的人力资源水平,优先考虑以患者为中心的卫生保健,整合卫生和社会保健服务,实施部门间行动以促进健康行为,保障社会经济地位较低群体获得卫生保健,最后,改进整个卫生系统的评估和监测工具。
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引用次数: 0
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Health systems in transition
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