Di Yang, Zlatko Nikoloski, Ghazna Khalid, Elias Mossialos
{"title":"巴基斯坦实现全民医保的道路:国家和地区见解。","authors":"Di Yang, Zlatko Nikoloski, Ghazna Khalid, Elias Mossialos","doi":"10.1186/s12939-024-02232-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level.</p><p><strong>Methods: </strong>We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).</p><p><strong>Results: </strong>Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.</p><p><strong>Conclusion: </strong>Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5000,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325752/pdf/","citationCount":"0","resultStr":"{\"title\":\"Pakistan's path to universal health coverage: national and regional insights.\",\"authors\":\"Di Yang, Zlatko Nikoloski, Ghazna Khalid, Elias Mossialos\",\"doi\":\"10.1186/s12939-024-02232-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level.</p><p><strong>Methods: </strong>We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).</p><p><strong>Results: </strong>Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.</p><p><strong>Conclusion: </strong>Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.</p>\",\"PeriodicalId\":13745,\"journal\":{\"name\":\"International Journal for Equity in Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2024-08-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325752/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal for Equity in Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12939-024-02232-1\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal for Equity in Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12939-024-02232-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
背景:全民健康覆盖(UHC)是可持续发展目标中概述的一项共同卫生政策目标。随着省级政府采取主动行动,巴基斯坦在复杂的公共卫生环境中实施并推广了全民健康覆盖计划。在此背景下,我们对巴基斯坦在国家和国家以下层面实现全民健康覆盖的进展情况进行了评估:我们利用人口与健康调查和家庭综合经济调查的数据,构建了 2007 年、2013 年和 2018 年国家和国家以下层面的全民健康保险指数。此外,我们还使用集中指数(CI)和集中指数分解法来评估医疗服务不平等的主要驱动因素。我们采用逻辑回归和萨托利两步模型来研究灾难性医疗支出(CHE)的主要决定因素:我们的分析强调了巴基斯坦在实现全民医保方面取得的稳步进展,同时也揭示了各省在全民医保进展方面的显著差异。贫困率较低的省份实现了较高的全民医保指数,这凸显了扶贫与全民医保扩展的协同作用。在所考察的指标中,儿童免疫接种仍然是一个关键的薄弱环节,有三分之一的儿童没有完全接种疫苗,而这些没有完全接种疫苗的儿童中有六分之一从未接种过任何疫苗。社会经济地位是造成获得医疗服务方面差异的主要因素,尽管随着时间的推移呈下降趋势。家庭社会经济地位与 CHE 发生率呈负相关,这表明较富裕的家庭较不易受到 CHE 的影响。对于发生 "健康受损 "的个人而言,医药支出在其医疗支出中所占比例最高,2018 年达到了惊人的 70%:巴基斯坦在实现全民医保方面取得的进展与其经济发展轨迹和扩大全民医保计划的政策努力密切相关。然而,经济欠发达和省际差距仍然是巴基斯坦实现全民医保的重大障碍。我们建议继续努力扩大全民医保计划,重点关注政策的一致性和财政支持,并结合有针对性的干预措施,以减轻欠发达省份的贫困状况。
Pakistan's path to universal health coverage: national and regional insights.
Background: Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level.
Methods: We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).
Results: Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.
Conclusion: Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.
期刊介绍:
International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.