中低收入国家的内外政治和对全民健康覆盖的支持

IF 1.3 Q3 DEVELOPMENT STUDIES Sociology of Development Pub Date : 2022-01-01 DOI:10.1525/sod.2021.0028
Ashley M. Fox, Megan M. Reynolds
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引用次数: 0

摘要

公众何时以及为何支持寻求通过全民卫生筹资提供社会风险保护的再分配政策?在低收入和中等收入国家建立全民健康覆盖(UHC)制度时面临的一个主要政治难题是,可用于促进卫生保健集中筹资的税基很小。正规部门的中产阶级工人(劳动力市场圈内人)可能已经通过国家或私营保险公司获得了医疗保险,这使得他们没有动力为全民健康覆盖做出贡献,而全民健康覆盖主要惠及非正规部门的贫困工人(劳动力市场圈外人)。运用局内人-局外人政治框架,我们利用非洲晴雨表在撒哈拉以南和北非36个国家调查的最新数据,探讨了人们对全民健康覆盖的态度。我们发现,尽管决策者越来越关注全民覆盖,但各国普通公民的支持度很低,尽管各不相同。此外,与预期相反,经济上有保障的劳动力市场内部人士比劳动力市场外部人士更愿意为医疗保险支付更多的税收。然而,是否支持为保健服务提供更多税收资金取决于对政府的信任和对政府效力的看法。对政府有效利用税收融资能力的信任,可能是支持全民健康覆盖的一个比理性的自身利益更重要的决定因素。
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Insider–Outsider Politics and Support for Universal Health Coverage in Low- and Middle-Income Countries
When and why does the public support redistributive policies that seek to provide social risk protection through universal health financing? One central political dilemma in establishing systems of universal health coverage (UHC) in low- and middle-income countries is the small tax base available to contribute to pooled financing of healthcare. Middle-class workers in the formal sector (labor market insiders) may already get health coverage through the state or private insurers, leaving them little incentive to contribute to UHC that will primarily benefit indigent workers in the informal sector (labor market outsiders). Applying the insider–outsider politics framework, we explore attitudes toward UHC using recent data from Afrobarometer surveys in 36 countries in Sub-Saharan and North Africa. We find that, in spite of growing attention to universal coverage among policymakers, support from the average citizen is low, though variable, across countries. Further, in contrast with expectation, economically secure labor market insiders are more willing than labor market outsiders to pay more in taxes to finance health coverage. However, support for more tax financing of health services was dependent on trust in government and perceptions of government efficacy. Trust in the government’s capacity to use tax financing effectively may be a more important determinant of support for UHC than rational self-interest.
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来源期刊
Sociology of Development
Sociology of Development Social Sciences-Development
CiteScore
1.90
自引率
8.30%
发文量
14
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