Cải cách tài chính y tế ở Đông Nam Á: NHỮNG THÁCH THỨC ĐỂ ĐẠT ĐƯỢC BAO PHỦ TOÀN DÂN
Tóm tắt
Trong bài viết này, chúng tôi xem xét cải cách tài chính y tế tại 7 nước thuộc khu vực Đông Nam Á, những nước đang cố gắng hạn chế sự phụ thuộc vào khoản chi trả trực tiếp (bằng tiền túi) của người bệnh, tăng tài chính y tế bằng quỹ chung, và mở rộng sử dụng dịch vụ y tế để dần tiến tới bảo hiểm y tế toàn dân. Lào và Campuchia là hai nước nghèo, chủ yếu dựa vào quỹ công bằng y tế của các nhà tài trợ để tiếp cận người nghèo và trong việc mở rộng chương trình ra phạm vi quốc gia đang có hai thách thức lớn, đó là đảm bảo sử dụng quỹ đúng mục đích và xác định đối tượng nghèo đúng tiêu chuẩn. Đối với Thái Lan, Philippines, Indonesia và Việt Nam thì bảo hiểm y tế có nguồn thu từ lương và được sử dụng chủ yếu cho những người lao động trong khu vực chính thức[1] (trừ Malaysia), với các kết quả đầu ra khác nhau về mặt bảo vệ tài chính[2] ở mỗi nước. Các phương thức chi trả khác nhau có tác động khác nhau đến hành vi của người cung cấp dịch vụ và khả năng bảo vệ tài chính. Hai phương pháp nhằm bảo vệ tài chính cho người không nghèo nằm ngoài khu vực lao động chính thức là mô hình đảm bảo tài chính dựa vào thuế và cơ chế cùng tham gia, với các khả năng khác nhau để đạt được độ bao phủ toàn dân một cách nhanh chóng. 'Không gian tài khóa'3 và huy động đóng góp từ lương đều rất quan trọng trong việc nâng cao tính bảo vệ tài chính. Mở rộng độ bao phủ các dịch vụ có chất lượng và đảm bảo nguồn nhân lực phù hợp cũng là điều quan trọng để đạt được bao phủ toàn dân. Vì cải cách tài chính y tế rất phức tạp, năng lực của tổ chức trong việc hình thành bằng chứng và thông tin cho chính sách là rất cần thiết và cần được đẩy mạnh.
Đây là bài viết thứ 6 trong tuyển tập 6 bài viết về y tế tại Đông Nam Á.
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