2025-03-09-世界银行-非传染性疾病和心理健康融资_资金从哪里来_（英）_8页_1mb

总结：NCDs和心理健康融资的改进策略

核心内容

本政策简报探讨了非传染性疾病（NCDs）和心理健康服务的融资问题，并提出了改善融资效率和实现全民健康覆盖（UHC）的策略。简报指出，随着经济成长、人口老龄化和疾病模式的变化，NCDs和心理健康问题在全球范围内日益突出，但许多国家仍面临政府支出不足、家庭自费支出过高以及资金使用效率低下的挑战。

主要观点

• 政府支出不足：政府对NCDs和心理健康服务的支出仍不足以满足人口需求，导致家庭自费支出（OOP）增加。
• 自费支出的不公平性：家庭自费支出在NCDs和心理健康服务中占比较高，这不仅加重了经济负担，也影响了患者获得最佳健康结果。
• 资金使用效率低下：当前支出多用于治疗而非预防，且缺乏对高价值干预措施的优先考虑。
• 公共卫生服务的不足：初级卫生保健（PHC）在NCDs和心理健康服务中的资金投入不足，限制了预防和早期干预的实施。
• 财政激励的重要性：改善融资的关键在于改变资源分配的激励机制，以支持整合式慢性病管理。
• 政策与改革的结合：NCDs和心理健康融资改革需与其他政策行动相结合，如提高公共财务管理效率、利用数字系统提升服务质量和效率。

关键信息

1. 强化PHC服务是关键

• PHC的重要性：PHC是NCDs和心理健康服务的核心，但目前资金投入不足。
• NCDs与心理健康服务的整合：慢性病管理需要整合式的治疗和预防措施，包括PHC、急性治疗和康复。
• 需抵制对三级医疗的过度投资：应避免因三级医疗成本高而忽视PHC的投入，这会加剧系统不平等和患者负担。

2. 改善资金分配的激励机制

• 改变支付方式：需从传统的按项目预算（公共部门）和按服务收费（私人部门）转向更有利于整合慢性病管理的支付方式。
• 数据与支付系统的整合：在覆盖计划碎片化的国家，整合数据和支付系统有助于提升服务连续性。
• 数字系统的作用：数字健康和财务管理系统可提高PHC和慢性病护理的质量和效率。

3. 利用现有资金提高效果

• 灵活预算的使用：各国可利用灵活预算支持特定疾病和干预措施，如癌症药物基金、社区筛查项目等。
• 财政干预措施：如烟草、酒精和含糖饮料（SSB）税，可减少风险因素并降低未来医疗需求。
• 非财政干预措施：如限制酒精和烟草销售、降低关键药品价格等，可改善服务可及性和财务保护。

4. 提高服务可及性与财务保护

• 降低自费支出：通过消除或限制用户费用、固定小额共付等方式，可减少患者负担。
• 确保药品可及性：提高公共设施中关键药品的可获得性，降低患者自费购买的频率和成本。
• 支持高成本服务：设立专门基金以覆盖高成本服务（如癌症治疗），确保患者无需承担高额费用即可获得必要治疗。

结论

实现NCDs和心理健康服务的可持续融资需要多方面的政策行动，包括加强PHC、优化资金分配机制、利用现有资源提升服务效果以及改善服务可及性和财务保护。这些措施将有助于推动全民健康覆盖（UHC）的实现，并改善全球范围内NCDs和心理健康问题的应对能力。

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