世界银行-跟踪全民健康覆盖：2021全球监测报告（英）-2021-103页_12mb

Summary of the 2021 Global Monitoring Report on Universal Health Coverage

Core Content

The 2021 Global Monitoring Report on Universal Health Coverage (UHC), published by the World Health Organization (WHO) and the World Bank, evaluates progress towards achieving UHC as outlined in the Sustainable Development Goals (SDG) 3.8.1 and 3.8.2. It highlights the global and regional trends in service coverage and financial hardship, emphasizing the need for more ambitious policies to ensure equitable access to health services and reduce the burden of out-of-pocket (OOP) health spending.

Main Viewpoints

1. Progress in Service Coverage

• Global UHC Service Coverage Index (SCI): The SCI increased from 45 in 2000 to 68 in 2019, showing substantial progress in essential health service coverage.
• Sub-index improvements: The infectious disease sub-index improved the fastest, with a pronounced acceleration around 2005. The reproductive, maternal, newborn and child health (RMNCH) sub-index also showed significant gains.
• Regional disparities: The WHO Western Pacific Region had the highest SCI (80), followed by the European Region (79) and the Region of the Americas (77). The African Region had the lowest SCI (46).
• Income correlation: There is a strong positive relationship between SCI and gross national income per capita, indicating that service coverage is driven by economic growth.

2. Trends in Financial Hardship

• Catastrophic health spending: The number of people spending more than 10% of their household budget on OOP health care increased from 579 million in 2000 to 996 million in 2017.
• Impoverishing health spending: The population pushed into extreme poverty due to OOP health spending decreased from 664 million in 2015 to 505 million in 2017, but it remained unacceptably high.
• Relative poverty: Impoverishing health spending also affected a large portion of the population at the relative poverty line, with no significant reduction in high-income countries.

3. Inequalities in Health Access and Financial Protection

• Disparities within countries: Inequalities in service coverage and unmet health care needs persist across income groups and regions.
• Unmet needs: In the Americas, unmet health care needs were more pronounced among lower-income groups. In Europe, older adults in lower-income groups faced greater unmet health care needs.
• Barriers to UHC: Key barriers include poor infrastructure, weak coverage policies, shortages of qualified health workers, high cost of medicines, and limited access to digital health technologies.

4. Impact of the COVID-19 Pandemic

• Disruptions in essential health services: The pandemic caused significant disruptions in health service delivery, particularly in low- and middle-income countries.
• Financial hardship: The economic recession caused by the pandemic is expected to increase financial barriers to health care, especially for disadvantaged populations.
• Accelerating progress: The report emphasizes the need for stronger primary health care (PHC) systems to support UHC and health security, particularly in the context of the pandemic.

5. Future Challenges and Recommendations

• Need for increased ambition: To meet the SDG 3.8 targets, the report calls for a significant increase in political and financial commitment.
• Policy focus: Policies must prioritize reducing financial hardship for the poor and near-poor, even in well-resourced health systems.
• Data and planning: Strengthening data collection and using performance metrics to guide health system development is essential for addressing gaps in coverage and financial protection.

Key Information

• SDG 3.8.1: Tracks coverage of essential health services using the UHC SCI, which measures the availability and accessibility of services.
• SDG 3.8.2: Measures catastrophic health spending, defined as OOP health expenditure exceeding 10% of a household's budget.
• Pre-pandemic shortfall: By 2023, without accelerated progress, the world would still be 730 million people short of the UHC target.
• Projected shortfall: The pandemic may increase this gap to between 800 and 840 million people.
• Country-level progress: Some countries have managed to expand service coverage without increasing financial hardship, indicating that it is possible with the right policies.

Figures and Data Highlights

• Figure ES.1: Shows the global progress in UHC SCI and catastrophic health spending from 2000 to 2017.
• Figure ES.2: Illustrates the level and change in UHC SCI across countries and regions from 2000 to 2019.
• Table ES.1: Provides data on financial hardship indicators, including the number of people facing catastrophic and impoverishing health spending from 2000 to 2017.

Conclusion

The report underscores that while progress has been made in expanding essential health services, the pace is insufficient to meet SDG targets. Financial hardship remains a significant challenge, especially for low-income populations, and inequalities in health access persist. The pandemic has further disrupted health service delivery and increased financial burdens. To achieve UHC, stronger political will, financial investment, and equitable policies are essential.