世界银行-追踪全民健康覆盖率：2023年全球监测报告（英）-2023.9-156页_9mb

Summary of the 2023 Global Monitoring Report on Universal Health Coverage

Core Content

The 2023 Global Monitoring Report on Universal Health Coverage (UHC) evaluates the progress made towards achieving UHC as outlined in the Sustainable Development Goals (SDGs), specifically SDG 3.8.1 (service coverage index) and SDG 3.8.2 (financial hardship due to out-of-pocket (OOP) health spending). The report highlights the stagnation of service coverage improvements since 2015 and the worsening of financial hardship, particularly in low- and middle-income countries (LMICs). It emphasizes the need for urgent policy actions and investment to ensure equitable access to health services and financial protection.

Main Points

1. Universal Health Coverage and SDG 3.8

• UHC aims to ensure that all people have access to essential health services without facing financial hardship.
• The report underscores that the 2030 Agenda for Sustainable Development's promise of "leaving no one behind" remains unfulfilled due to the lack of progress in achieving UHC.
• SDG 3.8.1 (Service Coverage Index) and SDG 3.8.2 (Financial Hardship) are the primary indicators used to monitor UHC.

2. Global Trends in Service Coverage (SDG 3.8.1)

• From 2000 to 2021, the global UHC Service Coverage Index (SCI) increased from 45 to 68 out of 100, showing progress.
• However, improvements have stagnated since 2015, with most countries experiencing no significant change or worsening in service coverage.
• Only 42 out of 138 countries managed to improve service coverage while reducing catastrophic OOP health spending.
• Low-income countries (LICs) and lower-middle-income countries (LMICs) showed the most significant gains in service coverage since 2000, but also experienced the largest increases in financial hardship.

3. Financial Hardship (SDG 3.8.2)

• Catastrophic OOP health spending (exceeding 10% of household budget) has increased in most countries since 2000.
• In 2019, 2 billion people faced financial hardship due to health spending, including 344 million in extreme poverty.
• Financial barriers to accessing health services have become a major driver of forgone care, especially during the COVID-19 pandemic.

4. Inequalities in Service Coverage and Financial Protection

• Inequalities in access to essential health services persist, particularly among poorer populations and older adults.
• Gini coefficients and distributional analysis reveal significant disparities in service coverage across income quintiles.
• RMNCH composite coverage index (reproductive, maternal, newborn, and child health) shows that economic inequality remains a key factor in limiting access to essential services.

5. Impact of the COVID-19 Pandemic

• The pandemic disrupted health services and increased financial hardship, especially in low-resource settings.
• Data collection was affected, leading to gaps in monitoring and reduced accuracy of financial hardship indicators.
• Forgone care increased significantly, with financial reasons being the primary barrier.

6. Data Availability and Methodological Considerations

• Data availability remains uneven, with limited reporting in many countries.
• Imputation and extrapolation are frequently used, which may affect the interpretation of results.
• The SCI calculation includes selected essential services and uses population-weighted scores.
• Financial hardship indicators are based on OOP spending thresholds and poverty lines.

7. Recommendations and Implications

• Substantial public investment and policy reorientation towards primary health care are needed to improve equity in service delivery and financial protection.
• Modern health information systems are essential for timely and reliable data to inform UHC strategies.
• Context-specific policies are required to address the root causes of stagnation and inequality in UHC progress.

Key Information

• Global UHC SCI score (SDG 3.8.1): Ranged from 45 to 68 out of 100 (2000–2021), with stagnation in recent years.
• Catastrophic OOP health spending: Increased in most countries, with 1.3–2 billion people affected in 2019.
• Low-income and LMICs showed the most progress in service coverage but also the most significant rise in financial hardship.
• Regional variations in progress are notable, with all regions experiencing stagnation in service coverage and worsening financial hardship.
• Data gaps and methodological challenges persist, especially in low-income and conflict-affected areas.
• Policy implications include the need for sustainable funding, health system reforms, and addressing multiple crises (economic, climate, demographic, political) that threaten UHC progress.

Conclusion

Despite some progress in expanding access to essential health services since 2000, the 2023 report highlights that the world is off track to achieve UHC by 2030. Financial hardship has worsened, and service coverage improvements have stalled, especially since the SDG era began in 2015. The report calls for urgent action, including increased public investment, equitable policy design, and robust health information systems, to ensure that UHC is achieved for all, without leaving anyone behind.