【世界银行】非传染性疾病和心理健康融资：资金从哪里来？-2025.2_9页_1mb

总结：NCDs和心理健康融资政策简报

核心内容

本政策简报聚焦于非传染性疾病（NCDs）和心理健康服务的融资问题，强调在财政预算紧缩的背景下，如何提高融资效率与公平性，以实现全民健康覆盖（UHC）目标。简报基于2024年国际可持续NCD和心理健康融资对话的成果，并结合多国经验与技术背景资料，提出一系列政策建议。

主要观点

1. 政府支出不足：政府对NCDs和心理健康服务的公共支出仍不足以满足人口需求，导致家庭不得不承担高额自费（OOP）费用。
2. 自费负担不均：自费支出在低收入国家尤为显著，加剧了财务困难，影响了患者对预防和早期治疗的获取。
3. 资源分配不合理：当前资金分配偏向昂贵的三级医疗服务，忽视了成本效益更高的初级卫生保健（PHC）服务。
4. PHC是关键：提高PHC服务的质量和覆盖是解决NCDs和心理健康问题的重要手段，需将其作为政策制定的指南。
5. 融资机制需改革：改变资源分配机制，从输入导向转向结果导向，是提升资金使用效率的关键。
6. 财政和非财政干预结合：通过税收、价格调控、补贴等财政手段，以及政策制定、监管等非财政措施，可以有效降低负担，提高服务可及性。
7. 数字系统与管理能力提升：加强数字财务与健康信息管理系统，有助于提升PHC和慢性病服务的质量与效率。

关键信息

1. 当前融资挑战

• 政府支出不足：NCDs和心理健康服务的公共支出比例低，尤其在低收入国家，平均仅占21%。
• 家庭自费负担重：多数支出为自费，尤其是药品费用，导致财务困难。
• 资源错配：资金更多用于三级医疗服务，而非预防和早期干预。

2. 改善融资的策略

• 加强PHC：PHC是实现UHC的关键，需将NCDs和心理健康服务纳入PHC体系。
• 调整激励机制：改革支付方式，从传统的项目预算和按服务付费转向更支持整合照护的模式。
• 财政干预：
  • 税收措施：对烟草、酒精和含糖饮料征税，有助于减少风险因素。
  • 价格调控：通过取消药品进口关税和降低价格，提高药品可负担性。
  • 补贴政策：为关键药品和高成本服务（如癌症治疗）设立专项基金。
• 非财政干预：
  • 健康促进活动：如大众媒体健康宣传。
  • 社区筛查项目：提高早期发现和干预的效率。
  • 政策制定与倡导：利用自由资金支持政策分析和倡导工作。

3. 政策建议

• 降低药品价格：通过监管和谈判，减少药品成本。
• 限制用户费用和共付比例：设置固定上限，减轻低收入人群负担。
• 建立专项基金：针对高成本治疗（如癌症）设立专项保障机制。
• 加强私营部门合作：确保药品在私营渠道的可负担性和可及性。
• 推动跨部门协作：在政策制定和资金分配中，整合不同部门的资源以实现共同目标。

4. 结论

NCDs和心理健康融资是实现UHC的重要组成部分，需要政府、卫生部门和私营部门的共同努力。2025年联合国高级别会议提供了重新承诺和改进融资的机会，政策制定者应采取综合措施，以提高资金使用效率和公平性。

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