老挝卫生系统现况及其对中老卫生合作的启示
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摘要
目的:分析老挝卫生体系的基本情况,为"一带一路"中老卫生合作提供参考。方法:以WHO卫生系统模块框架为基础,使用统计数据对老挝国民健康状况和卫生系统现状、国际组织在老挝开展的卫生相关工作、中老现有卫生合作进行分析。结果:老挝卫生行政结构较为完善。2012年其卫生总费用占GDP的比重为1.9%,外部卫生投入占卫生总费用的比重为32.9%。2016年,社会医疗保险覆盖率为39%。老挝的年住院人次数和平均住院日均呈下降趋势,社区卫生服务中心和私人诊所的数量大幅增加,每千人口资源配置量呈上升趋势。国际组织开展具有特色的工作支持老挝卫生体系的发展,中老现有卫生合作主要关注传染病防控与技术援助领域。结论:老挝卫生体系存在卫生投入和政府卫生参与不足,医疗保险覆盖率低,卫生人力资源稀缺,对外部援助的依赖程度较高等问题。中老之间的卫生合作,应以帮助老挝建立较为独立的卫生体系为重要目标。
Objective: To analyze the basic situation of the health system in Laos, so as to provide reference for the "the Belt and Road" health cooperation between China and Laos. Methods: Based on the WHO building blocks framework, the statistical data was used to analyze the health status of Laotian, the Laos health system,the assistance from international organizations, and current health cooperation between China and Laos. Results: Laos health administrative structure is relatively complete.In 2012,its total health expenditure accounted for 1.9% of GDP, and its external health expenditure accounted for 32.9% of total health expenditure. In 2016,its social health insurance coverage was 39%. The number of annual hospitalizations and average hospitalization days showed a downward trend. The number of health service centers and private clinics increased significantly. The health resource per thousand population was on the rise.International organizations carry out distinctive work to support its health system development. The health cooperation between China and Laos mainly focuses on infectious disease prevention and technical assistance currently. Conclusion: The Laos health system has problems such as insufficient health investment and government participation,low coverage of medical insurance,scarcity of health workforce, and high dependence on external assistance. It's important to help Laos establish a more independent health system through the cooperation.
Objective: To analyze the basic situation of the health system in Laos, so as to provide reference for the "the Belt and Road" health cooperation between China and Laos. Methods: Based on the WHO building blocks framework, the statistical data was used to analyze the health status of Laotian, the Laos health system,the assistance from international organizations, and current health cooperation between China and Laos. Results: Laos health administrative structure is relatively complete.In 2012,its total health expenditure accounted for 1.9% of GDP, and its external health expenditure accounted for 32.9% of total health expenditure. In 2016,its social health insurance coverage was 39%. The number of annual hospitalizations and average hospitalization days showed a downward trend. The number of health service centers and private clinics increased significantly. The health resource per thousand population was on the rise.International organizations carry out distinctive work to support its health system development. The health cooperation between China and Laos mainly focuses on infectious disease prevention and technical assistance currently. Conclusion: The Laos health system has problems such as insufficient health investment and government participation,low coverage of medical insurance,scarcity of health workforce, and high dependence on external assistance. It's important to help Laos establish a more independent health system through the cooperation.
引文
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[2]MOUNIER-JACK S,GRIFFITHS U K,et al.Measuring the health systems impact of disease control programmes:a critical reflection on the WHO building blocks framework[J].BMC Public Health,2014(14):278.
[3]Ministry of Health,Laos.Health Development Plan for Reaching LDC,UHC and SDGs in Lao PDR[R].2017.
[4]The Lao PDR,WHO.Health Sector Reform Strategy and Framework till 2025[R].2016.
[5]WHO.World health statistics 2015[R].2015.
[6]WHO.Overview of Lao Health System Development 2009-2017[R].2018.
[7]刘稚.大湄公河次区域合作发展报告(2015)[M].北京:社会科学文献出版社,2015.
[8]Global Forum on Human Resources for Health.Human resources for health:foundation for universal health coverage and the post-2015 development agenda[R].2013.
[9]徐鹏,董蓬玉.我国西南边境地区传染病防控体系存在的问题及原因分析[J].医学与社会,2017,30(1):8-11.
[10]张春.东盟落实联合国2030年可持续发展议程减贫目标分析[J].东南亚纵横,2018(4):56-66.
[11]王力男,李芬,张晓溪.我国卫生筹资制度建设进展及问题[J].中国卫生经济,2017,36(9):46-50.
[12]ALKENBRACK S,HANSON K,et al.Evasion of “mandatory” social health insurance for the formal sector:evidence from Lao PDR[J].BMC Health Serv Res,2015(15):473.
[13]GBD 2016 SDG COLLABORATORS.Measuring progress and projecting attainment on the basis of past trends of the health-related sustainable development goals in 188 countries:an analysis from the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1423-1459.
[14]QIAN Y,YAN F,et al.Challenges for strengthening the health workforce in the Lao People’s Democratic Republic:perspectives from key stakeholders[J].Human resources for health,2016,14(1):72.
[15]王林,贺加.全球医学教育资源失衡下的医学人才流失[J].复旦教育论坛,2014,12(4):108-112.
[16]SA-ANGCHAI P,PHIENPHOMMALINH S,et al.Geographical distribution of health workforces in lao pdr[J].Southeast Asian journal of tropical medicine and public health,2016,47(4):868.
[17]苏婕,李红梅.中国消除疟疾的督导与评估:政治、经济、社会和技术分析[J].中国寄生虫学与寄生虫病杂志,2018,36(3):286-290.