Những thành công và thách thức của governance hệ thống y tế hướng tới bảo hiểm y tế toàn dân và an ninh y tế toàn cầu: một đánh giá kể chuyện và tổng hợp tài liệu
Tóm tắt
Sự chuyển dịch gánh nặng bệnh tật toàn cầu từ các bệnh truyền nhiễm sang không truyền nhiễm đã góp phần huy động hỗ trợ cho một chương trình sức khỏe rộng lớn hơn sau Mục tiêu Phát triển Thiên niên kỷ (MDGs). Để hạn chế các vấn đề sức khỏe toàn cầu này và những vấn đề khác, 193 Quốc gia Thành viên của Liên Hợp Quốc (UN) đã trở thành những người ký kết các Mục tiêu Phát triển Bền vững (SDGs) và cam kết đạt được bảo hiểm y tế toàn dân (UHC) vào năm 2030. Trong bối cảnh đại dịch bệnh coronavirus 2019 (COVID-19), vai trò của governance hệ thống y tế (HSG) được cảm nhận mạnh mẽ hơn bao giờ hết trong việc ứng phó với đại dịch và tiếp tục cung cấp các dịch vụ y tế thiết yếu. Tuy nhiên, còn rất ít thông tin về những thành công và thách thức của HSG liên quan đến UHC và an ninh y tế. Do đó, nghiên cứu này nhằm tổng hợp chứng cứ và xác định những thành công cũng như thách thức của HSG đối với UHC và an ninh y tế.
Chúng tôi đã thực hiện một đánh giá kể chuyện có cấu trúc về các nghiên cứu được công bố cho đến ngày 28 tháng 7 năm 2021. Chúng tôi đã tìm kiếm tài liệu hiện có trên ba cơ sở dữ liệu: PubMed, Scopus và Web of Science. Các thuật ngữ tìm kiếm bao gồm ba chủ đề: HSG, UHC và an ninh y tế. Chúng tôi đã tổng hợp các phát hiện theo năm chức năng cốt lõi của HSG: xây dựng chính sách và kế hoạch chiến lược; thu thập thông tin; quy định; hợp tác và liên minh; và trách nhiệm giải trình.
Tổng số 58 bài báo đã được đưa vào đánh giá cuối cùng. Chúng tôi xác định rằng các chính sách y tế và cơ chế tài chính y tế phù hợp với bối cảnh đã giúp tăng tốc tiến trình hướng tới UHC và an ninh y tế. Thông tin y tế vững mạnh, hợp tác liên ngành và liên minh cũng rất quan trọng để chống lại đại dịch và đảm bảo cung cấp các dịch vụ y tế thiết yếu. Ngược lại, việc thực hiện một phương pháp HSG theo kiểu 'một kích cỡ phù hợp cho tất cả', thiếu nguồn tài trợ cho y tế, tham nhũng, lực lượng lao động y tế không đủ, và chính sách quản lý và quy định y tế yếu kém là những thách thức lớn trong việc đạt được UHC và an ninh y tế.
Các quốc gia, cả cá nhân lẫn tập thể, cần có HSG mạnh mẽ để thúc đẩy tiến trình hướng tới UHC và an ninh y tế. Việc phân quyền dịch vụ y tế đến các cấp cơ sở, hỗ trợ từ các bên liên quan, sự đóng góp và phân phối tài nguyên công bằng là rất cần thiết để hỗ trợ việc thực hiện các chương trình hướng tới UHC và an ninh y tế. Cũng rất quan trọng để đảm bảo sự công nhận quy định độc lập của các tổ chức trong hệ thống y tế và tích hợp các chỉ số dịch vụ y tế có liên quan đến chất lượng và công bằng vào hệ thống giám sát và đánh giá bảo vệ xã hội quốc gia; những điều này sẽ thúc đẩy tiến trình hướng tới UHC và an ninh y tế.
Từ khóa
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