The Caribbean Netherlands: Health System Review.

Q1 Medicine
Health systems in transition Pub Date : 2024-10-01
Nathan Shuftan, Jane O'Flynn, Judith Meijer, Robert Borst, Soraya Verstraeten, Dorette Courtar, Giovanni Frans, Amy van der Linden, Indira Madhuban, Michael Mercuur, Ewout van Ginneken
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引用次数: 0

Abstract

This analysis of the health system of the Caribbean Netherlands reviews developments in governance, organization, financing and delivery of care, health reforms and health system performance on the islands of Bonaire, St Eustatius and Saba (the BES islands). Since the dissolution of the Netherlands Antilles in 2010, residents of the BES islands live in special municipalities of the Netherlands, each with its own government (public entity). The Ministry of Health, Welfare, and Sport (VWS) in The Hague, through the Department of Care and Youth Caribbean Netherlands (ZJCN), oversees the health system and the mandatory, centrally financed health insurance scheme. The publicly funded system had per capita spending on health (US$ 6 471) below that of the European Netherlands (US$ 6 729) in 2022; without logistical costs of referrals (accommodation and ground transportation, flight tickets, per diem allowances), per capita health spending on the BES islands was US$ 5 895, though these levels have not been adjusted for purchasing power parity. Cost-sharing within the public system is low, but voluntary insurance for uncovered services is unavailable, and data on out-of-pocket payments are unknown. Limited on-island care capacity necessitates many off-island referrals to cross-border contracted providers, which are fully covered by insurance. Challenges include recruiting and retaining qualified staff, although an agreement with Amsterdam University Medical Center helps to provide specialist care in the hospital on Bonaire. Besides primary and secondary care, there are long-term, dental and mental care facilities. Each island has at least one pharmacy, and protocols are in place for off-island care needs. The next development stage aims for an "equivalent" level of services as in the European Netherlands, improving from the "acceptable" standard set post-2010. Poverty is higher on the BES islands than in the European Netherlands. Health risks include limited access to fresh foods, physical inactivity and behaviours like alcohol and tobacco use, highlighting the need for better disease prevention and health promotion. Although life expectancy at birth was higher on the BES islands in 2019 than in the European Netherlands, data on health outcomes and system performance indicators are lacking. Enhancing evidence-based interventions and comparisons with the European Netherlands, other Dutch Caribbean islands and the wider Caribbean region can support future planning and health system assessments.

本报告对荷兰加勒比海地区的卫生系统进行了分析,回顾了博内尔岛、圣尤斯特歇斯岛和萨巴岛(BES 群岛)在治理、组织、筹资和医疗服务提供、卫生改革以及卫生系统绩效方面的发展情况。自 2010 年荷属安的列斯群岛解体以来,博内尔岛、圣尤斯特歇斯岛和萨巴岛的居民生活在荷兰的特别市镇中,每个市镇都有自己的政府(公共实体)。海牙的卫生、福利和体育部(VWS)通过荷兰加勒比护理和青年部(ZJCN)负责监督医疗系统和中央资助的强制性医疗保险计划。2022 年,公共资助系统的人均医疗支出(6 471 美元)低于欧洲的荷兰(6 729 美元);如果不考虑转诊的后勤成本(住宿和地面交通、机票、每日津贴),则 BES 岛屿的人均医疗支出为 5 895 美元,但这些水平尚未根据购买力平价进行调整。公共系统内的费用分担率较低,但没有为未覆盖的服务提供自愿保险,有关自付费用的数据不详。由于岛内医疗能力有限,许多岛外转诊需要转至跨境签约医疗机构,而这些医疗机构的费用完全由保险支付。尽管与阿姆斯特丹大学医疗中心签订的协议有助于在博内尔岛的医院提供专科医疗服务,但招聘和留住合格的工作人员仍是一项挑战。除了初级和二级医疗外,还有长期、牙科和精神医疗设施。每个岛屿至少有一家药房,并为岛外的医疗需求制定了协议。下一个发展阶段的目标是达到与欧洲荷兰 "同等 "的服务水平,在 2010 年后设定的 "可接受 "标准基础上有所提高。BES 岛屿的贫困率高于欧洲荷兰。健康风险包括获得新鲜食品的机会有限、缺乏体育锻炼以及酗酒和吸烟等行为,这凸显了更好地预防疾病和促进健康的必要性。尽管 2019 年 BES 岛屿的出生时预期寿命高于欧洲荷兰,但缺乏有关健康成果和系统绩效指标的数据。加强循证干预以及与欧洲荷兰、其他荷属加勒比群岛和大加勒比地区的比较,可为未来规划和卫生系统评估提供支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health systems in transition
Health systems in transition Medicine-Medicine (all)
CiteScore
16.00
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