タイ及びメキシコにおけるユニバーサル・ヘルス・カバレッジに向けた医療保障制度に関する比較考察 (SDGs：目標3)

抄録

Universal health coverage (UHC), a target of SDG 3, aims to offer health services for all people at an affordable cost, filling the gap in health disparity, and thus realizing health equity.

Both Thailand and Mexico, which are categorized as upper-middle-income countries according to the World Bank's definition, established public health security systems for their informal sectors in the early 2000s, aiming to achieve UHC. However, the policies of the two countries differ and have generated different outcomes.

Through making comparisons between their UHC systems, I attempted to identify the differences in their policy options and the factors that have hindered the progress of UHC.

I conducted the research mainly through literature reviews to investigate their public health security systems and used WHO HEAT software for measuring health service coverage, WHO Global Health Observatory data repository, and the World Bank's Open Data, to analyze the trends of health expenditures.

The results are as follows: (1) The policy of voluntary affiliation to public health insurance has resulted in delays in achieving UHC in Mexico; (2) while the division of purchasers and providers may have enabled Thailand to oversee health services and costs, it did not take place in Mexico; (3) Thailand has successfully implemented UHC on the bedrock of primary health care; in Mexico, the weakness of PHC has caused underuse of public health insurance, increasing out-of-pocket health expenditures; (4) both a government commitment to raising the health budget and more efficient use of health services at public and private health facilities may be required to reduce the consistently high rate of out-of-pocket expenditures in Mexico.