克服全民健康覆盖道路上的障碍：巴勒斯坦卫生系统分析（英）2025

Investment Rating - The report does not explicitly provide an investment rating for the Palestinian health system, but it highlights significant challenges and inefficiencies that could impact investment decisions. Core Insights - The Palestinian health system faces structural barriers to equitable service provision due to political fragmentation and movement restrictions, particularly affecting access to health services in Gaza and the West Bank [24][30]. - Health outcomes in the region are mixed, with a high burden of non-communicable diseases (NCDs) and rising maternal and infant mortality rates, indicating a need for improved health policies and interventions [28][40]. - The health financing system is characterized by high out-of-pocket expenditures, significant arrears, and a reliance on external financing, which complicates sustainability and efficiency [31][32]. Summary by Sections Health Outcomes - The Palestinian population is predominantly young, with a high total fertility rate and a declining dependency ratio, indicating potential for a demographic dividend [38]. - Life expectancy has declined from 74 in 2022 to 65 in 2024 due to the ongoing conflict, with maternal and infant mortality rates showing an upward trend [28][40]. - NCDs account for 72% of the disease burden, with high rates of risk factors such as smoking and obesity contributing to this trend [29][44]. Physical and Human Resources, Health System Capacity and Quality - The health service delivery system is fragmented, with a reliance on public facilities and significant shortages of medical equipment and essential medicines, particularly in Gaza [30][52]. - There is a need for improved management of chronic diseases and a more comprehensive approach to service provision, including better training for healthcare providers [52][53]. Overview of Health Financing Flows - In 2022, health spending in West Bank and Gaza was US$1.9 billion, representing 10.5% of GDP, significantly higher than regional averages [31]. - Out-of-pocket spending has increased, highlighting gaps in financial risk protection, with 14% of general government expenditures allocated to health [31][34]. Revenue Raising and Health Expenditures - The government health budget is heavily weighted towards wages and outside medical referrals, limiting resources for investments in primary health care [31][32]. - Health sector arrears exceeded US$900 million in 2024, with financing constraints leading to high unit costs and medicine stockouts [32]. Pooling Arrangements - The Government Health Insurance (GHI) scheme covers approximately 64% of the population, but low contribution rates limit its effectiveness as a risk-pooling mechanism [33]. - Out-of-pocket expenditures have risen significantly, with catastrophic health expenditures affecting 10% of households in 2023 [34]. Purchasing Arrangements - The PMOH is the sole purchaser of health services, relying on passive purchasing modalities, which constrains the ability to improve service quality and efficiency [35][36]. - Outside medical referrals (OMR) are a significant fiscal burden, with high costs and inefficiencies in purchasing arrangements [35][36]. Policy Recommendations - The report suggests a four-step plan to address the challenges in the Palestinian health financing system, focusing on improving purchasing arrangements, expanding coverage, and enhancing governance [37].