创建有效、公平和可持续的筹资体系是现代卫生体系面临的一个重要的挑战。在发展中国家,卫生的筹资趋向于分散化,家庭和卫生系统只能靠自费,这既容易造成贫困又缺乏效率和公平。本研究以墨西哥为例,分析了该国1992—2004年间灾难性和致贫性卫生支出的演变和决定因素,该时期历经了经济危机和卫生改革的初始阶段。结果表明,卫生筹资的公平性可以防止家庭因暂时冲击而造成永久性贫困。 Creating an effective, equitable and sustainable funding system is an important challenge for the modern health system. In developing countries, health financing tends to be decentralized and family and health systems can only be used at their own expense, making it both vulnerable and inefficient and inequitable. Taking Mexico as an example, this study analyzes the evolution and determinants of disastrous and poor health expenditures in the country between 1992 and 2004, which have gone through the initial stages of the economic crisis and health reform. The results show that equity in health financing can prevent families from being permanently impoverished by temporary shocks.