"Top-Three" health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview.

Digital health Governance Health reform Organisation of care Reform implementation Top reform areas

Journal

Health policy (Amsterdam, Netherlands)
ISSN: 1872-6054
Titre abrégé: Health Policy
Pays: Ireland
ID NLM: 8409431

Informations de publication

Date de publication:
07 2021
Historique:
received: 23 11 2020
revised: 02 04 2021
accepted: 11 04 2021
pubmed: 1 6 2021
medline: 29 6 2021
entrez: 31 5 2021
Statut: ppublish

Résumé

High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from considering reform experiences abroad, exchange is limited. This paper provides an overview of health reform trends in 31 high-income countries in 2018 and 2019, i.e., before Covid-19. Information was collected from national experts from the Health Systems and Policy Monitor network. Experts were asked to report on the three "top" national health reforms 2018 and 2019. In 2019, they provided an update of 2018 reforms. Reforms were assigned to one of 11 clusters and identified as one of seven different reform types. 81 reforms were reported in 28 countries in 2018. 44/81 went to four clusters: 'insurance coverage & resource generation', 'governance', 'healthcare purchasing & payment', and 'organisation of hospital care'. In 2019, 86 reforms in 30 countries were reported. 48/86 fell under 'organisation of primary & ambulatory care', 'governance', 'care coordination & specialised care', and 'organisation of hospital care'. Most 2018 reforms were reported ongoing in 2019; 27 implemented; seven abandoned. Health agency-led reforms were implemented most frequently, followed by central government-legislated reforms. Policymakers can leverage international experience of distinct reform approaches addressing similar challenges and similar approaches to address distinct problems. Such knowledge may help inspire or support future successful health reform processes.

Sections du résumé

BACKGROUND
High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from considering reform experiences abroad, exchange is limited. This paper provides an overview of health reform trends in 31 high-income countries in 2018 and 2019, i.e., before Covid-19.
METHODS
Information was collected from national experts from the Health Systems and Policy Monitor network. Experts were asked to report on the three "top" national health reforms 2018 and 2019. In 2019, they provided an update of 2018 reforms. Reforms were assigned to one of 11 clusters and identified as one of seven different reform types.
RESULTS
81 reforms were reported in 28 countries in 2018. 44/81 went to four clusters: 'insurance coverage & resource generation', 'governance', 'healthcare purchasing & payment', and 'organisation of hospital care'. In 2019, 86 reforms in 30 countries were reported. 48/86 fell under 'organisation of primary & ambulatory care', 'governance', 'care coordination & specialised care', and 'organisation of hospital care'. Most 2018 reforms were reported ongoing in 2019; 27 implemented; seven abandoned. Health agency-led reforms were implemented most frequently, followed by central government-legislated reforms.
CONCLUSIONS
Policymakers can leverage international experience of distinct reform approaches addressing similar challenges and similar approaches to address distinct problems. Such knowledge may help inspire or support future successful health reform processes.

Identifiants

pubmed: 34053787
pii: S0168-8510(21)00103-2
doi: 10.1016/j.healthpol.2021.04.005
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Pagination

815-832

Informations de copyright

Copyright © 2021. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors report no conflict of interest.

Auteurs

Katherine Polin (K)

Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium. Electronic address: katherine.polin@tu-berlin.de.

Maximilien Hjortland (M)

Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.

Anna Maresso (A)

European Observatory on Health Systems and Policies, Brussels, Belgium.

Ewout van Ginneken (E)

Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium.

Reinhard Busse (R)

Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium.

Wilm Quentin (W)

Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium.

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Classifications MeSH