Reform Initiatives Research Articles

1.X.2. Reducing inequalities in access to care in Europe: achieving universal health coverage and more

Abstract Accessibility is multi-dimensional. Universal Health Coverage emphasises the role of population coverage, the scope of services covered, and the depth of financial protection. However, there are other major barriers for patients that can inhibit universal access to health services: geographical inequalities, organisational barriers, and care denial. Health systems can provide extensive cover in some dimensions such as financial coverage or the range of services covered, but gaps in other dimensions can still act as a major barrier to care. Some groups are excluded from population coverage, other patients must navigate waiting times, medical deserts or cultural barriers in order to access care. In this session we will use an innovative filter framework outline common obstacles that patients in the European Union must overcome before they can access the care they need. We will then highlight policy responses to meet the dual goals of reducing inequalities in access to care and ensuring Universal Health Coverage. This workshop will provide a platform for sharing knowledge on reducing inequalities in access to care in EU countries. The objectives of the workshop are to i) highlight cross-cutting themes and approaches, and ii) establish opportunities for cross-country research and learning. The workshop will consist of four short presentations, followed by a broad discussion with audience interventions to bring in the experience of other Member States. Each panel member will make a short presentation in Pecha Kucha format: firstly outlining the filter framework for understanding access to health services then moving to descriptions of a policy journey to strengthening UHC in Cyprus, Estonia and Spain respectively. Bold reforms in Cyprus have expanded coverage under a new universal system; changes in Estonia have improved access to medicines; and policy-makers in Spain have sought to expand coverage of dental care. The moderated discussion will emphasise the potential for cross-country learning - identifying those policy choices of relevance for the rest of Europe. Presentations about specific policy initiatives draw on the latest Health Systems Reviews for Cyprus, Estonia and Spain. Health System Reviews underpin the Health Systems in Transition (HiT) series, a core part of country monitoring undertaken by the European Observatory on Health Systems and Policies. These Reviews are routinely updated and provide a systematic description of the functioning of health systems in countries as well as reform and policy initiatives in progress or under development. As these are in-depth descriptions which detail the intricacies of health systems and an assessment of their performance, they provide the ideal basis for understanding the true multidimensionality of accessibility. Key messages • Even health systems in high-income countries need to address inequalities in access to care to ensure universal health coverage. • The workshop will identify themes and approaches to improving access to care from a cross-country perspective through a multidimensional understanding of accessibility. Speakers/Panelists Erica Richardson European Observatory on Health Systems and Policies, London, UK Cristina Hernandez Quevedo European Observatory on Health Systems and Policies, London, UK Yulia Litvinova European Observatory on Health Systems and Policies, Berlin Hub, Berlin, Germany Gemma Williams European Observatory on Health Systems and Policies, London, UK

Large scale public health system transformation: Ireland

Abstract Ireland has coped comparatively well with the COVID-19 pandemic when considering excess mortality. The reasons are likely complex and multifaceted, but it may be, in part, attributable to a comparatively young population and progress on indicators related to premature mortality and preventable mortality on chronic diseases and lifestyle risk factors. “Healthy Ireland” is a national framework in place since 2013 and utilizes a settings based approach to promote health and wellbeing in communities. It aims to improve collaboration between government, institutions, local communities, and individuals. Sláintecare is an all’party long-term health reform initiative developed in 2017 aimed at delivering the right care, at the right time, in the right place by the right team. In addition, in 2018 Ireland embarked on an ambitious public health reform programme with the implementation of the recommendations of the Crowe Horwath review of Public Health. While challenges exist, including access to services and waiting times, the governments has put in place initiatives to address these and is committed to, amongst other things, promo ting the continued integration of services across a variety of domains including primary to quaternary prevention. As Ireland began to emerge from the COVID-19 pandemic it established “The Public Health Reform Expert Advisory Group” to identify learnings from the public health components of the response, with a view towards strengthening public health and health protection generally and, specifically, future public health pandemic preparedness. The group, made up of national and international public health experts, submitted its final report in September 2023 which outlined a series of recommendations focused on potential improvements to public health policy, structures and governance. The WHO analysis of the Essential Public Health Functions provided complementary results. More work is now ahead to consider and implement these recommendations and foster institutional reforms including at the Health Services Executive, the Department of Health, and at the Health Protection Surveillance Centre.

Governance and health system reform: a case study of new health regions in Ireland, 2018-2023

Abstract Background While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation. Methods The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis. Results Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. Key messages • Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives. • Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.

Reform and Practice of University Physics Experimental Teaching Based on OBE Concept

Aiming at the problems of unclear teaching objectives, obsolete content, and single method in the experimental teaching of university physics at our university, we have implemented a series of reform initiatives. It mainly includes clarifying the student-centered teaching objectives, optimizing the experimental content, innovating the teaching methods, improving the assessment and evaluation system, and improving the experimental conditions [1,2]. After the implementation of the reform, the learning effectiveness of students has been significantly improved, the teaching level of teachers has been significantly enhanced, the curriculum system has been optimized, the efficiency of teaching management has been enhanced, and social recognition has been strengthened. Practice shows that the teaching reform based on the outcome-based education concept effectively improves the quality of university physics experimental teaching and lays the foundation for cultivating innovative talents.

Erratum: Improving the Training of Frontline Extension Workers in Tanzania: A Pilot Curriculum Reform Initiative with the Ministry of Agriculture Training Institute at Ilonga

Erratum: Improving the Training of Frontline Extension Workers in Tanzania: A Pilot Curriculum Reform Initiative with the Ministry of Agriculture Training Institute at Ilonga

Research on Mixed Ownership Reform of State-Owned Enterprises from the Perspective of Marxist Political Economy

Under China’s socialist system, state-owned enterprises are key forces driving the economic trajectory and providing strong momentum. These enterprises not only bear the crucial responsibility of advancing the process of national modernization but also serve as the core of the national economic lifeline through their irreplaceable status and function amidst changing times. In the new era, with the advent of the technological revolution and the wave of globalization, state-owned enterprises face unprecedented opportunities and challenges. As a significant aspect of state-owned enterprise reform, the mixed ownership reform is not only a transformation in the structure of enterprise ownership but also a reflection of China’s broader, comprehensive reform efforts. By deeply advancing this reform, it will help optimize the allocation of state-owned assets and significantly boost technological and management innovation within state-owned enterprises, ensuring their competitiveness in the intense market environment. Therefore, this paper will conduct an in-depth analysis of the mixed ownership reform of state-owned enterprises from the perspective of Marxist political economy.

Decentering governance models: education policy and school accountability in Post-Devolution Wales

ABSTRACT This paper investigates education policy reform in post-Devolution Wales with a focus on school accountability. Specifically, it provides a historicist analysis of Wales’ decision to abandon publicly mandated school league tables and subsequent accountability reforms. The paper uses the literature on four governance models to investigate successive accountability regimes in Wales through time. These have changed from a Trust and Altruism model, via a Transparent Public Rankings model, to a new, emerging model that relies on self-assessment and collaborative accountability standards. Notably, the Organization for Economic Cooperation and Development (OECD) has played an increasingly important role in shaping this process. Central to our analysis is Mark Bevir and Roderick Rhodes’ decentered theory. The paper argues that governance models need to be understood with reference to the dynamic interplay of historical constraints, power struggles and new belief systems that respond to policy dilemmas. As Wales has embarked on several substantial education policy reform initiatives, the paper demonstrates the importance of a historically informed approach to policy design and implementation which is responsive to competing traditions and beliefs.

"Timely help" or "one disaster after another": The impact of potential and transition interim CEO succession on corporate performance.

The succession mode of interim CEO is highly uncertain. The smooth transition function of interim CEO is particularly important in the process of enterprise reform. We divide interim CEOs into potential successors and transition successors. Then we empirically analyze the heterogeneous impact and mechanism of interim CEOs on firm performance. The results show that compared with transition CEO, potential CEO has less negative impact on corporate performance. Interim CEO has a negative impact on enterprise performance by reducing agency efficiency. The mechanism analysis of this paper are as follows. For the potential CEO, strong incentive constraints can effectively mitigate the negative impact of the succession on corporate performance. For a transitional CEO, superior personal capabilities coupled with an effective oversight mechanism represent more optimal solutions. In today's corporate landscape, the frequencies of executive changes and interim successions are on the rise annually. Our research is tailored to aid enterprises in navigating these transitions seamlessly and in expediting their recovery processes.

Historical and Legal Aspects of the Use of Land Plots for Horticulture

The article focuses on the peculiarities of legislative support for the establishment and development of land plots for horticulture within a historical context. Given that the current legal regulation of land use in the field of horticulture significantly differs from that which existed before the start of land reform in Ukraine, the article analyses the normative-legal framework that has laid the groundwork for the initiation of this type of land use. As a result of the analysis, the role of gardening and viticulture societies is characterized, which were users of land for collective gardening and viticulture even during Soviet times. Attention is drawn to the fact that the Land Code of the Ukrainian SSR of 1970 enshrined only the collective organizational and legal form of gardening (viticulture) and contained provisions according to which the lands occupied by collective gardens are in permanent use by gardening (viticulture) societies.Land plots were allocated to them from reserve lands, the state forest fund, and vacant lands within populated areas. Membership in the society was limited to citizens who did not own private plots or gardens. The activities of each society as a legal entity were regulated by the society’s charter, which was registered in accordance with established procedures. On the land plots designated for collective gardening (viticulture), members of the society were to establish orchards and vineyards on a collective basis and carry out the construction of summer­type garden buildings. Special attention in the article is given to the analysis of social relations that are formed in the field of gardening, which have undergone significant changes due to the initiation of land reform, as well as the adoption of the Land Code of the Ukrainian SSR in 1990 and its new edition in 1992. The article also analyzes the provisions of the current Land Code of Ukraine that regulate the mechanism for transferring land of general use into private ownership of legal entities of gardening societies. It examines, in a comparative aspect, the legal regime of land of general use and other categories of land in Ukraine.

Reverse mixed ownership reform and financial risks in private enterprise

The mixed ownership reform is an important part of the economic restructuring in our country. In addition to the participation of non-state-owned capital in soes, it is also more and more common for state-owned capital to participate in the reverse mixed ownership reform of private enterprises. As an important force in China's economic development, the national economy has entered a new normal in recent years, and due to the impact of COVID-19, the Sino-US trade war and other events, many private enterprises have fallen into financial crisis and entered a "wave of closure." Based on this background, this paper empirically studies the impact of state-owned capital shareholding on the financial risk of private enterprises by using the sample of A-share listed enterprises in Shanghai and Shenzhen Stock exchanges from 2007 to 2021. In addition, this paper also discusses the influencing mechanism from two aspects of resource acquisition and governance supervision, and further analyzes that the effect of reverse mixed ownership reform of private enterprises on reducing financial risk mainly comes from the shareholding of state-owned non-financial institutions. This paper enriches the research on the economic consequences of reverse mixed ownership reform and the influencing factors of financial risks, and provides new ideas for improving the ability of private enterprises to prevent financial risks and promoting the healthy and stable development of private enterprises.

Challenges Afflicting Prisons – A First-hand Observation

Prisons encounter numerous challenges stemming from systemic, social, and administrative shortcomings. Overcrowding stands out as a significant problem, with facilities operating well beyond their intended capacities, leading to strained resources, increased tensions, and substandard living conditions. The high volume of pretrial detainees exacerbates overcrowding, prolongs the wait for justice, and creates excessive difficulties for those who are imprisoned. Deficiencies in infrastructure, a lack of initiatives to build new prisons or expand the capacity of current facilities, insufficient medical care - particularly in mental health services - and shortages of staff all jeopardize the well-being and safety of inmates. Additionally, gender-specific issues, such as insufficient facilities for women and the absence of open prisons, underscore the system's failure to support marginalized groups. Furthermore, the scarcity of rehabilitation programs hinders the reintegration of prisoners into society. Malpractices, gang activity, and substance abuse in prisons worsen these conditions, leading to violence and fatalities that hinder reform initiatives. Addressing these interconnected challenges requires extensive reforms that involve robust administrative commitment, investments in infrastructure and workforce, improvements to the legal framework, and the creation of rehabilitation programs aimed at cultivating a more humane and efficient prison system.

Relationship between Tax Reform Initiatives and Employee Job Satisfaction in the Public Sector: A Case of the County Government of Uasin Gishu, Kenya

Relationship between Tax Reform Initiatives and Employee Job Satisfaction in the Public Sector: A Case of the County Government of Uasin Gishu, Kenya

Optimization of Big Data Analysis Resources Supported by XGBoost Algorithm: Comprehensive Analysis of Industry 5.0 and ESG Performance

To enable state-owned enterprises in Industry 5.0 to better carry out M&A activities, it is important and necessary to provide early warning of M&A risks, which directly affects the interests of both parties and even affects the effectiveness of state-owned enterprise reform. The author proposes the optimization of big data analysis resources supported by the XGBoost algorithm: a comprehensive analysis of Industry 5.0 and ESG performance. Design a comprehensive evaluation system to measure the M&A risk of state-owned listed companies. Using Python programming language to achieve data crawling and processing. Build an early warning model using the XGBoost algorithm. To further evaluate the effectiveness of the early warning model, comparative experiments were conducted. Using multiple linear regression models to study the significant factors of merger and acquisition risk. The experimental results show that the prediction accuracy based on the XGBoost algorithm is 80%, which performs the best among all models and has stronger reliability and applicability. ConclusionThe return on investment capital, operating profit margin, and net profit from paid consideration are more important and effective in predicting merger and acquisition risks; The total asset turnover rate, return on investment capital, equity balance, and audit quality are more conducive to suppressing merger and acquisition risks.

Building Our Families: Navigating Barriers in 2SLGBTQ+ Family Building Through Doula Supports

Queer and transgender individuals often encounter barriers when attempting to build their families, Beginning by identifying barriers that 2SLGBTQ+ people face in their fertility and reproductive journeys -- including limited access to information, inadequate diversity in donor gametes, and minority stress -- this article looks to the role of doulas in mitigating challenges by providing critical and tailored support, educational resources, and support and advocacy in navigating medical systems. Using a reproductive justice and intersectional framework, the article highlights the need for inclusive care practices that address the historical and ongoing exclusion of marginalized 2SLGBTQ+ communities. It underscores the importance of improved training for healthcare providers and systemic changes to ensure equitable family-building experiences for 2SLGBTQ+ individuals. By integrating community supports and peer advocacy, the article proposes strategies to enhance both the physical and mental health outcomes of 2SLGBTQ+ intended parents and their families. It calls for a comprehensive approach that combines professional training, systemic reform, and community-based initiatives to create a more inclusive and supportive environment for family-building among 2SLGBTQ+ individuals.

From local networks to national reform? Programmatic groups in the regionalization of German health policy

AbstractBefore policy reform initiatives reach the agenda of national decision makers, such initiatives often start at a small‐scale, local level. The Programmatic Action Framework (PAF) emphasizes the importance of biographical connections to understand how a group of policy actors forms, and how it develops programs that may lead to decade‐long policy change. This article applies the PAF to study the emergence of a programmatic group behind initiatives on regionalization in German health policy through discourse analysis and expert interviews. The study contributes to understanding social networks behind policy programs and social‐psychological, partly informal drivers of policy change. The results show that many PAF conditions have already been met in the German health policy subsystem. We describe a network of policy actors with local and organizational drivers that has led to nationwide cooperation on regionalization.Related ArticlesCaliskan, Cantay. 2020. “The Influence of Elite Networks on Green Policy Making.” Politics & Policy 48(6): 1104–37. https://doi.org/10.1111/polp.12382.Petridou, Evangelia, Per Becker, and Jörgen Sparf. “Policy Entrepreneurs in Public Administration: A Social Network Analysis.” Politics & Policy 49(2): 414–45. https://doi.org/10.1111/polp.12400.Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.

Forms of culture in the implementation of school reform efforts: A conceptual framework

Despite concerted efforts to improve educational practices through reform, classroom implementation remains a persistent challenge. This theoretical article draws on recent work in cultural sociology to offer a fresh perspective on this problem. It introduces a framework that differentiates between declarative, procedural, and public forms of culture, highlighting their unique mechanisms of internalization and enactment. This multidimensional understanding of culture reveals the cognitive challenges inherent in translating reform principles into classroom practices. More specifically, the article contends that the common assumptions of convertibility and transferability between these forms of culture underlie the limited success of many reform initiatives. By attending to the cognitive dimensions of cultural dynamics, the proposed framework opens new avenues for understanding and addressing the difficulties of educational change. This article concluded with an agenda for future research to test and refine the framework.

Research on the Problems and Countermeasures of Using Management Accounting Methods to Promote the Reform of State-owned Enterprises

This paper deeply discusses how to use the power of management accounting to promote the deepening of the reform of state-owned enterprises, and proposes effective solutions to the existing problems. The reform of state-owned enterprises, as an indispensable part of China's economic map, is of great importance. Management accounting, as a mature and efficient management tool, is gradually becoming an indispensable supporting force in the reform of state-owned enterprises. This paper provides an in-depth analysis of the unique role of management accounting in the reform of state-owned enterprises. We find that by introducing management accounting concepts and methods, we can effectively optimize resource allocation, improve decision-making efficiency, and inject new vitality into the reform of state-owned enterprises. The research results of this paper are of great significance for guiding the reform practice of state-owned enterprises and improving the operating performance of state-owned enterprises. We believe that with the help of management accounting, the reform of state-owned enterprises will be able to take more solid steps and contribute more to the sustainable development of China's economy.

Reverse mixed-ownership reform and earnings quality of Chinese private enterprises: from the perspective of state-owned capital participation

ABSTRACT This paper employs a multiple regression model to empirically investigate the economic effects of Chinese private enterprises’ reverse mixed-ownership reform from the perspective of earnings quality. The results indicate that state-owned capital participation primarily enhances private enterprises’ earnings quality by augmenting its resource support effect in obtaining government subsidies. Meanwhile, a certain degree of checks and balances is required for state-owned capital to participate in the process to mitigate the second type of principal-agent problem to exert a governance supervision effect. Furthermore, state-owned capital participation does not contribute to the value appreciation of private enterprises solely through improving earnings quality.

Evaluation of the Pradhan Mantri Mudra Yojana Performance Across the Indian States

Financial inclusion stands as a pivotal strategy in India, reflecting a commitment to sustainable and inclusive growth within our economic framework. The primary objective of financial inclusion is to ensure that all segments of the population have access to financial services. The Government of India (GOI) has implemented several significant measures aimed at "funding the unfunded" micro-enterprise sector. A key initiative in this regard is the Pradhan Mantri Mudra Yojana (PMMY), which is instrumental in advancing financial inclusion efforts. This scheme is designed to meet the credit needs of small businesses, offering loans of up to 10 lakhs. This research paper provides an overview of PMMY along with a performance analysis of the scheme across different regions. Promoting financial inclusion via the PMMY scheme is crucial for driving economic transformation within society. MUDRA, which stands for the Micro Unit Development and Refinance Agency, represents a significant reform initiative by the Government of India aimed at enhancing the financial stability of micro, small, and medium enterprises (MSMEs). This financial initiative, embodied in the MUDRA scheme, is designed to support micro units by providing them with access to credit and funding necessary for the growth of their small businesses.

The endless reform process: Realities behind Jordan's political modernization efforts

AbstractThe latest royal committee headed by Samir Al‐Rifai to modernize Jordan's political system is often portrayed as a significant step toward political reform. However, this narrative overestimates the committee's impact and overlooks historical limitations and institutional obstacles to reform in Jordan. This study highlights how political reform initiatives in Jordan can be manipulated to serve the regime's objectives rather than the people's will. Historically, despite public pressure for genuine political reform, the regime's responses have been minimal. Royal committees and initiatives have rarely produced tangible results, serving more to provide the regime with narratives of superficial reform than to achieve real change.