Health Care Reform Research Articles

Navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region)

Objective. To assess navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region). Materials and methods. Navigation literacy of primary health care personnel was assessed among all heads of medical and obstetric centers in Orenburg region (n = 58). For this purpose, a single-stage continuous online survey was conducted using a combined questionnaire developed by the Central Research Institute for Healthcare Organization and Informatization of the Ministry of Heath of the Russian Federation. Results. The level of navigation literacy among the heads of the medical and obstetric centers of Orenburg region in 65.7 % of cases was excellent and sufficient. In the list of navigation skills, the heads of the medical and obstetric centers noted difficulties in the implementation of: issues of medical insurance (48.3 %), legal aspects of medical care and protection of patients' rights (27.5-48.3 %), healthcare reform (36.2 %). It was found out that from 63.7 % to 91.4 % of the heads of the medical and obstetric centers are aware of the ongoing state measures in the field of public health. The majority of the respondents (60.0 %) noted that they search for necessary information for professional purposes using digital tools. However, every third respondent (32.7 %) mentioned the difficulties in finding it on legislative issues, interpreting the quality and safety of food products according to their product labeling (27.6 %), solving problems related to mental health and well-being (18.9 %). These data demonstrate the need to improve navigation literacy of medical and obstetric centers managers in the digital environment. Conclusions. The modern multilevel and multicomponent healthcare system is associated with the need to improve the navigation literacy of medical personnel. The data obtained determined the main directions for improving navigation literacy of the heads of medical and obstetric centers.

Can China’s national comprehensive medical reform increase medical resources and reduce healthcare burden: evidence from Chinese provinces

ObjectivesChina’s national comprehensive medical reform (NCMR) is an important attempt in the reform of healthcare system, and quantitative evaluation of its effect is of great significance for continuously deepening medical reform, grasping the reform direction, and building a healthy China. Therefore, focusing on medical resources and medical burden, this study aims to systematically explore the policy effectiveness and the provincial heterogeneity of NCMR, as well as the potential influencing factors.MethodsUtilizing the collected multi-period panel data of 31 provinces in mainland China in 2006–2021, we regarded the release of the two batches of pilot provinces in NCMR as a quasi-natural experiment and comprehensively adopted a Staggered difference-in-differences (DID) model and Synthetic Control Method (SCM), combined with word frequency statistics and grouping regression analysis.ResultsNCMR can effectively increase the number of licensed physicians by 12.6% and reduce the per capita medical expense for in-patients by 7.2% in the pilot provinces. Furthermore, the NCMR policy effect in different pilot provinces shows various characteristics, and only Jiangsu, Zhejiang, and Chongqing achieve both the growth of medical resources and the reduction of medical expenditure. Meanwhile, word frequency statistics are conducted based on related policy descriptions and news reports on the official websites, so as to summarize the specific policy means in the three provinces, and provide a reference for other provinces to practice the healthcare reforms. Besides, extensibility analysis shows that the effect of NCMR is affected by the population aging and health status. Groups with low degree of population aging (low-AG)/high population health status (high-HE) performed a more obvious reform effect.ConclusionThis study provides beneficial policy implications for increasing medical resources, reducing medical burden, and promoting medical reform process.

ORGANIZATION OF METHODOLOGICAL PRINCIPLES OF THE STATE INNOVATION POLICY IN THE SPHERE OF INFORMATIZATION OF THE HEALTH PROTECTION SYSTEM OF UKRAINE

The article highlights the key issues related to the need to modernize the health care system, globalization and integration into international structures, health care reform. In Ukraine, the process of health care reform is underway, which involves increasing the efficiency of the medical services system, their availability and quality. Innovations can accelerate these processes, in particular through the introduction of digital technologies (e-health, telemedicine), automation of management of medical facilities, development of remote diagnosis and treatment. The state innovation policy will allow to more effectively prepare for similar challenges in the future through the development of new vaccines, diagnostic methods, monitoring systems and management of medical resources. Support from the state (for example, through preferential taxation) to the development of the private medical services sector will reduce the burden on the state budget. In addition, it contributes to the attraction of investments in this area. Therefore, the state innovation policy in the field of health care is a relevant tool for ensuring the sustainable development of the health care system of Ukraine, increasing its efficiency and competitiveness, which meets the modern challenges and needs of society. The authors analyze the key aspects of the state policy aimed at the informatization of medical institutions, in particular, the digitalization of medical services, the introduction of electronic medicine, the creation of unified information platforms and patient databases. The article examines the importance of developing a clear methodology for the implementation of innovative solutions, as well as the role of the state in creating favorable conditions for the informatization of the health care system. The authors also analyze the international experience and the possibilities of its adaptation for Ukrainian realities, emphasizing the need to establish effective cooperation between state bodies, medical institutions and technological companies. The article concludes about the importance of an integrated approach to the informatization of the health care sector in order to improve the quality of medical services and increase the efficiency of medical resource management.

ACCREDITATION EXPERTISE OF THE “GENERAL MEDICINE” TRAINING PROGRAM FOR THE SPECIALTY 222 “MEDICINE” OF THE SECOND (MASTER’S) LEVEL OF HIGHER EDUCATION AT IVAN HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE

The article characterizes the procedure of accreditation expertise of the “General Medicine” training program for the second (master’s) level in the specialty 222 “Medicine”, implemented at Ivan Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine. The relevance of the topic is determined by new approaches to the accreditation of educational programs in Ukraine, which require the implementation of autonomous methods for managing the quality of education in accordance with European standards. The results of the expertise carried out by the members of the expert group and the sectoral expert council of the National Agency for Higher Education Quality Assurance (NAQA) was analysed. The article describes how the Ministry of Education and Science of Ukraine, the Accreditation Commission, and the National Agency for Higher Education Quality Assurance conduct monitoring of training programs through assessing their compliance with established standards. The research shows that accreditation not only determines the quality of education but also helps identify the strengths and weaknesses of training programs, providing information to all stakeholders. The main results of the expert evaluation highlight a high level of training for specialists in line with current labour market demands and emphasize the importance of adapting curricula to the conditions of healthcare reform. The article underscores the significance of ongoing monitoring of education quality to enhance the competitiveness of graduates. The manuscript focuses on the uniqueness and advantages of the training program, its evaluation, as well as the recommendations and suggestions provided by NAQA experts.

Junior Doctor Retention Strategies: Integrating Knowledge Management with Supportive Leadership and Organizational Climate

AbstractThis study aims to evaluate interventions and strategies used to retain junior doctors, with a specific focus on the roles of organizational climate, supportive leadership, and work engagement influenced by effective knowledge management practices. We examine how knowledge management—the systematic process of creating, sharing, using, and managing the knowledge and information of an organization—contributes to creating a favorable organizational climate and supportive leadership strategies. Engaging in a quantitative study with a sample of 950 junior doctors across four Central European countries, we explore the impact of an integrated approach that combines traditional performance-oriented climate models (rational goals model) with knowledge management practices tailored to the unique demands of healthcare settings influenced by current healthcare reforms and bureaucratic systems. Our findings suggest that not only do supportive leadership and a positive organizational climate enhance work engagement among junior doctors, but robust knowledge management practices also play a crucial role in improving retention rates by facilitating continuous learning and effective information sharing. To the best of our knowledge, our research is the first to draw on the synergy between rational goals, organizational climate, supportive leadership, and knowledge management practices to explain the antecedents of junior doctor work engagement and retention. This approach offers new insights into the dynamics of employee retention and underscores fundamental factors influencing junior doctors’ retention, paving the way for a more resilient and thriving healthcare workforce amidst the ongoing turbulence in global healthcare.

Stress mindset and nurses' sleep quality: mediating effects of stress overload and anxiety.

Previous studies have shown that overall sleep quality among Chinese nurses is relatively low, with a sleep disorder prevalence rate of approximately 66.4%. Against the backdrop of healthcare reforms, China has been striving to improve the mental health and sleep quality of nurses. Stress mindset can influence how individuals respond to stress, but there is limited research on how stress mindset affects nurses' sleep quality. This study aims to explore the impact of stress mindset on sleep quality among nurses, as well as the mediating roles of stress overload and anxiety in this relationship. The study was conducted online using a questionnaire from February 18 to February 22, 2024. It utilized the Stress Mindset Measure (SMM), the Stress Overload Scale-Short (SOS-S), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Pittsburgh Sleep Quality Index (PSQI) to survey 441 nurses in three regions of China: Chongqing, Hunan, and Shandong (M = 34.39, SD = 7.82, 95.7% female). A chain mediation model was employed to examine the mediating roles of stress overload and anxiety in the relationship between stress mindset and sleep quality. The participants' average sleep quality score was 7.18 ± 3.47. Nurses' stress mindset was significantly negatively correlated with both stress overload and anxiety, and significantly positively correlated with sleep quality. Stress overload was significantly positively correlated with anxiety and significantly negatively correlated with sleep quality. Anxiety was also significantly negatively correlated with sleep quality. The direct effect of nurses' stress mindset on sleep quality was significant (effect size = -0.10, 95% CI: -0.19 to -0.01), as were the indirect effects through stress overload (effect size = -0.05, 95% CI: -0.11 to -0.01) and anxiety (effect size = -0.09, 95% CI: -0.13 to -0.05), along with their chain mediation effect (effect size = -0.10, 95% CI: -0.14 to -0.06). Our study demonstrates that a higher level of nurses' stress mindset is associated with better sleep quality, with stress overload and anxiety mediating this relationship. A positive stress mindset helps nurses cope more effectively with professional challenges and reduces anxiety, leading to improved sleep quality. Healthcare institutions should therefore prioritize fostering positive stress mindsets in nurses, encouraging regular psychological training and workshops to support the development of effective coping strategies.

Overcoming Barriers to Healthcare Reform: A Call to Action.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.

Problems and critical reforms in mental health care: an examination of Nigeria’s situation

Problems and critical reforms in mental health care: an examination of Nigeria’s situation

Service Users' Perspectives on Communicating Compassion in Mental Health Practice.

When people talk about their healthcare experience, compassion is often a common ingredient in the stories they share. After a decade of healthcare reforms and research on compassion, the experience of receiving compassionate care has been shown to be important to patients and their families. Yet, there is little guidance to inform compassionate practice in the context of providing mental health care. In this article, the authors suggest three things that mental health nurses can use in their practice to demonstrate compassion.

Healthcare Reforms Within and Without

Healthcare reform has been a significant and ongoing issue in the United States, with various initiatives and policies implemented over the years to improve access, quality, and affordability of healthcare. We review recent literature as to attempts to reform a healthcare system in the US that is driven by profit greed and fraud. Examples of such attempts are critiqued for their working within a system that is structurally broken.

Agricultural payment mechanisms, medical cost anxiety, and incomemobility in China

This study investigates the relationship between agricultural payment mechanisms, medical cost anxiety, and income mobility in China. The study made use of the World Bank (2021) Global Financial Inclusion data. Utilizing a range of figures to visually represent data trends and relationships, the study reports how agricultural payment mechanisms relate to income mobility while accounting for the impact of medical cost anxiety. The findings reveal that while agricultural payments positively affect income mobility, their effectiveness is significantly dampened by the presence of high medical expenses. Households that receive agricultural payments but face substantial healthcare costs tend to experience limited upward mobility compared to those with lower medical expenditures. The study concludes that to improve income mobility in rural China, policy interventions must address both agricultural productivity and healthcare affordability. A dual approach that integrates agricultural subsidies with healthcare reforms is recommended, focusing on expanding access to affordable healthcare, reducing out-of-pocket expenses, and strengthening social safety nets.

The patient's medical home: A meta-analysis of case studies exploring its impact on patient outcomes

This meta-analysis investigates the impact of the Patient's Medical Home (PMH) model on healthcare delivery, focusing on quality of care, patient satisfaction, accessibility, and cost-effectiveness. Utilizing a comprehensive search across multiple databases, studies relevant to the PMH model were identified and analyzed, adhering to strict inclusion and exclusion criteria. The findings reveal significant improvements in the adherence to practice guidelines for chronic disease management, patient satisfaction scores, access to primary care services, and reductions in overall healthcare costs, with a notable reduction in emergency department visits and hospital admissions. Despite moderate heterogeneity among studies, indicating variability in PMH implementation, the analysis underscores the PMH model's potential to enhance healthcare delivery. This study contributes to the growing body of evidence supporting the PMH model's effectiveness in improving healthcare outcomes and efficiency, advocating for its broader adoption and adaptation across diverse healthcare settings. The research highlights the importance of addressing implementation challenges to fully realize the PMH model's benefits, marking a significant step towards patient-centered, sustainable healthcare reform.

Healthcare performance for patients with heart failure in Iran: addressing the tip of the iceberg.

Chronic diseases, such as heart failure with reduced ejection fraction (HFrEF), remain significant factors in the healthcare burden in Iran. Healthcare systems must have comprehensive data on the current usage, costs, and quality of care to tackle these challenges and formulate strategic plans effectively. The study included 209 patients with a mean age of 58 years (SD = 16.5) who met the inclusion criteria of having an ejection fraction of less than 40% and a confirmed diagnosis of HFrEF. This study used nationally representative data to assess the healthcare usage, costs, and quality of HFrEF management in Iran. The most used services were medication dispensing (76%) and outpatient visits (53%), while rehabilitation (3%) and homecare (2%) were used less frequently. The annual per-patient direct medical cost was $1,464, with $308 (21%) paid out-of-pocket (OOP). Hospitalization accounted for most of the total cost (68%), and pharmacy expenses comprised the largest portion of OOP payments (46%). Echocardiography was performed for 91.1% of patients upon admission. Only 71.6% of patients had arrangements for a cardiology visit within seven days following hospital discharge. Additionally, only 67.5% of patients received prescriptions for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and 85% were prescribed beta-blockers. Patients with heart failure in Iran face challenges in accessing adequate cardiac care, including a lack of care continuity and advanced cardiac services. The study provided an essential benchmark for future healthcare reform.

Can public hospital reform reduce medical resource mismatches? Evidence from China

BackgroundThe mismatch of medical resources is a significant issue in global healthcare, undermining both service accessibility and system efficiency. In China, despite the implementation of the “Healthy China” strategy, persistent mismatches remain due to factors such as industrialization, urbanization, and population aging. This study empirically evaluates the impact of Public Hospital Reform (PHR) on mitigating these mismatches.MethodsA Difference-in-Differences (DD) approach is applied to panel data from 300 cities spanning 2010 to 2021, using the phased implementation of PHR as a quasi-natural experiment. This allows for a comparative analysis of changes in resource allocation between cities that adopted the reform and those that did not. Quantile regression assesses the effects of PHR across varying levels of resource mismatch, while mechanism tests investigate how PHR influences mismatches through cost reduction and supply expansion.ResultsPHR is found to reduce medical resource mismatches by 13.9%, primarily driven by cost reductions and increased resource supply. The effects are more pronounced at both lower and higher levels of mismatch, with a limited impact at mid-levels. Furthermore, the reform’s effectiveness diminishes as it is extended to more cities, suggesting a potential saturation effect.ConclusionsThis study demonstrates that PHR significantly alleviates medical resource mismatches in China. The findings underscore the need to focus on cost control and resource supply in future healthcare reforms, providing key insights for policymakers in developing countries facing similar healthcare resource challenges.

4.D. Scientific session: From policy to implementation: Learnings around health system reforms and Universal Health Coverage

Abstract In this session, the authors and audience have the opportunity to engage in discussions around health policy integrity and reform implementation. Introducing and implementing health system reform has been a perennial issue for countries around the world over the past number of decades. Recently, the introduction and implementation of Universal Health Coverage (UHC) has been of particular focus, with 193 countries committed to introducing UHC by 2030. At the same time, European countries that previously established national health systems are introducing new reforms in the hope of making their health systems more efficient and equitable. However, there are a number of challenges along the path of policy development and implementation with which all countries must grapple, and how individual countries go about reforming their health systems depends on their social, political, cultural and economic contexts. Learnings from around the world have highlighted that reforms can be challenged or stalled in both the design and implementation phases. This workshop, which conceptualises implementation as the “acid test” of a policy, thus explores, through three case studies, the factors that facilitate or challenge the implementation of reforms. At the same time, we discuss policy integrity, exploring reasons for why policies pivot away from original design and intent. Furthermore, we discuss the implications of health reform on equity, cognisant that the primary objective of this collective reform work is to reduce the financial burden of healthcare on households and improve access. The first presentation will provide the framework for audience discussions, outlining international lessons in relation to UHC reforms and equity. The second presentation will provide a snapshot of the Finnish experience of introducing a “big bang” structural reform. The third presentation highlights lessons from the Portuguese experience of primary healthcare reforms, the opportunity these offer for creating patient-centred care and the integral role that politics and governance play in the reform process. Finally, the Irish case study highlights the experiences of a High Income County attempting to introduce UHC much later than its European counterparts, and negotiations between the public and private sectors. Through this, we hope to hold the tensions and stimulate debate about policy robustness and resilience, and reform implementation. Each presenter will be given a strict deadline of 10 minutes each by the chair and then the audience will be invited to debate the problems identified and strategies proposed to discuss: (i) what are the facilitators and barriers to reform implementation, (ii) what are the factors that encourage policy integrity and change and (iii) whether greater cooperation across Europe regarding health reforms can be more effective in supporting robust health systems. Key messages • For reforms to be facilitated, there must be cohesion and commitment across the political, social, economic and cultural systems, and no fragmentation across health system functions. • As policy implementation is attempted, there is a tension between remaining true to key values and adapting to new circumstances.

2.L. Round table: Monitoring health reforms to inform policy innovation: the Health Systems and Policies Monitor

Abstract Background The European Observatory on Health Systems and Policies’ (Observatory) Health Systems and Policy Monitor (HSPM) network convenes an international group of around 50 national health systems researchers from over 40 institutions across 31 high-income countries, including all EU countries, Canada, Israel, the UK and the US. In advance of the HSPM annual meeting, experts share the current year’s “top-three” health reforms in their countries via a standardized survey, soliciting details on content and general implementation processes. Reforms are iteratively organized into to 2 of 11 clusters, derived from the WHO health system building blocks. Experts then discuss background, status and content of national reforms in the year’s main clusters and initiate cross-country collaborations. A repository of over 650 reforms since 2018 has been created and is available online, showcasing reform patterns in HSPM countries. The collected data have informed studies on reform trends in HSPM countries from 2018-2019 and between 2020-2022, with work ongoing. Data are also consulted by researchers and policymakers wishing to learn about and from reforms in other countries. This workshop specifically aims to: • Inform participants about the methodologies used by the HSPM network to track reforms • Highlight common trends in major health reforms across countries since 2018 • Discuss national health reforms and the value of understanding and tracking these across countries • Identify research gaps in reform monitoring relevant to policy makers • Discuss how the health system research community can generate more relevant and actionable evidence Added-value The comparative analysis of reform trends provides insights into how systems operate and the types of reforms more likely to be implemented. The sharing of these insights also serves as a source of inspiration, allowing countries to learn from each other’s successes and failures and adopt proven best practices. This is relevant for policymakers and researchers striving to support health systems strengthening. Therefore, the workshop will support knowledge exchange between researchers and policymakers by (1) informing researchers and policymakers about similar ongoing reforms in other countries and (2) identifying areas where researchers can contribute to country reform agendas, and (3) stimulating interest in cross-country collaborative research on similar and topical reforms in different countries. Format This is a roundtable workshop chaired and moderated by the Observatory. An overview of reform trends and patterns since 2018 will set the scene, followed by an interactive discussion with policymakers and HSPM network members to (1) delve into trend dynamics and implications for health policy and research and (2) identify major (missing) research areas relevant to policymakers. In addition, we will leverage the geographic scope and expertise of the audience to reflect on the value of monitoring reforms. Key messages • Cross-country exchange of information on reform trends and implementation patterns can inspire future reforms and help policymakers identify promising policy approaches abroad. • Knowledge exchange between researchers and policymakers helps to determine evidence gaps and to generate relevant and actionable evidence that can drive policy innovation. Speakers/Panelists Reinhard Busse Berlin University of Technology, Berlin, Germany Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Iwona Kowalska-Bobko Jagiellonian University Medical College, Institute of Public Health, Cracow, Poland Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg Vesna-Kestrin Petric Ministry of Health, Ljubljana, Slovenia

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

1.D. Scientific session: Cross national perspectives: the many faces of health inequities

Abstract Health inequities come in different forms in different countries, often times based on country and population demographics, and exist around the world. Ample evidence has revealed how inequities to accessing and utilizing health services can have detrimental consequences for certain populations and exist across numerous strata including geography, income, race and ethnicity, age, and gender. This workshop identifies different examples of inequities across countries, and their impact on health outcomes and health care use. Health inequities, in whichever form, lead to one common outcome: worse health outcomes and lower life expectancy for those who are marginalized by inequities compared to their counterparts. This session will dive into the research on health inequities by geography (rural versus non rural), income (low/average income versus high income), race/ethnicity, and among people with substance use disorder (SUD) particularly those who use and inject drugs with the goal of 1) exposing the stark disparities in health care among these populations; 2) discussing lessons which can be learned and adapted from other countries; and 3) discussing promising solutions and approaches to restoring justice and access to care for all. The panel will be composed of 1 moderator and up to 5 panelists. Panelists are experts in their fields, established researchers and practitioners, and either employees of the Commonwealth Fund or alumni of the Harkness Fellowship from various high-income countries including Canada, Germany, Norway, the United Kingdom, and the United States. A moderator from the Commonwealth Fund will frame the discussion by introducing a deep dive into affordability barriers utilizing the Commonwealth’s Fund International Health Policy Survey of nine countries. Munira Gunja, senior researcher on the Commonwealth Fund’s International program, will present how a lack of affordability in health care is a growing threat and will likely widen the disparities by income without serious health reforms. Neil MacKinnon, Senior Harkness Fellow from Canada, will continue the discussion focusing on an analysis he and his team at Augusta University completed on disparities in health care by geography in eleven (primarily European) countries. The second panelist, Sidra Khan-Gokkaya, the 2023-2024 Harkness Fellow from Germany, will present on her study of racism in health care in Germany and the U.S. Another of the 2023-2024 Harkness Fellows, Claire Wilson, will present on her research of racial disparities in perinatal mental illness in the U.K. and U.S. Lastly, the fifth panelist, Ane Kristine Finbråten will discuss the unique health needs of those with SUD and the inequities faced by people who use and inject drugs as they navigate health care. Each panelist will speak for roughly 8 minutes, with 20 minutes saved for moderator and audience questions. Key messages • All stakeholders, including patients, public health systems, and health systems benefit when all populations are able to access comprehensive health services. • Health inequities come in many different forms, and to improve health outcomes, we must address them at all levels.

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.

Co-producing research on universal health system reform in the context of COVID-19

Abstract Issue How to co-produce and embed research into universal health system reform implementation in the context of COVID-19. In many respects the pandemic revolutionised the use of data and research, with near real-time data informing key health policy and system decisions. This was evident in the production of publicly available data sets tracking COVID-19 infection as well as health system dashboard tracking activity in real-time and influencing day-to-day decisions made. How can this use of data and research evidence become the norm for all health system reform and policy decisions? Results The Foundations’ research project is a partnership project in place since Autumn 2019. Initially focused on producing evidence to inform the design and implementation of new regional areas with the Department of Health Sláintecare Reform Office and the Irish national Health Service Executive as partners. When COVID-19 occurred all work on the regions was paused the research pivoted to harness the learnings form the COVID-19 response to inform universal health system reform. The partnership applied research nature of the programme allowed research to be coproduced and co-designed with health system leaders, meant the researchers understood if and when it was possible to engage with partners and how to feed result into the health system at the earliest opportunity. Lessons Trust and pre-existing working relationships with partners allowed the research to pivot and to continue during the pandemic. The applied partnership nature of the research meant that at times the health system was very engaged in the research and at other times (eg during COVID waves and surges or the cyber-attack) there was limited engagement. The co-production nature of the research allowed a dynamic, ongoing, two-way learning between the health system and the research team. It is extremely difficult to measure impact of research on health system and reform decisions.