Reforms In Healthcare Sector Research Articles

State Institution “Institute for Children and Adolescents Health Care at the NAMS of Ukraine” – pages of history and modernity

The State Institution “Institute of Children and Adolescents’ Healthcare under the National Academy of Medical Sciences of Ukraine” (SI “ICAH of NAMSU”) is a multidisciplinary research, diagnostics & treatment, organizational & methodological center, the activities of which have been always responding to the most urgent needs of the contemporary healthcare. Functioning of this center has been always directed on solving the top priority tasks in the field of healthcare for school children and youth, including: prevention of chronic non-infectious diseases during childhood and adolescence; maintenance of the reproduction potential and of the psychological health among children and adolescents; prevention of the negative impacts from the educational process upon the health of school-age children and studying youth; scientific substantiation of the efficient use of new inventions in the related field; medical assistance for the patients of childhood and adolescence age under the conditions of healthcare sector reforms. As per the determined functions, the Institute is the only research institution of such specialization in Ukraine today. During the last decade, the state of health among Ukraine’ population of childhood age has been subject to negative changes: the morbidity rate has been growing along with the number of diseases, including non-infectious somatic pathologies. The share of healthy children of the school age does not exceed 5–10 %. Therefore, timely detection of the diseases of endocrine, reproduction, bronchopulmonary, cardiovascular, osteomuscular systems as well as of kidneys and liver becomes of vital importance. Attention should be particularly focused on the children and adolescents from the ATO zone and those suffered from the military actions, on the state of their psychological health and physical development. An important direction in maintaining and strengthening the health of children from the military conflict zone is the application of principles of the medical & psychological assistance based on organizational, curative and preventive measures carried out by the PI “ICAH of NAMSU”. The Institute’s personnel will be directing their further efforts towards solving the most acute and most socially important issues related to reformation of healthcare for children and adolescents below 18 y.o. as well as on the development of advanced medical technologies for diagnostics, treatment and rehabilitation of children and adolescents. Key words: children; adolescents; psychological health; psychical development; medical & psychological assistance.

Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS

This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services' coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians' tendency to blame BPJS's management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians' own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.

Social impacts of health care reforms in Russia

The article considers the stages of healthcare sector reforms in Russia and the impact of this process on public health as the main indicator of the social state. A definition of public health is given; the scientific significance and relevance of the research are justified. The works of foreign and domestic authors, their approaches to the study of factors affecting public health are analysed. The analysis of the state of public health in 80s-90s of the last century during the political and economic crisis is made; the transition process from the so-called “budget-funded” financing model to the “insurance” one is described. Based on statistics and expert assessments, as well as international confrontations, conclusions are drawn about the multi-year underfunding of the healthcare sector, primarily from the state budget. A new stage of reforms is analysed: since 2014, the Russian government has begun the so-called “optimization” of healthcare. Its goals, results, feedbacks from doctors and patients are stated. They show the new reform is a negative process for health system. The blunders of health care reform have been sharply marked with the beginning of the pandemic of coronavirus infection. The facts of the self-sacrificing work of the doctors and nursing personnel during the pandemic period, the measures of the Government and the society to support medical workers were described.

Programming Regulation and Strategic Planning in the Health Care Sector

The article deals with the legal characteristics of forecasting and strategic planning in the health care sector through program regulatory acts, their rationality and effectiveness of application, revealing the main characteristics and regularities of such regulation and the place in the system of national legislation, as well as identifying problems and shortcomings of program regulation of the health care sector in Ukraine, the formulation of propositions to eliminate the relevant complications in domestic practice.
 The objective of the article is to analyze the problems of program regulation of legal relations in the health care management system in Ukraine and its legal provision.
 The methodological basis of the article is a set of generally scientific and special research methods. In particular, through the dialectical method, the set tasks are considered in the unity of their social content and legal form.
 The author of the article discusses the development and implementation of regulatory programs in the health care sector in Ukraine. It has been found out that the draft target-oriented program should be developed on the basis of forecasts of economic and social development of Ukraine, forecasts of the development of the health care sector for the medium-term period of the approved concept by the state customer or its designated developer. Accordingly, health regulatory programs are used at the interstate, nationwide, governmental, departmental and regional levels.
 The authorities of state agencies in this field have been revealed; the system, content and orientation of the main legal programs in the health care sector have been analyzed. In particular, the Program of Medical Guarantees and State Health Strategies, approved by the Cabinet of Ministers in November 2019, becomes particularly important in the context of the health care sector reform. The content of existing programs in the health care management system has been studied and the need for their widespread use has been proved.
 The main problems of program regulation in the health care sector have been distinguished. These are disadvantages of both the general system of organization and effectiveness of the programs, as well as of certain mechanisms of the implementation, in particular financing of programs on a residual principle (underfunding, and sometimes even its absence); unclear formulation of the purpose and objectives of the programs, which indicate the process rather than the final result; the absence of clearly identified performers and obligated entities; insufficient analytical activity; lack of responsibility for non-compliance with mandatory measures and action plan; insufficient control over funds spending; declarative nature, etc.

The Challenge of Introducing New Public Management to Kosovo’s Healthcare Sector

The paper outlines the current healthcare sector reform process in Kosovo and the challenges to its implementation. The reform attempts to introduce modern public management principles into Kosovo’s healthcare sector, including a purchaser–provider split, performance incentives, and performance-based contracting, as well as a reorganisation of healthcare service delivery with a view to improving effectiveness and efficiency. This is the first major reform of the healthcare sector since Kosovo declared independence in 2008, and it intends to replace the healthcare system established by the United Nations between 1999 and 2008. Kosovo’s earlier healthcare system had been characterised by decentralised decision-making, but was re-established by the UN in the form of an emergency healthcare system after the UN was deployed to administer Kosovo in 1999. The reform envisages separating healthcare regulators from healthcare providers and healthcare purchasers. Kosovo Hospital and University Clinical Services is established as a new entity providing healthcare services, and a new Health Insurance Fund will become the healthcare purchaser. The Ministry of Health will be restricted to the functions of a regulator, divested of all administrative functions in favour of healthcare providers and purchasers. A major challenge lies in the limited capacities of the Kosovo Government to implement such an ambitious reform. This is also an attempt to introduce modern public management principles into a public administration which is dominated by traditional public administration principles. Lack of implementation capacities and contradictory public administration principles are the most important factors that may endanger the successful implementation of the reform.

Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China.

BackgroundImproving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China’s healthcare sector reform in China.ObjectivesThis study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution.MethodsBenefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews.ResultsHigh-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and −0.0273 [95% CI, −0.1702 to 0.1156] in 2007).ConclusionsOur study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms

Th is paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system; second a process of fiscal decentralisation. The electoral system was changed in 1995 and replaced a pure proportional system by a majoritarian system, fostering the transition of regional governments towards a presidential regime. The process of fiscal decentralisation took effect in 1998, when intergovernmental grants earmarked for the health care sector were replaced by regional taxes. The Italian context offers a unique source of data to test the predictions of recent theoretical models that support a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralisation. The paper provides two main contributions: 1) a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s; 2) the evaluation of the impact of the electoral reform in a quasi-experimental setting. The final results provide empirical evidence in line with the findings of the theoretical models.

Provincial health accounts in Kerman, Iran: an evidence of a “mixed” healthcare financing system

Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province. The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General's office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province. During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services. The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector.

HEALTH INSURANCE SYSTEM IN SERBIA – QUALITY, REFORM, FINANCIAL SUSTAINABILITY

Constrained by difficult economic situation, the health system in Serbia is facing a great challenge, and in order to overcome it and handle the gap between possibilities and expectations, it is necessary to implement economic reform of health care sector in Serbia, i.e. its decentralization, which implies improvements in providing health services while trying to find a model of financial sustainability of health care system in Serbia. One of the most essential impulses of society to its economic and general social development is the health of its population. In fact, in addition to being a social potential, health is to be considered as an economic potential of a country as well. The need to examine health from economic point of view, as well as in the sense of sustainable economic development, is gaining in presence in the newly made circumstances of an advancing economic crisis. There is an evident gap in the social community between the expectations of health care beneficiaries who are used to high-quality services with considerably subsidized health care and the new situation where health care institutions dispose of no funds to ensure the necessary prerequisites for providing health care, with an obvious weakening of social interlinkage and a fading trust in health care institutions. Any change in terms of scope, quality and prices of health care may and does runs into the wall of disapproval, even judgment; therefore, it is necessary to regulate and legally define health care quality standards in the health system of Serbia and thus precisely determine the quality of service provided and, at the same time, manner of payment, i.e. responsibility for the costs incurred. In order to reach a financially sustainable health care system in Serbia, it is necessary to analyze different models of funding, implement rationalization and reorganization of methods of funding and reexamine the health insurance models in Serbia. The priority concerning the health system financing is the selection of the most adequate method of raising sufficient funds. There are numerous factors which will determine our choice of a particular The address of the author: Ana Gavrilovic  anagavrilovic22@gmail.com Gavrilovic A. Health insurance system in Serbia MEST Journal Vol. 1 No. 2 pp. 114 – 126 Published: July 2013 MESTE | 115 model of health care system funding in Serbia, among which the following are most important: degree of socio-economic development of the country, fiscal capacity of the country, methods and efficiency of fund raising, support from the political system in its feasibility.

Capacity of middle management in health-care organizations for working with people—the case of Slovenian hospitals

BackgroundEffective human resources management plays a vital role in the success of health-care sector reform. Leaders are selected for their clinical expertise and not their management skills, which is often the case at the middle-management level. The purpose of this study was to examine the situation in some fields that involve working with people in health-care organizations at middle-management level.MethodsThe study included eight state-owned hospitals in Slovenia. A cross-sectional study included 119 middle managers and 778 employees. Quota sampling was used for the subgroups. Structured survey questionnaires were administered to leaders and employees, each consisting of 24 statements in four content sets evaluated on a 5-point Likert-type scale. Respondents were also asked about the type and number of training or education programmes they had participated in over the last three years. Descriptive statistics, two-way analysis of variance, Pearson’s correlation coefficient and multiple linear regression were used. The study was conducted from March to December 2008.ResultsStatistically significant differences were established between leaders and employees in all content sets; no significant differences were found when comparing health-care providers and health-administration workers. Employment position was found to be a significant predictor for employee development (β = 0.273, P < 0.001), the leader–employee relationship (β = 0.291, P < 0.001) and organizational motivation (β = 0.258, P < 0.001). Area of work (β = 0.113, P = 0.010) and employment position (β = 0.389, P < 0.001) were significant predictors for personal involvement. Level of education correlated negatively with total scores for organizational motivation: respondents with a higher level of education were rated with a lower score (β = -0.117, P = 0.024). Health-care providers participate in management programmes less frequently than do health-administration workers.ConclusionEmployee participation in change-implementation processes was low, as was awareness of the importance of employee development. Education of employees in Slovenian hospitals for leadership roles is still not perceived as a necessary investment for improving work processes. Hospitals are state owned and a national strategy should be developed on how to improve leadership and management in Slovenian hospitals.

Chapitre 1. Healthcare sector reform and its influence on public hospitals in mainland China

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Electoral Accountability and Local Government Efficiency: Quasi-Experimental Evidence from the Italian Health Care Sector Reforms

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system; second a process of fiscal decentralization. The electoral system was changed in 1995 and replaced a pure proportional system by a majoritarian system, fostering the transition of regional governments towards a presidential regime. The process of fiscal decentralization took effect in 1998, when intergovernmental grants earmarked for the health care sector were replaced by regional taxes. The Italian context offers a unique source of data to test the predictions of recent theoretical models that support a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralization. The paper provides two main contributions: a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s; the evaluation of the impact of the electoral reform in a quasi-experimental setting. The final results provide empirical evidence in line with the findings of the theoretical models.

Determinants of out‐of‐pocket expenditures on prescribed medications in Tajikistan

The purpose of this paper is to quantify the impact of socio-economic characteristics on out-of pocket expenditures for prescribed medications in Tajikistan and provide recommendations for healthcare sector reform. The research question in this paper is: what household, personal, economic, and health factors help explain expenditures on medications? From a theoretical perspective, this paper contributes to the on-going discussion of out-of-pocket expenditures in Tajikistan. From a practical perspective, in line with this recent development in the Tajikistan healthcare sector, it helps to develop evidence-based decision-making by answering practical questions: what factors affect pattern of out-of-pocket expenditures for prescribed medication? Which groups of the population should be granted a discount or fee-waiver when buying them? Based on micro-file data from the most recent cross-sectional nationally-representative survey of Tajik households, this paper develops and tests a multivariate model of identifying determinants of out-of-pocket expenditures on prescribed medications in Tajikistan. The paper finds that economic status, chronic illness, disability, number of small children, short supply of necessary drugs, and cardiac and acute illnesses are the strongest determinants of spending for prescribed medications in the country. This paper demonstrates that to ensure accessibility to and affordability of prescribed medications, discounts or fee-waivers should be granted to specific categories of households, those in poverty, with chronically ill members and with small children. These discounts or fee-waivers should cover prescribed medications for children, long-standing illness as well as for cardiac and acute infectious diseases. Administrative and economic measures should be taken to reduce the extra costs incurred due to the shortage of prescribed medications. Hence, these findings can be used in developing and designing reforms in the Tajikistan healthcare sector.

Challenging the Neoliberal Trend

Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Mision Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Mision Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Mision Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada.

Challenging the neoliberal trend: the Venezuelan health care reform alternative.

Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Misión Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Misión Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada.

Venezuela's Barrio Adentro: An Alternative to Neoliberalism in Health Care

Throughout the 1990s, all Latin American countries but Cuba implemented health care sector reforms based on a neoliberal paradigm that redefined health care less as a social right and more as a market commodity. These reforms were couched in the broader structural adjustment of Latin American welfare states as prescribed by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program, Misión Barrio Adentro (Inside the Neighborhood). In this article, the authors review the main features of the Venezuelan health care reform, analyzing, within their broader sociopolitical and economic contexts, previous neoliberal health care reforms that mainly benefited transnational capital and domestic Latin American elites. They explain the emergence of the new health care program, Misión Barrio Adentro, examining its historical, social, and political underpinnings and the central role played by popular resistance to neoliberalism. This program not only provides a compelling model of health care reform for other low- to middle-income countries but also offers policy lessons to wealthy countries.

The international community and the reconstruction of health care in South Eastern Europe

Today, with the aid of the international community [European Union (EU), World Bank (WB), World Health Organisation (WHO), United Nations Children's Fund (UNICEF), nongovernmental organisations (NGOs), Global Fund (GF), Stability Pact, etc.] the ministries of health in transitional countries in the South Eastern Europe (SEE) region are in the process of expanding the capacities and skills of the health workforce in order to achieve successful health care reform and accomplish necessary steps for EU integration. The aim of this paper is to review international community support to reconstruction of the health care in SEE countries, with main focus on the EU and WB donors and projects. Review was done on the basis of existing donor reports, Internet search (search of official Web sites and electronic databases, check of references from selected documents, and use of a generic Internet search engine) and authors’ experience from different health projects. The governments of SEE countries, in order to create an effective and efficient health system, overcame a period of transition and soon or later became ready for the process of EU integration, and began working on the following issues: rehabilitation, reconstruction and equipping of health facilities; developing a health strategy and policy documents; legislation and financing framework; building institutional, human resource and management capacity; health care sector reform; support to public health development and restructuring of the pharmaceutical sector. In many SEE countries, the capacity of the Ministry of Health and Health Insurance Fund was strengthened, and policy and strategy documents were drafted to guide reorganisation and reorientation of health care services. The public health system was strengthened. A family medicine model was introduced and developed in most countries. Development of enabling legislation mostly followed proposed changes in the health system. Although progress on several important fronts in achieving transition and progress in the rehabilitation health sector in SEE countries is significant, a lot remains to be done. Experience in some countries can be used to stimulate, motivate and encourage professionals throughout the civil service to grasp with both hands the opportunities for positive change.