Implementation Of Health Reform Research Articles

Addressing health equity within the implementation of health system reforms: A scoping review

Abstract Background Health equity is a commonly asserted goal of health systems. However, there is limited understanding on appropriate equity-promoting strategies within system reform initiatives. To address this knowledge gap, we conducted a scoping review to (1) identify and characterise strategies that promote health equity during the implementation of health reform initiatives; and (2) reflect on implications for reform implementation and research. Methods Using scoping review methodology, we systematically searched peer-reviewed literature from 2013-2022. A comprehensive search strategy captured literature inclusive of four domains: (1) health equity; (2) implementation; (3) health system; and (4) reform, policy, or theories. Thematic analysis was conducted, and findings reported according to the PRISMA checklist. Results Of 10,999 identified articles after duplicates were removed, 69 articles met the inclusion criteria. A vast number of health equity promoting themes derived from individual strategies was identified, with a median of 10 strategies (interquartile range 7, 15) per article. Two a priori conditions were observed: (1) the need for health equity promoting strategies to be made explicit, and (2) the need for alignment and complementarity of strategies at community, regional, state, and national health system levels. Themes identified, such as accountability, leadership commitment, shared power, adaptability, and trust, present opportunities to support strategy selection and alignment across health system levels. Underpinning strategies were present across a range of governance domains, although emphasis varied by health system level. Conclusions The review recognises that different strategies may be applicable in different contexts; however, it may help to be explicit toward health equity strategies and align across health system levels. In future, reform implementation reporting should be made more consistent to promote a shared language. Key messages • A comprehensive review identified two a priori conditions to support equity promoting strategies within reform implementation; being explicit towards equity, and alignment across system levels. • Our research identified health equity-promoting strategies within health reform implementation. Common across system levels included accountability, leadership commitment, shared power and monitoring.

2.M. Workshop: Fostering integrated care through a large-scale structural health system reform in Finland

Abstract Several countries have introduced health system reforms to foster integrated care within their health systems and in some case also between health and other welfare services such as social care. These integrated care initiatives have included reorganization of the work of professionals, developing patient pathways and removing barriers for organisations to work together. Comprehensive structural reforms to foster integrated care have not been that common. In health systems, like in public policy in general, small, micro-level reforms are common but only seldom large-scale structural reforms are enacted. Also integrated care is often fostered through small-scale reforms which are not always even scaled up from the local or regional level to national level policies. In Finland a large-scale structural reform was introduced in 2023 which can be marked as one of the most comprehensive health system reform in Europe over the past decades. As a result of the reform the responsibility for organizing health care, social services and rescue services was transferred from over 300 municipalities to 22 health and social care authorities which all get funding from the state. A key tool in pursuing the reform has been to implement administrative and financial integration both in terms of vertical integration within health system and horizontal integration between health care and social services. The workshop uses the Finnish health system reform as a case study to present how integrated care can shape the health reform agendas and implementation of the reform. We discuss how structural reformation can foster integrated care at patient level and how the rather radical restructuration of the Finnish health system looks from the wider European perspective. Key messages • One of the most comprehensive health-system reforms in Europe over the past decades was introduced in Finland in 2023. • The radical structural health-system reformation can foster integrated care at patient level and offers a learning opportunity to other European health systems.

Results of the seminars on HIV prevention in Tashkent city educational institutions

The article is devoted to the role of nurses in the prevention of immunodeficiency virus. Since nurses, by virtue of their activities, are closest to the sick and their families, they are able to create the most favorable atmosphere for them, which is very important for the success of treatment and control. Today's nurse is the foremost force of modern medicine. It plays an important role in the implementation of health reforms. Based on international requirements, the nursing education system is being improved.

Implementation of mental health policies and reform in post-conflict countries: the case of post-genocide Rwanda.

The global burden of mental illness is rising, with populations in post-conflict countries contributing significantly to the numbers. Governments in these countries face the dual challenge of responding to increased mental health needs and implementing this response with institutions and economies weakened by war. This research studies the process, successes and challenges of implementing mental health reform in a low-resource, post-conflict country, a subject that is rarely studied. Based on fieldwork conducted in Rwanda in 2019, the study focuses on the implementation of this African country's post-genocide mental health policy, which relies primarily on strategies of decentralization and integration into the primary health care system. The results are based on 30 interviews conducted in Kigali and Ngoma with primary stakeholders including government officials, representatives from nongovernmental organizations, service providers and academics. These stakeholders held a positive view of the main strategies of the policy as they resulted in increased accessibility and availability of care for Rwandans. However, they also noted the institutionalization and individualization of mental health care as gaps in the implementation that do not respond to the Rwandan context. Building on complexity theory, the analysis found that many of these gaps, as well as opportunities to address them, are missed by the government due to top-down implementation and a lack of collaboration with local organizations and service providers working in the domain. The research results suggest that although it is possible to prioritize mental health in low-resource, complex settings, the implementation of such reform requires collaborative, adaptive and horizontal approaches in order to adequately address and respond to citizen needs and ensure quality mental health care for all.

Human rights in the context of implementing health reform

In general, the legal state of social orientation places the person in the first place as the highest value of society; therefore, human health is not only a guarantee of its long, active and useful life, but also a source of spiritual health of society.
 Since health care activities are related to the reproduction of real everyday life of people, it is necessary to identify the main criteria for modernization and organizational and legal support of the state doctrine of health care of the social state governed by the rule of law: 1) socio-economic, psycho-emotional, environmental conditions for health; 2) the level of medical care; 3) availability of safe and healthy forms of life; 4) civil rights and guarantees for receiving medical care and living in a safe environment; 5) the ability to choose medical services and health-friendly behaviors and lifestyles; 6) material and socio-cultural bases for the development of human health potential in accordance with his social status and health status; 7) ways of regulation, social control of health care, pharmacology and medicine; 8) the degree of responsibility of social actors for the preservation of health; 8) the degree of responsibility of social actors for the preservation of health; 9) ways to reduce social inequality in health care and health care; 10) social interests, needs, expectations, motives and incentives of social actors in the field of health care.
 The purpose of formation of the state doctrine of health care of the social legal state of the decision of the following tasks: 1) methodological substantiation of the criteria for distinguishing social innovations in the field of health care from the whole array of innovations; 2) sociological analysis of innovative solutions in the field of health care, considered in relation to the principles of social policy in the field of health care: justice, equality (accessibility), efficiency, coordination of interests; 3) sociological analysis of satisfaction with health services and the expectations of different groups and categories of the population on the need and directions for improving certain aspects of its activities; 4) development of methods for studying health self-assessments as a quality in demand in the innovative economy; 5) public opinion on the prospects for the development of the health care system; 6) study of the professional vocation of doctors in the context of increasing work motivation and the formation of a relationship of trust between doctor and patient; 7) development of scientifically substantiated recommendations aimed at improving the quality of management of innovative development in the field of health care.

The Change in DMFT of Six-Grade Primary School Children in Shiraz two Years after Implementation of the National Oral Health Reform Plan.

Statement of the Problem: The oral health reform plan has been added to the Iran's health reform plan since the beginning of 2015. Evaluation of Iran’s oral health reform plan has rarely been conducted.Purpose: The aim of this study was to evaluate the change in DMFT among the six-grade primary school children of the city of Shiraz, two years after implementation of oral health reform plan.Materials and Method: A repeated cross-sectional study was conducted on six-grade primary school children of Shiraz in 2015 and 2017. About four hundred children were selected each year by cluster randomization sampling. The schools were randomly selected from three socioeconomically different types of schools including private schools, state schools in affluent areas, and state schools in deprived areas. The DMFT Index of selected children was compared between 2015 and 2017, and among three socioeconomically different areas. One-way ANOVA and Poisson regression tests were used for statistical analysis.Results: The mean DMFT of children was 1.47±1.83 in 2015 and 1.29±1.79 in 2017. There was significant difference in mean DMFT value between years 2015 and 2017 (p= 0.048). The percentage of children with untreated dental caries was 46% and 36.7% in 2015 and 2017 respectively. There was no statistically difference in DMFT of the three socioeconomically different schools.Conclusion: There has been significant improvement in DMFT of sixth grade school children of Shiraz two years after implementation of oral health reform plan.

The Relationship between the Kind of Delivery and 5 Indexes of Mother and Baby's Health Before and After Implementing Health Reform Plan in Selected Hospitals of Azarbaijan Sharghi

Introduction and aim: To improve the individuals' health, reforms should be made in the health systems. As a result, assessing the impacts of reforms is a way to evaluate the effectiveness of the health system. The aim of this study was to study the relationship between the kind of delivery and the five indexes of mother and baby's health before and after implementing the health reform plan in selected hospitals of Azarbaijan Sharghi, Iran.
 Issues and methods: This descriptive-analytical study was conducted in 2017. The study was conducted among eight educational, medical, and private hospitals. Before and after the program, 800 files were selected using simple random sampling method. The researcher made a check list with confirmed validity to extract the data. The data were analyzed using descriptive statistics and T-tests by SPSS-22.
 Results: The average age of mothers in the two intervals was 27 years. Most participants did not deliver before and their education was diploma or lower. The rate of natural delivery from 34.5% (before the plan) reached 44.2% (after the plan)(p<0.05). The rate of mothers and babies' mortality reduced from 0.3 and 0.8 to 0 and 0.5, respectively. Mothers and babies' mortality and stillbirth had no significant difference based on the kind of delivery (p>0.05).
 Conclusion: Findings indicated significant increase of natural delivery after the reform plan in health system. Moreover, the rate of mothers and babies' mortality decreased. These results can guide the policymakers for deciding about the course of plan and its review.

Universal Health Coverage in Marginalized Populations: A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador.

In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further.

Making Universal Health Care Effective in Argentina: A Blueprint for Reform

The reform of a health care system requires attention to specific components but also to the creation of an environment that supports change. Argentina has achieved nominal universal health coverage (UHC) but it still needs to work on achieving effective universal health coverage, especially with regard to quality and equity. Nominal coverage means that everyone has been enrolled and has the right to access, and effective coverage means that people have actually received prioritized health care services. In this article, we present our proposals to advance UHC in Argentina. The article includes an overview of Argentina’s health system, then introduces the driving forces for reform, and finally analyzes four key issues where we provide our action plan to implement health reform for moving Argentina forward. Overall, our ultimate goal is to provide actual UHC and not aspirational UHC in Argentina by strengthening provincial health systems through enforcing public insurance schemes; utilizing an explicit priority-setting approach to make decisions on health coverage; reducing health disparities in coverage and outcomes, at least on prioritized health problems; and building a primary care–oriented health care system.

Barack Obama, Organizing for Action, and Executive-Centered Partisanship

This article examines the historical significance of Barack Obama's creation of “OFA,” a presidential grassroots organization. It attempts, as Theda Skocpol has put it, to analyze American political development “as it happens.” Born as “Obama for America” during the 2008 campaign, OFA was renamed “Organizing for America” and ensconced in the Democratic National Committee during Obama's first term, where it served as the “grassroots arm” of the party. After 2012, it was spun off as a nonprofit social-welfare entity called “Organizing for Action” dedicated to advocating for Obama's second-term objectives: immigration reform, efforts to fight climate change, gun safety legislation, LGBT rights, and the implementation of health reform in the face of continuing intense opposition. That OFA was kept intact after Obama's successful election and reelection efforts marks it as an especially pioneering effort. Making use of several personal interviews, a wealth of primary documents, and data on spending and mobilization tactics, we explain how Obama's paradigm-shifting organization marked an effort to meet the challenges of forging a new progressive coalition in a fractious polity. More broadly, the article considers how this digital age grassroots effort has been influenced by, and in turn has contributed to the advance of an executive-centered partisanship characterized by high expectations for presidential leadership in a context of widespread dissatisfaction with government, strong and intensifying political polarization, and high-stakes battles over the basic direction of domestic and foreign policy programs.

Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles

Introduction:This study evaluates implementation of the Quebec Mental Health Reform (2005–2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered.Methods:Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies.Results:While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions.Conclusion:Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

Developing an HMIS Architecture Framework to Support a National Health Care eHealth Strategy Reform: A Case Study from Morocco

—An increasing number of low- and middle-income countries are receiving significant investments to implement health reform strategies featuring a health management information system (HMIS) as a fundamental eHealth intervention. We present the case of Morocco's first step toward the implementation of a national HMIS: the “urbanization” of its health information systems—an information architecture methodology designed to leverage existing capacity while ensuring sustainability of the new HMIS. We report on this process and share lessons learned, applicable to similar countries involved in HMIS interventions, including involving all stakeholders from inception to rollout, encouraging local ownership of the new HMIS, fostering active data usage among users, and leveraging existing personnel rotation policies when developing adoption strategies and facilitating capacity building efforts.

Financing strategies to improve essential public health equalization and its effects in China.

BackgroundIn 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions.MethodsWe reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants’ interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003–2014 were collected, descriptive and equity analyses were used.ResultsBefore 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China’s tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases.ConclusionsThe delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.

Drug Supply Chain Management and Implementation of Health Reform Plan in Teaching Hospital Pharmacies of Ahvaz, Iran

Background: Drugs play a strategic role as a health commodity. Thus, the supply chain management of drugs is an important issue to reducing costs and thereby improving patient health. Objective: This study evaluated the status of drug supply chain management and health reform in the pharmaceutical sector of teaching hospitals in Ahvaz, Iran. Methods: This cross-sectional study was carried out in pharmacies of teaching hospitals in Ahwaz, Iran in 2015. Data was collected through a checklist extracted from the Evaluation Checklist of the Food and Drug Deputy and related articles. The study checklist examined six dimensions of the Evaluation Checklist, including drug storage, administrative regulations, preparation of medicines, drug distribution, taking medication, and implementation of health reforms in the pharmaceutical sector. The content validity of the checklist was confirmed by experts and pharmaceutical specialists. Data was analyzed for descriptive characteristics such as frequency and percentage using EXCEL version 2010 software. Results: The findings show that hospitals met standards for administrative regulations with 78.5% and preparation of medicines with 77.25%. The dimensions of drug storage with 74.75%, taking medication with 74.25%, implementation of health reforms with 71.5%, and drug distribution with 62.5% were in a near-standard state. Conclusion: Supply chain management systems of medicines in teaching hospitals are near-standard. To improve hospitals, offering proper training to employees, using the fixed-rate shopping system, and providing facilities to patients are recommended.

Implementation of the Quebec mental health reform (2005-2015).

BackgroundThis study evaluates implementation of the Quebec Mental Health (MH) Reform (2005–2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined.MethodsEleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks.ResultsWhile implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH.ConclusionsSuccessful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1832-5) contains supplementary material, which is available to authorized users.

Editor's Note

Editor's Note

Liking Health Reform But Turned Off By Toxic Politics

Six years after the Affordable Care Act (ACA) became law, the number of nonelderly Americans with health insurance has expanded by twenty million, and the uninsurance rate has declined nearly 9 percentage points. Nevertheless, public opinion about the law remains deeply divided. We investigated how individuals may be experiencing and responding to health reform implementation by analyzing three waves of a panel study we conducted in 2010, 2012, and 2014. While public opinion about the ACA remains split (45.6percent unfavorable and 36.2percent favorable), there have been several detectable shifts. The share of respondents believing that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those considering reform to have some or a great impact increased by 19 percentage points. Among individuals who held unfavorable views toward the law in 2010, the percentage who supported repeal-while still high, at 72percent-shrank by 9 percentage points from 2010 to 2014. We found that party affiliation and distrust in government were influential factors in explaining the continuing divide over the law. The ACA has delivered discernible benefits, and some Americans are increasingly recognizing that it is improving access to health insurance and medical care.

Recovery-Oriented Mental Health Practice: A Social Work Perspective

This paper explores the concept of recovery-oriented social work practice in mental health settings as it is understood and practised by social workers. The authors describe an investigation of the implementation of mental health reforms in Quebec. This study explored the gap between the reforms' philosophical orientations of mental health recovery and its practical realisation. Specifically, we will discuss the ways in which the social work field encompasses approaches that potentially espouse contradictory understandings of recovery. The study highlights the external and internal obstacles and facilitators to recovery-oriented social work practice. This qualitative research project used semi-structured interviews with eleven primary care mental health social workers in two health care agencies to better understand how they situate themselves with respect to the recovery orientation. The findings illustrate the impact of organisational constraints on social workers' attempts to practise from a recovery-oriented perspective. Specifically, they show that (i) managerial orientations espoused by the reforms have paradoxically led to systemic barriers to recovery-oriented practice and (ii) recovery practice by social workers is facilitated in part by their understanding of this philosophy and by leadership on the part of their managers. This paper will allow for a better understanding of social work perspectives and practical frustrations regarding current primary care mental health practice.

Making Federalism Work? The Politics of Intergovernmental Collaboration and the Ppaca

The Patient Protection and Affordable Care Act (PPACA) is a complex piece of legislation that requires a high level of collaboration between actors at multiple levels of government, federal and state, to successfully implement its provisions. However, the polarized political environment in which the law was passed has created roadblocks for implementation, with Republican governors claiming that they will not negotiate with federal agencies over many of the law's key details. Though the decisions of governors and of state legislatures are critical for policy implementation, much of the effort will require administrators at multiple levels of government, and often with different preferences, to collaborate with one another to set policy priorities and oversee the operation of key features of the law. This paper reports on the results of a recent in-depth survey of state-level administrators that examines the extent of state-federal collaboration to implement health reform. Using qualitative and quantitative indicators, I find that state administrators’ engagement in collaborative activity is generally robust. Even so, state administrators’ perceptions of their relationship with federal agents appear to vary by the partisan compositions of their respective states, suggesting that political conflict over the reform may pose some dilemmas for future implementation efforts.

Medicaid provider reimbursement policy for adult immunizations

BackgroundState Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. ObjectiveDetermine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. DesignObservational analysis using document review and a survey. Setting and participantsMedicaid administrators in 50 states and the District of Columbia. MeasurementsWhether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. ResultsMedicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. LimitationsStudy results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. ConclusionsMedicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services.