National Health System Reform Research Articles

Is the EU steering national social and health policy making? A case-study on Finland's national reform

As part of the European Semester, Finland received country-specific recommendations (CSRs) in 2013–2020 that encouraged the reform of national social and health services. These recommendations were part of efforts to balance public finances and implement public-sector structural reforms. Finland has been struggling to reform the national social and health care system since 2005. Only on 1 January 2023 did the new wellbeing services counties become liable for organizing social, health, and rescue services. Studying the CSRs for Finland enables us to understand better what genuinely occurs at the EU member state level. This data-driven case study aims to disclose the relevance of the European Semester for Finland in the pursuit of a national social and health system reform. The mixed-method approach is based on the research tradition of governance, and the study contains features of data sourcing and methodological triangulation. Empirically, the research material consists of Finland's official policy documents and anonymous semi-structured elite interviews. The study highlights that although the received CSRs on the need to restructure social and health services corresponded to Finland's views, their influence to national reform efforts was limited. The CSRs were administered according to the established formal routines, but separately from the national reform preparations. The CSRs, however, delivered implicit steering, which were considered to affect social and health policy making in various ways.

Can ENGLAND'S National Health System Reforms Overcome the Neoliberal Legacy?

England’s National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal “market” are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.

Building a Performance Management System for Hospitals Based on Diagnosis-Related Group (DRG) Payment

With the deepening of the national medical and health system reform, various supporting reform measures are being promoted. The reform of medical insurance payment methods is an important part of the process, and payment through diagnosis-related groups (DRGs) will gradually become the main way for medical insurance to pay medical institutions. According to the analysis of the impact of DRG payment on hospital performance management, this research examines the construction and implementation of the internal performance management system (IPMS) based on DRG payment in hospitals. The IPMS based on DRG payment includes four elements: organizational management system, assessment system, communication and feedback system, and information support system. In addition, this study explores how IPMS can be implemented in hospitals, including the preparation before implementation, key points to be grasped during implementation, and considerations to be focused on.

Defining community health services in Australia: a qualitative exploration.

The Community Health Program of the 1970s was an attempt to introduce a national community health model. However, although community-based health care is an important element of the health systems of all Australian states and territories, the definition of what constitutes a 'community health service' in Australia today is not clear. A search of government websites failed to provide information about the types and characteristics of services that would be included in the term. Therefore, semi-structured interviews were conducted with 13 key informants in roles with responsibility for primary and community health services from health departments in all Australian states and territories. Questions explored their understanding of community health services as they operated in their jurisdiction. The study adopted a blended inductive and deductive orientation within a qualitative descriptive method. There was little consistency in the way community health services were described across jurisdictions. The defining attributes of a 'community health centre' described by an international peak body did not apply to services in the majority of jurisdictions in Australia. Victoria was more aligned with the description than other jurisdictions, with organisations defined through legislation and a separate funding stream to support aspects of service delivery. Those designing and implementing national health system programs and reforms need to be aware that terms, such as 'community health', do not mean the same thing across jurisdictions; attempts to create consistency have to recognise differences that will affect new initiatives, as well as the spread of successful policies and programs from one jurisdiction to another. Without a consistent description, it is difficult to explore the current role of community-based health care across Australia in improving access to health care.

The developing family doctor system: evidence from the progress of the family doctor signing service from a longitudinal survey (2013\u20132016) in Pudong New Area, Shanghai

BackgroundThe family doctor system is a vital part of China’s national medical and health system reform. Evidence of the degree of implementation of the family doctor system is required to assist managers and policy makers in Pudong with resource allocation planning. This study analyzed changes in indicators (family doctor team construction, contracted medical services, health management services and so on) over time to evaluate the progress of the family doctor system in Pudong.MethodsWe used a cross-sectional design with an online questionnaire survey to collect 3-year (2013–2016) consecutive data. The online questionnaires were completed by the doctors responsible for information reporting in each community health service center of Pudong. The data were sorted, and the indices calculated and analyzed using descriptive statistics and statistical tests.ResultsThe proportion of registered general practitioners increased each year, from 50.8% in 2013 to 66.5% in 2016; this difference was statistically significant (P = 0.000). The number of family doctors per 10,000 permanent residents rose each year, from 1.7 in 2013 to 2.1 in 2016. The rate of contracted household residents was 55.7% in 2013 and increased to 71.7% in 2016, with the difference being significant in different years (P = 0.012). Analysis of referral services showed the people times of contracted residents transferring to higher-level hospitals from family doctors increased each year, from 172,734 in 2013 to 341,615 in 2016; differences among different regions were statistically significant for 2013–2016. The rate of health screening for contracted residents also increased each year, with statistically significant differences in different years (P = 0.000). The rate of health assessment interventions for contracted residents rose each year, with statistically significant differences in different years (P = 0.003).ConclusionsThe family doctor signing service in Pudong made headway in general practitioner availability, contract service rate of household residents, and providing health management services. However, problems included family doctor shortages and limited supporting policies, especially in rural and suburban areas compared with urban divisions. Increasing the enrollment rate of family doctors and speeding up the implementation of “contract service fees” are key tasks for the sustainable development of the family doctor system in Pudong.

Community health and public health nursing

Community health and public health nursing is a relevant issue in the context of the Portuguese National Health System reforms. International organizations, such as the World Health Organization, have emphasized the importance of nurses in community and public health care, and international studies report ongoing changes in this area in many countries. Through a Systematic Literature Review, conducted in early 2019, following an Equator Network protocol, Systematic Reviews, CRD's guidance for undertaking reviews in health care, prepared by York University, we addressed the research issue: what has been published about community health and public health nurse competencies and interventions. The inclusion of articles followed PRISMA 2009 and 36 of the total number of publications were selected. The contributions refer to the expansion of nurses’ competences, events such as health fairs, nutrition, and caries assessments, performance in contexts of natural disasters, development of management skills, understanding and influencing the making of public health policies. With the ongoing public health reform taking place in Portugal, it is also a good opportunity for nursing to investigate, produce, innovate, and recreate itself.

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China.

Background:China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development.Methods:We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions.Results:During 2010–2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015.Conclusions:In 2010–2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

Inside the black box: The EU’s economic surveillance of national healthcare systems

In the context of macro-economic surveillance, the European Union(EU) increasingly addresses national health system reform. Member States receiving financial assistance are required to implement detailed reforms stipulated in ‘Memorandums of Understanding’ (MoUs). But the health systems in other (non-MoU) countries are also scrutinised in the context of the ‘European Semester’: through this annual policy cycle, the EU has continuously strengthened the tools it uses to enforce compliance. This article aims to open the black box of the EU’s economic surveillance of national healthcare systems by outlining the complex policy architecture of the EU’s newly acquired role in this area. The story of how health has emerged on the European agenda illustrates how the Eurozone crisis created a policy ‘window of opportunity’ to push through fiscal surveillance of health systems as part of the solution to the crisis. The cognitive frameworks put forward by certain elites added up to the primacy of an economic perspective over health objectives. Finally, our analysis of the role of the actors involved in the elaboration of EU guidance in the field of health points to the dominance of ‘economic’ actors and relative absence of ‘health’ actors, in spite of increased attempts by the latter to gain influence.

In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study.

Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. Secondary analysis of a prospective study of patients >65years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. In-hospital mortality occurrence was 6.8%, and 37% of the patients died during the weekend. The logistic regression model explained 34.3% (R 2) of the variance of in-hospital mortality: patients were six times (95% CI=3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3months were also at increased risk of dying (RR 1.360, 95% CI=1.024-1.806) as well as those receiving more care from family carers (RR=1.017, 95% CI=1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR=2.236, 95% CI=1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR=0.940, 95% CI=0.912-0.969). Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.

A decade of peace: Mental health issues and service developments in the Solomon Islands since 2003.

To describe the impact on mental health and psychosocial wellbeing of the armed conflict that occurred in the Solomon Islands from 1998-2003 and the subsequent political unrest and natural disasters, and the developments in mental health services since 2003. A literature and document review was conducted, supplemented by the written reflections of senior staff in the Solomon Islands Mental Health Service. Conflict and natural disaster have had a significant impact on the mental health and functioning of individuals, families and communities. National health system reform has been accompanied by the reorientation of the mental health services from custodial care to care in the community and greater emphasis on mental health promotion and prevention. The dedication of the small group of Solomon Islands mental health professionals, supported by local health service managers and external donors, has been a major strength. However, they face significant challenges. Continued investment in mental health, including the treatment and prevention of mental and substance use disorders, is essential for mental health and development outcomes. All development stakeholders, including civil society, government, academic and research institutions, and development partners, have a role to play.

Injury Prevention as an Integral Part of Health System Reform Efforts: Lessons Learned from Recently Enacted Massachusetts Laws

—Injury is the leading cause of mortality in people younger than 44 years of age. Injury prevention laws and policies are not only effective in saving lives at a population level but are also remarkably cost-effective compared to most public health interventions. For example, the implementation of a stricter Massachusetts Graduated Driver Licensing Law in 2007 resulted in a very significant and rapid decrease in the rates of motor vehicle crashes of teenager drivers, saved thousands of lives, and resulted in more than $10 million dollars savings in health care costs over 5 years. We therefore suggest that trauma and injury prevention should be made a priority in any attempt at local, regional, or national health system reform.

Trends in Indonesia’s Nurse Migration Policy: Changes in Out-migration in the Era of Aging and National Health System Reform

Trends in Indonesia’s Nurse Migration Policy: Changes in Out-migration in the Era of Aging and National Health System Reform

The burden of inappropriate emergency department pediatric visits: why Italy needs an urgent reform.

To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010-2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24hours a day and 7days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health.

Transforming rural health care through information technology: an interventional study in China

This article estimates the impacts of health information technology (HIT) on health-care delivery in the Wenchuan County of China, where the devastation of the 2008 Great Wenchuan Earthquake and the subsequent large-scale HIT implementation (the Healthy Wenchuan Program) offers a 'natural experiment' opportunity, enabling us to conduct a difference-in-difference evaluation of the potential benefits of HIT on accessibility, affordability and appropriateness of health-care services in the underdeveloped rural area. Based on data collected from two field surveys in township hospitals, we find that for both the inpatient and outpatient samples, the HIT system promotes access to medical care by increasing doctor referrals and encouraging within-county medical utilization, reduces patient financial burden in certain expenditure categories, and contributes to higher patient satisfaction on medical care quality. On the other hand, we also find that HIT leads to increased patient waiting time for hospital registration, reflecting the unique challenges in implementing HIT in the underdeveloped areas. Our study contributes to the growing body of literature on evaluating the impacts of HIT application in the developing regions, and provides implications on the potential role of HIT in China's national health system reforms.

International experiences of promoting generics use and its implications to China

To summarize international experiences in promoting use of generics and to extract essence for China's reference. This is a commentary of two systematic reviews about policies to promote use of generics and its implications to China. Price, reimbursement, and generic substitution policies in European countries, and approaches in low and middle income countries in promoting market competition, appropriate intellectual property right protection strategy, and necessary demand side incentives, are all meaningful for China to contain soaring pharmaceutical expenditures, and to maintain the achievements and outcomes of the national health system reform. Effective promotion of generics use must be practice based on the real situation. Tailor-made and comprehensive measures are needed to address both demand and supply sides barriers before achieving tangible cost containment effect without unexpected side effects.

Constantly improve the medical security system to achieve universal coverage

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012. Key words: Medical security; Medical insurance; Institutional system; Universal coverage

Current challenges in the provision of ambulance services in New Zealand

Emergency Medical Services (EMS) in New Zealand has been serving the society since the first ambulance in 1892. Since then it has developed rapidly following national health system reforms and changes in lifestyle that increase demands and expectations from local communities. Today, the system provides high-quality pre-hospital emergency care. This article will briefly introduce some of the issues facing EMS that will impact the future of this crucial system in New Zealand. These issues include demands because of an aging population funding, double crewing, and volunteerism, registration, and unified standards.

The Potential Impact of the World Trade Organization's General Agreement on Trade in Services on Health System Reform and Regulation in the United States

The collapse of the World Trade Organization's (WTO) Doha Round of talks without achieving new health services liberalization presents an important opportunity to evaluate the wisdom of granting further concessions to international investors in the health sector. The continuing deterioration of the U.S. health system and the primacy of reform as an issue in the 2008 presidential campaign make clear the need for a full range of policy options for addressing the national health crisis. Yet few commentators or policymakers realize that existing WTO health care commitments may already significantly constrain domestic policy options. This article illustrates these constraints through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues. The author concludes with some recommendations to the U.S. Trade Representative to suspend existing liberalization commitments in the health sector and to interpret current and future international trade treaties in a manner consistent with civilized notions of health care as a universal human right.

A SAÚDE MENTAL NA ATENÇÃO BÁSICA - ARTICULAÇÃO ENTRE OS PRINCÍPIOS DO SUS E DA REFORMA PSIQUIÁTRICA

Pesquisa de caráter qualitativo desenvolvida em uma Unidade Básica de Saúde localizada em Betim (MG). Oobjetivo desta investigação foi discutir a Saúde Mental na Atenção Básica como articulação entre os princípios do SistemaÚnico de Saúde e da Reforma Psiquiátrica. Os dados foram coletados através de entrevista semi-estruturada e observaçãoparticipante e analisados pela técnica do Discurso do Sujeito Coletivo. Os princípios do Sistema Único de Saúde e daReforma Psiquiátrica são efetivados através das ações de atendimento individual, recepção da saúde mental, visitadomiciliar, discussão de caso e oficinas de trabalhos manuais desenvolvidas na Atenção Básica e das estratégias adotadasde participação e capacitação dos Agentes Comunitários de Saúde, acolhimento coletivo, expressão subjetiva da equipee envolvimento da família/comunidade.

What Should Be Done Now That National Health System Reform Is Dead?

The demise of the movement toward major federal health system reform legislation leaves us facing two stark realities. First, many of the widely recognized problems of our health care system will remain with us. Second, the failure of our political system, after 2 years of public and legislative debate, to enact any version of comprehensive legislation suggests it is unlikely to do so in the near future. This legislative impasse has major implications for what will happen in the years ahead. See also p 242. We highlight briefly the problems we expect to persist as a result of the national failure to develop comprehensive reform. We then suggest alternative strategies for incremental reform, distinguishing between those issues easily and those not so easily resolved in our emerging political environment. We can expect in the near term the following: The number of Americans without health insurance will remain high. Just last