Health systems and reform最新文献

Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study. 数字化和超竞争研究文化时代的高效和有效的糖尿病护理：西太平洋地区以马来西亚为例的重点回顾。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-01-06 DOI: 10.1080/23288604.2024.2417788

Boon-How Chew, Pauline Siew Mei Lai, Dhashani A/P Sivaratnam, Nurul Iftida Basri, Geeta Appannah, Barakatun Nisak Mohd Yusof, Subashini C Thambiah, Zubaidah Nor Hanipah, Ping-Foo Wong, Li-Cheng Chang

{"title":"Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study.","authors":"Boon-How Chew, Pauline Siew Mei Lai, Dhashani A/P Sivaratnam, Nurul Iftida Basri, Geeta Appannah, Barakatun Nisak Mohd Yusof, Subashini C Thambiah, Zubaidah Nor Hanipah, Ping-Foo Wong, Li-Cheng Chang","doi":"10.1080/23288604.2024.2417788","DOIUrl":"https://doi.org/10.1080/23288604.2024.2417788","url":null,"abstract":"There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2417788"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How Health Systems World-wide Fail Type 2 Diabetics.

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-01-23 DOI: 10.1080/23288604.2024.2437898

Abdo S Yazbeck, Son Nam Nguyen, Maria-Luisa Escobar

引用次数: 0

Resilience of Primary Health Care in Ukraine: Challenges of the Pandemic and War. 乌克兰初级卫生保健的复原力：大流行病和战争的挑战。

Health systems and reform Pub Date : 2024-12-31 Epub Date: 2024-06-14 DOI: 10.1080/23288604.2024.2352885

Elina Dale, Julia Novak, Denys Dmytriiev, Olga Demeshko, Jarno Habicht

{"title":"Resilience of Primary Health Care in Ukraine: Challenges of the Pandemic and War.","authors":"Elina Dale, Julia Novak, Denys Dmytriiev, Olga Demeshko, Jarno Habicht","doi":"10.1080/23288604.2024.2352885","DOIUrl":"10.1080/23288604.2024.2352885","url":null,"abstract":"This commentary examines the resilience of primary health care in Ukraine amidst the ongoing war, drawing a few reflections relevant for other fragile and conflict-affected situations. Using personal observations and various published and unpublished reports, this article outlines five reflections on the strengths, challenges, and necessary adaptations of Primary Health Care (PHC) in Ukraine. It underscores the concerted efforts of the government to maintain public financing of PHC, thereby averting system collapse. The research also highlights the role of strategic adaptations during the COVID-19 pandemic in fostering resilience during the war, including the widespread use of digital communication and skills training. The commentary emphasizes the role of managerial and financial autonomy in facilitating quick and efficient organizational response to crisis. It also recognizes emerging challenges, including better access to PHC services among the internally displaced persons, shifting patient profiles and service needs, and challenges related to reliance on local government financing. Finally, the authors advocate for a coordinated approach in humanitarian response, recovery efforts, and development programs to ensure the sustainability and effectiveness of PHC in Ukraine.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 1","pages":"2352885"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Impact of Centralized Procurement on Treatment Patterns for Myocardial Infarction and More Principled Utilization of Coronary Stents. 集中采购对心肌梗塞治疗模式的影响以及冠状动脉支架的更合理利用。

Health systems and reform Pub Date : 2024-12-31 Epub Date: 2024-06-21 DOI: 10.1080/23288604.2024.2366167

Weiyan Jian, Shanshan Huo, Lanyue Zhang, Wuping Zhou

{"title":"The Impact of Centralized Procurement on Treatment Patterns for Myocardial Infarction and More Principled Utilization of Coronary Stents.","authors":"Weiyan Jian, Shanshan Huo, Lanyue Zhang, Wuping Zhou","doi":"10.1080/23288604.2024.2366167","DOIUrl":"10.1080/23288604.2024.2366167","url":null,"abstract":"Reducing the price of expensive medical products through centralized procurement is generally considered an effective way to save public medical resources. Against this background, this paper presents an analysis of the impact of centralized procurement in China by comparing the treatment costs and patterns for acute myocardial infarction (AMI) patients before and after the introduction of this method of purchasing, with specific reference to the use of coronary stents. We found that, after the implementation of centralized procurement for coronary stents, the total expenditure of AMI cases receiving percutaneous coronary interventions with stent implantation (PCI with stents) dropped by 23.4%. The use rate of PCI with stents decreased by 32.5%, with the most significant decrease being evident in cases in which two stents were used simultaneously (32.9%). Meanwhile, percutaneous coronary interventions with balloon implantation (PCI with balloons) increased by 31.5% and coronary artery bypass grafting (CABG) increased by 80.3%. Based on these patterns, it can be observed that the use of centralized procurement significantly reduced the profits of the relevant medical manufacturers, forcing them to decrease their marketing investments, weakening their influence on providers, and ultimately resulting in a more principled use of coronary stents. We therefore conclude that, with reference to the data cited, the centralized procurement program led not only to a reduction in procurement prices but also to decreased overuse of these expensive medical products.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 1","pages":"2366167"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Public Financial Management Save Life? Evidence from a Quantitative Review of PFM and Health Outcomes in Sub-Saharan African Countries. 公共财政管理能拯救生命吗？对撒哈拉以南非洲国家公共财政管理和卫生成果的定量研究证据。

Health systems and reform Pub Date : 2024-12-31 Epub Date: 2024-01-15 DOI: 10.1080/23288604.2023.2298190

Yann Tapsoba, Amna Silim, Kingsley Addai Frimpong, Hélène Barroy

{"title":"Does Public Financial Management Save Life? Evidence from a Quantitative Review of PFM and Health Outcomes in Sub-Saharan African Countries.","authors":"Yann Tapsoba, Amna Silim, Kingsley Addai Frimpong, Hélène Barroy","doi":"10.1080/23288604.2023.2298190","DOIUrl":"10.1080/23288604.2023.2298190","url":null,"abstract":"Public financial management (PFM) theory suggests that improvements in the allocation, execution, and monitoring of public funds can result in improved sectoral outcomes, including in health. However, the existing literature on the relationship between PFM quality and health outcomes provides limited empirical documentation and insufficient explanation of the mechanics of that relationship. This paper contributes to the literature by estimating the correlation between PFM quality and health outcomes from a sample of sub-Saharan African countries over the period 2005-2018, using a pooled ordinary least squares (OLS) estimator. The analysis uses Public Expenditure and Financial Accountability (PEFA) scores as proxies for PFM quality. The findings indicate that countries with high-quality PFM tended to have the lowest maternal, under-five and noncommunicable diseases (NCDs) mortality. Among the standard PFM dimensions, the one associated with the higher correlation with maternal and under-five mortality was \"predictability and control in budget execution.\" Better PFM quality was significantly associated with a drop in maternal and under-five mortality in countries which allocated a higher proportion of their budget to the health sector. In countries allocating a lower proportion of their budget to health, the correlations between PFM quality and the three mortality indicators were not significant. The negative correlations between PFM quality and maternal and under-five mortality were significant only in countries with more effective governance. These findings support an emphasis on strengthening PFM as a means of improving health service provision and health outcomes.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 1","pages":"2298190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

COVID-19 Deaths in Long-Term Care Facilities in the US: An Urgent Call for Equitable and Integrated Health Systems and an All-Hazards Approach to the Next Crisis. COVID-19 美国长期护理机构中的死亡案例：紧急呼吁建立公平、综合的医疗系统，并采用全危险方法应对下一次危机。

Health systems and reform Pub Date : 2024-12-31 Epub Date: 2024-01-29 DOI: 10.1080/23288604.2023.2298652

Eriko Sase, Christopher Eddy, Richard J Schuster

引用次数: 0

Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria. 评估地方卫生系统跨规划效率低下的根本原因和解决方案：尼日利亚阿南布拉州的案例研究。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2025-01-08 DOI: 10.1080/23288604.2024.2441533

Obinna Onwujekwe, Uchenna Ezenwaka, Prince Agwu, Chukwudi Nwokolo, Francis Ukwuije, Alexandra J Earle, Agnes Gatome-Munyua, Susan Sparkes

{"title":"Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria.","authors":"Obinna Onwujekwe, Uchenna Ezenwaka, Prince Agwu, Chukwudi Nwokolo, Francis Ukwuije, Alexandra J Earle, Agnes Gatome-Munyua, Susan Sparkes","doi":"10.1080/23288604.2024.2441533","DOIUrl":"https://doi.org/10.1080/23288604.2024.2441533","url":null,"abstract":"Cross-programmatic inefficiencies are duplications or misalignments that arise from undue fragmentation of health systems by vertical health programs. Identifying and addressing the root causes of cross-programmatic inefficiencies in a health system can ensure more efficient use of resources to make progress toward Universal Health Coverage. This paper examines the root causes of cross-programmatic inefficiencies related to governance and financing in the state health system of Anambra in southeast Nigeria. Data were collected from 38 in-depth interviews and four focus group discussions and analyzed thematically. The governance- and finance-related cross-programmatic inefficiencies identified were duplicative and misaligned roles within and between state and federal agencies, functions, and activities within and across health programs; misaligned donor priorities with that of the state; and poor formulation and implementation of the approved annual state health budget. The root causes of governance and financing cross-programmatic inefficiencies included weak policy development, communication, and enforcement; excessive influence of external donors and the federal government; weak accountability mechanisms affecting program coordination and service delivery; and a disharmony between state priorities and objectives with planning, budgeting, and execution of the budget. Addressing the root causes of cross-programmatic inefficiencies has the potential to significantly improve the overall efficiency and performance of the health system to contribute to improved health outcomes in Anambra state. This approach can serve as a model for other states and regions facing similar challenges.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2441533"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Staying the Course: Reflections on the Progress and Challenges of the UHC Law in the Philippines. 坚持到底：菲律宾全民医保法的进展与挑战反思》。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-12 DOI: 10.1080/23288604.2024.2397829

Pura Angela Co, Ileana Vîlcu, Denese De Guzman, Eduardo Banzon

{"title":"Staying the Course: Reflections on the Progress and Challenges of the UHC Law in the Philippines.","authors":"Pura Angela Co, Ileana Vîlcu, Denese De Guzman, Eduardo Banzon","doi":"10.1080/23288604.2024.2397829","DOIUrl":"https://doi.org/10.1080/23288604.2024.2397829","url":null,"abstract":"The Philippine Universal Health Care (UHC) law enacted in 2019 aimed to address entrenched health system challenges to achieving equitable access to quality health care. This commentary discusses the progress in its implementation to meet its objectives. Some of these health system challenges include overlapping financing roles; weak incentives for integrating health services across local government units (LGUs), the inclusion of the private sector in networks of care, and fragmented primary health care services. The UHC law introduced reforms to transform the Philippine Health Insurance Corporation (PhilHealth) into a strategic purchaser of health services, expand population coverage, and prioritize comprehensive outpatient and primary care services. Furthermore, the law mandated bolstering subnational health financing through a Special Health Fund (SHF) intended to encourage LGUs to integrate into provincial or city health systems. Pilots of the SHF highlighted opportunities and challenges in pooling, prioritizing, and redistributing resources if local health systems are capacitated. Despite facing implementation challenges, including changing priorities, politics, and lack of resources, the Philippines' experience emphasizes the importance of adaptive leadership, sustained commitment, and effective stakeholder engagement to ensure that these health financing reforms remain objective-oriented. Maximizing the UHC law's potential going forward requires addressing ongoing challenges: sustained resource generation, ensuring effective coverage of the poor, and capacitating local health systems. The journey of the Philippines toward UHC offers valuable insights for global health reformers, underscoring the need for adaptive approaches and active political engagement to sustain and achieve progress toward universal and equitable health care access.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2397829"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cross-Programmatic Efficiency: The System is Greater Than the Sum of Its Programs. 跨程序效率：系统大于其程序的总和。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-12-12 DOI: 10.1080/23288604.2024.2427715

Susan P Sparkes, Alexandra J Earle, Joseph Kutzin

{"title":"Cross-Programmatic Efficiency: The System is Greater Than the Sum of Its Programs.","authors":"Susan P Sparkes, Alexandra J Earle, Joseph Kutzin","doi":"10.1080/23288604.2024.2427715","DOIUrl":"10.1080/23288604.2024.2427715","url":null,"abstract":"Health programs play important roles in health systems, contributing to the development of best practices, guidelines, awareness, and advocacy for specific services, populations, or conditions. However, a person's health is not defined by single conditions or interventions and therefore cannot be fully catered to by only one program. Additionally, the Universal Health Coverage (UHC) index has stagnated in recent years, even for programmatic outcomes heavily supported by external assistance, raising concerns about the efficiency and sustainability of many programs and their objectives. The World Health Organization's cross-programmatic efficiency analysis (CPEA) approach provides a way to assess programs with a system-wide perspective. CPEA is an approach for analyzing programs based on health system functions and considers how the entire system, including programs, aligns to meet objectives. It focuses on identifying areas of duplication or misalignment as targets for reforms. This policy report summarizes findings from CPEA analyses conducted by six countries (Bhutan, Ghana, Kenya, South Africa, Sri Lanka, and Tanzania) between 2017 and 2021. The cases demonstrate the extent and areas of duplication across programs, including information systems, health workforce, and supply chains. Duplications and misalignments in the generation of human and physical resources (subsequently referred to as \"inputs\") are often driven by how health programs are financed and governed. These inefficiencies directly impact how people receive health services. Comparing CPEA findings from multiple countries demonstrates that using the whole health system as the unit of analysis is critical when seeking to increase system efficiency and align available resources to meet UHC objectives.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2427715"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Data Integration of Health Financing Systems as a Critical Enabler for Objective-Oriented Health System Reform: A Scoping Review from India. 卫生筹资系统的数据整合是以目标为导向的卫生系统改革的关键推动因素：印度的范围审查。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-12 DOI: 10.1080/23288604.2024.2401190

Grace Achungura, Arif Raza, Vijendra Katre, Jaidev Singh Anand, Nirmala Ravishankar, Rathan Kelkar

{"title":"Data Integration of Health Financing Systems as a Critical Enabler for Objective-Oriented Health System Reform: A Scoping Review from India.","authors":"Grace Achungura, Arif Raza, Vijendra Katre, Jaidev Singh Anand, Nirmala Ravishankar, Rathan Kelkar","doi":"10.1080/23288604.2024.2401190","DOIUrl":"10.1080/23288604.2024.2401190","url":null,"abstract":"Health financing fragmentation poses a challenge to reforms intended to address system-wide objectives vis-à-vis universal health coverage (UHC). India's experience with publicly subsidized health insurance schemes (PSHIs), such as Rashtriya Swasthya Bima Yojana (RSBY) and its state adaptations, testify to the challenges inherent in effecting objective-oriented health systems reforms, particularly owing to wide variation in programmatic and operational design. Recent efforts to defragment PSHIs under the aegis of a new government initiative called Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) using, inter alia, a unified information and communication technology (ICT) interface provide important policy lessons. This paper presents a theory of change for the role that ICT systems can play in promoting the objectives of UHC and highlights the early effects of ICT reforms in India on UHC. Holistic and defragmented ICT systems have a positive effect on the processes and operations of government health programs, according to the literature reviewed. Streamlined ICT systems promote equity through the introduction of portability modules, which increase access to services and facilitate stronger transparency and accountability measures by using big data and machine learning for fraud detection. Although reliability issues persist on certain fronts, India's experience with homegrown, incremental reforms to defragment ICT systems for health financing have proven of paramount importance for progressing toward UHC.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2401190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0