Health systems and reform最新文献

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 Using personal observations and various published and unpublished reports, this article outlines five reflections on the strengths, challenges, and necessary adaptations of Primary Health Care (PHC) in Ukraine.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

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.

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":"https://doi.org/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

Public Financial Management: A Pathway to Universal Health Coverage in Low-and-Middle Income Countries. 公共财政管理：公共财政管理：中低收入国家实现全民医保的途径》。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-12-09 DOI: 10.1080/23288604.2024.2368051

Hélène Barroy, Pierre Yameogo, Mark Blecher, Martin Sabignoso, Moritz Piatti, Joseph Kutzin

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

Using a Small Lever to Achieve Big Outcomes in a Devolved Health System: 20 Years of Programa Sumar in Argentina. 在权力下放的卫生系统中利用小杠杆实现大成果：阿根廷 Sumar 计划 20 年。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-12 DOI: 10.1080/23288604.2024.2422105

Martin Sabignoso, Susan P Sparkes, Alexandra J Earle

{"title":"Using a Small Lever to Achieve Big Outcomes in a Devolved Health System: 20 Years of Programa Sumar in Argentina.","authors":"Martin Sabignoso, Susan P Sparkes, Alexandra J Earle","doi":"10.1080/23288604.2024.2422105","DOIUrl":"10.1080/23288604.2024.2422105","url":null,"abstract":"Incremental health system transformations towards universal health coverage run the risk of losing sight of the overarching objectives and can lose momentum in the implementation process. Argentina's Programa Sumar is a program born out of response to both urgent and long-standing health challenges. Starting with a relatively small share of the government's budget for health, the Program over the last 20 years has gradually expanded in pursuit of increasing access to quality health care, fostering coherence through policy alignment and coordination in a highly decentralized system, and achieving its performance objectives through conditional transfers linked to results. This commentary reflects on how Programa Sumar created and has sustained its approach to health system transformation and provides four lessons: 1) distribute leadership across levels of government to enhance autonomy, collaboration, and implementation; 2) expand gradually, with a clear long-term vision - Programa Sumar took an incremental approach to expansion in terms of regions, populations, services, and management capacities; 3) ensure evolution through solid and flexible design - the Program needed both the flexibility to adapt strategies to various challenges and a constancy of purpose; and 4) compromise to make progress. The Argentine experience with Programa Sumar shows that strengthening a scheme does not have to mean adopting a fragmented approach. Instead, by implementing Programa Sumar thoughtfully and collaboratively, the reform has developed a solid foundation with the flexibility to adapt across geographies and time, creating the necessary conditions for expansion to and greater coherence across the entire system.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2422105"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634218","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

Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya. 研究肯尼亚全民医保试点的实施经验。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-19 DOI: 10.1080/23288604.2024.2418808

Lizah Nyawira, Yvonne Machira, Kenneth Munge, Jane Chuma, Edwine Barasa

{"title":"Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya.","authors":"Lizah Nyawira, Yvonne Machira, Kenneth Munge, Jane Chuma, Edwine Barasa","doi":"10.1080/23288604.2024.2418808","DOIUrl":"https://doi.org/10.1080/23288604.2024.2418808","url":null,"abstract":"The Kenyan government implemented a Universal Health Coverage (UHC) pilot project in four (out of 47) counties in 2019 to address supply-side gaps and remove user fees at county referral hospitals. The objective of this study was to examine the UHC pilot implementation experience using a mixed-methods cross-sectional study in the four UHC pilot counties (Isiolo, Kisumu, Machakos, and Nyeri). We conducted exit interviews (n = 316) with health facility clients, in-depth interviews (n = 134) with national and county-level health sector stakeholders, focus group discussions (n = 22) with community members, and document reviews. We used a thematic analysis approach to analyze the qualitative data and descriptive analysis for the quantitative data. The UHC pilot resulted in increased utilization of healthcare services due to removal of user fees at the point of care and increased availability of essential health commodities. Design and implementation challenges included: a lack of clarity about the relationship between the UHC pilot and existing health financing arrangements, a poorly defined benefit package, funding flow challenges, limited healthcare provider autonomy, and inadequate health facility infrastructure. There were also persistent challenges with the procurement and supply of healthcare commodities and with accountability mechanisms between the Ministry of Health and county health departments. The study underscores the need for whole-system approaches to healthcare reform in order to ensure that the capacity to implement reforms is strengthened, and to align new reforms with existing system features.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2418808"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677966","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