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1.
Indian J Public Health ; 65(4): 332-339, 2021.
Article in English | MEDLINE | ID: covidwho-1608240

ABSTRACT

The debate around approaches to health sector reform is one of the foundational questions around which the discipline of health policy and systems research has grown. In the immediate postwar period, health and health care were recognized as areas of market failure, requiring state action in the provision of free or subsidized services. In the eighties and nineties, due to both geopolitical and ideological reasons, this understanding changed, leading to a wave of market-based health sector reforms. An academic discourse built around neoliberal economics initiated, shaped, and legitimized these reforms. Faced with worsening health outcomes and costs of care after a decade of such reforms, there was a partial reversal of policy toward improving health sector performance that relied on nonmarket solutions built around notions of solidarity, trust, and rights. In India, this took the form of the National Rural Health Mission. Examples of health systems research that supported this direction of change are discussed. In the last decade, a second wave of health sector reforms sought to make markets work by repositioning government as purchaser of health care from private providers through insurance and contracts. There is little evidence that this worked. The need to rely on public services to cope with the COVID-19 pandemic, further questioned this direction of reform. We emphasize the need to expand and develop a framework of health systems and policy studies that are more appropriate to the achievement of universal health care, health equity, and health rights in the Indian context.


Subject(s)
COVID-19 , Health Services Accessibility , Health Care Reform , Human Rights , Humans , India , Pandemics , SARS-CoV-2
3.
Am J Nurs ; 122(1): 48-53, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1584032

ABSTRACT

ABSTRACT: COVID-19 has accelerated the dialogue surrounding access to health insurance, including the potential for a public option, "Medicare for All," or modification of the 2010 Affordable Care Act. A dizzying array of terms and assertions surround these health policy discussions, as well as misrepresentation and lack of specificity. This article offers a primer on contemporary reform terms and options that are likely to be prominent over the next several years and outlines some health care-related elements of the American Rescue Plan Act, a massive COVID-relief act passed in March 2021. The aim of this nonpartisan overview is to enhance nurses' understanding of these terms as a basis for effective participation in public policy and patient advocacy.


Subject(s)
Communication , Health Care Reform/methods , Health Care Reform/trends , Health Policy , Humans , United States
6.
Aust J Gen Pract ; 492020 Sep 16.
Article in English | MEDLINE | ID: covidwho-1503122

ABSTRACT

This case study of GP Shared Care provides an interesting lens though which to view the current opportunities for improved healthcare partnerships as we respond to the COVID-19 challenges.


Subject(s)
COVID-19 , Health Care Reform , Delivery of Health Care , Humans , SARS-CoV-2
9.
PLoS One ; 16(10): e0258274, 2021.
Article in English | MEDLINE | ID: covidwho-1470665

ABSTRACT

OBJECTIVE: We aim to estimate the total factor productivity and analyze factors related to the Chinese government's health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009. MATERIALS AND METHODS: We use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004-2020). RESULTS: We find that the average TFP of China's 31 provincial health care expenditure was lower than 1 in the period 2009-2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government's health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact. CONCLUSION: Although the implementation of the new medical reform has improved the efficiency of the government's health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input. SIGNIFICANCE: This study systematically analyzes the efficiency and influencing factors of the Chinese government's health expenditure after it introduced new health care reforms. The results show that China's new medical reform will help to improve the government's health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.


Subject(s)
Government , Health Care Reform/economics , Health Expenditures , China , Regression Analysis
10.
BMJ Open ; 11(8): e048449, 2021 08 25.
Article in English | MEDLINE | ID: covidwho-1373965

ABSTRACT

INTRODUCTION: In the past three decades, China has made great strides in the prevention and treatment of tuberculosis (TB). However, the TB burden remains high. In 2019, China accounted for 8.4% of global incident cases of TB, the third highest in the world, with a higher prevalence in rural areas. The Healthy China 2030 highlights the gate-keeping role of primary healthcare (PHC). However, the impact of PHC reforms on the future TB burden is unclear. We propose to use mathematical models to project and evaluate the impacts of different gate-keeping policies. METHODS AND ANALYSIS: We will develop a deterministic, population-level, compartmental model to capture the dynamics of TB transmission within adult rural population. The model will incorporate seven main TB statuses, and each compartment will be subdivided by service providers. The parameters involving preference for healthcare seeking will be collected using discrete choice experiment (DCE) method. We will solve the deterministic model numerically over a 20-year (2021-2040) timeframe and predict the TB prevalence, incidence and cumulative new infections under the status quo or various policy scenarios. We will also conduct an analysis following standard protocols to calculate the average cost-effectiveness for each policy scenario relative to the status quo. A numerical calibration analysis against the available published TB prevalence data will be performed using a Bayesian approach. ETHICS AND DISSEMINATION: Most of the data or parameters in the model will be obtained based on secondary data (eg, published literature and an open-access data set). The DCE survey has been reviewed and approved by the Ethics Committee of the School of Public Health, Sun Yat-sen University. The approval number is SYSU [2019]140. Results of the study will be disseminated through peer-reviewed journals, media and conference presentations.


Subject(s)
Tuberculosis , Adult , Bayes Theorem , China/epidemiology , Health Care Reform , Humans , Models, Theoretical , Primary Health Care , Tuberculosis/epidemiology , Tuberculosis/prevention & control
13.
J Health Polit Policy Law ; 46(4): 535-547, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1334768

ABSTRACT

Given the close division of power in Washington, DC, how might health reformers pursue their bolder aims? In particular, how might they pursue the robust public option that was a centerpiece of Joe Biden's health plan during the campaign? This new iteration of the public option-far more ambitious than anything seriously considered during the debate over the ACA-is not in the cards right now. But instead of giving up on it, advocates should recast it in an inspiring vision that can structure immediate initiatives designed to make its achievement more feasible. This strategy, which might be called "building power through policy," would involve using the openings for policy change that are likely to exist in the near term to reshape the political landscape for the long term. Three interim steps in particular could advance the public option's prospects: (1) pursuing immediate improvements in the ACA that are tangible and traceable yet do not work against the eventual creation of a public option, (2) building the necessary foundations for a public option within Medicare while encouraging progressive states to experiment with state public plan models, and (3) seeding and strengthening movements to press for more fundamental reform.


Subject(s)
Health Care Reform , Health Policy , Insurance Coverage/standards , Insurance, Health/standards , Politics , Consumer Advocacy , Medicare , United States
15.
J Ambul Care Manage ; 43(4): 267, 2020.
Article in English | MEDLINE | ID: covidwho-1319202
16.
BMJ Glob Health ; 5(5)2020 05.
Article in English | MEDLINE | ID: covidwho-1311087
18.
Health Policy ; 125(7): 815-832, 2021 07.
Article in English | MEDLINE | ID: covidwho-1248912

ABSTRACT

BACKGROUND: High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from considering reform experiences abroad, exchange is limited. This paper provides an overview of health reform trends in 31 high-income countries in 2018 and 2019, i.e., before Covid-19. METHODS: Information was collected from national experts from the Health Systems and Policy Monitor network. Experts were asked to report on the three "top" national health reforms 2018 and 2019. In 2019, they provided an update of 2018 reforms. Reforms were assigned to one of 11 clusters and identified as one of seven different reform types. RESULTS: 81 reforms were reported in 28 countries in 2018. 44/81 went to four clusters: 'insurance coverage & resource generation', 'governance', 'healthcare purchasing & payment', and 'organisation of hospital care'. In 2019, 86 reforms in 30 countries were reported. 48/86 fell under 'organisation of primary & ambulatory care', 'governance', 'care coordination & specialised care', and 'organisation of hospital care'. Most 2018 reforms were reported ongoing in 2019; 27 implemented; seven abandoned. Health agency-led reforms were implemented most frequently, followed by central government-legislated reforms. CONCLUSIONS: Policymakers can leverage international experience of distinct reform approaches addressing similar challenges and similar approaches to address distinct problems. Such knowledge may help inspire or support future successful health reform processes.


Subject(s)
COVID-19 , Health Care Reform , Telemedicine , Delivery of Health Care , Developed Countries , Humans , SARS-CoV-2
19.
Lancet ; 397(10288): 1859, 2021 05 22.
Article in English | MEDLINE | ID: covidwho-1237925
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