Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium.
Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.
Health Policy. 2021 Jul;125(7):815-832. doi: 10.1016/j.healthpol.2021.04.005. Epub 2021 Apr 15.
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.
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.
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.
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.
高收入国家不断改革其医疗体系。通常，类似的改革会在各国同时进行。尽管国家政策制定者从国外的改革经验中受益，但交流却很有限。本文概述了 2018 年和 2019 年（即新冠疫情之前）31 个高收入国家的卫生改革趋势。
从健康系统和政策监测网络的国家专家那里收集信息。专家们被要求报告 2018 年和 2019 年的三项“顶级”国家卫生改革。2019 年，他们提供了 2018 年改革的最新情况。改革被分配到 11 个集群之一，并确定为七种不同改革类型之一。
2018 年，28 个国家报告了 81 项改革。其中 44 项改革属于四个集群：“保险覆盖范围和资源生成”、“治理”、“医疗保健采购和支付”以及“医院护理组织”。2019 年，30 个国家报告了 86 项改革。其中 48 项改革属于三个集群：“初级和门诊护理组织”、“治理”、“护理协调和专科护理”以及“医院护理组织”。2018 年的大多数改革在 2019 年仍在继续进行；27 项改革已实施；7 项改革已放弃。最常实施的是卫生机构主导的改革，其次是中央政府立法的改革。
政策制定者可以借鉴解决类似挑战的不同改革方法的国际经验，以及解决不同问题的类似方法。这些知识可能有助于激发或支持未来成功的卫生改革进程。
