How to do better health reform

Health systems are continually being reformed but why? And how?

An article in ‘Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries’ analyses the impact that health-reform initiatives have had on the quality and safety of care in low-, middle- and high-income countries—Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialing innovative funding models. All countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns.

The article also highlights two important points: firstly that a population’s health is not determined solely by the acute system, but is a product of inter-sectoral effort—that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Secondly, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed rather than measured.

Read the full abstract on Health Reform on the intqhc.oxfordjournals.org website