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Book part
Publication date: 12 October 2011

Rebecca L. Utz, Richard Nelson and Peter Dien

This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health

Abstract

This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health insurance affect public opinion toward the current US health-care system. Opinions about the health-care system were measured in terms of consumer confidence and perceived need for health-care reform. Data come from the 2008 Cooperative Congressional Election Study (CCES), a nationwide survey of 1,000 respondents. All data were collected in November 2008, thus providing a useful alternative to volatile polling data because they were collected prior to and are thus immune to the polarized tone of the debates that have occurred over the past few years. Overall, we found that public confidence in medical technology and quality of care were consistently high, while confidence in the affordability of medical care was much lower among respondents. Younger adults, those with poor health, and those without health insurance had particularly low confidence in their ability to pay for health care. Although a strong majority of the population agreed that the US health-care system was in need of major reform, support for particular types of government-sponsored health insurance programs was primarily determined by political affiliation. In an era where a large proportion of the population has little access to health care (due to lack of insurance) and where the US government is facing tremendous opposition to the implementation of major reform efforts, it is useful to understand which subgroups of the population are most confident in the current health-care system and most likely to support reform efforts, as well as those who are most resistant to change given their precarious health needs, their inability to access health care (as a result of insurance or noninsurance), or their political affiliation.

Details

Access to Care and Factors that Impact Access, Patients as Partners in Care and Changing Roles of Health Providers
Type: Book
ISBN: 978-0-85724-716-2

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Article
Publication date: 15 May 2017

Krishna Hort, Rohan Jayasuriya and Prarthna Dayal

The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the…

Abstract

Purpose

The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC.

Design/methodology/approach

Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system.

Findings

Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an “adaptive” response), while China and Vietnam have tended to persist with traditional hierarchical governance modes (“reactive” responses).

Originality/value

This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

Details

Journal of Health Organization and Management, vol. 31 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 4 May 2010

E. Kojo Sakyi

The aim of this paper is to examine how internal communication of reform objectives to health workforces and stakeholders has influenced the implementation of Ghana's…

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Abstract

Purpose

The aim of this paper is to examine how internal communication of reform objectives to health workforces and stakeholders has influenced the implementation of Ghana's health sector decentralisation at district level.

Design/methodology/approach

Data collection involved in‐depth interviews with district public health officials, private health providers, local government officials and health‐related non‐government organisations which had been working in the district for at least two years.

Findings

The study's findings showed that communication (the sharing of information) about reform objectives were centralised among the top hierarchy of the District Health Management Teams; and the process of transferring reform information to district health workforces and stakeholders was through a top‐downward approach. This vertical style of communication resulted in limited information getting through to district health workforces tasked with the implementation. This impacted negatively on reform implementation.

Originality/value

The paper reveals that there is a connection between the level of comprehension of the objectives for decentralisation reform both by the health workforce and stakeholders, particularly the expected new roles they are supposed to play. A lack of effective transfer of information affects commitment and ownership of the decentralisation reform at district level; contributing significantly to the poor implementation of the reform programme.

Details

Leadership in Health Services, vol. 23 no. 2
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 21 March 2016

Helen Dickinson and Jon Pierre

Many developed countries have seen significant reforms of their health systems for the last few decades. Despite extensive investment in these changes, health systems…

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1005

Abstract

Purpose

Many developed countries have seen significant reforms of their health systems for the last few decades. Despite extensive investment in these changes, health systems still face a range of challenges which reform efforts do not seem to have overcome. The purpose of this paper is to argue that there are two particular reasons, which go beyond the standard explanations of changing demographics and disease profiles.

Design/methodology/approach

The paper is a commentary based on the literature.

Findings

The first explanation relates to the relationship between substantive health care reform and governance reform. These are intertwined processes and the pattern of interaction has distorted both types of reform. Second, reform has multiple meanings and may sometimes be more of an intra-organizational ritual and routine than a coherent plan aiming to bring about particular changes. As such, part of the reason why reform so frequently fails to bring about change is that it was not actually intended to bring about specific changes in the first place. The limited success of reform in recent years, the authors argue, has been a result of the fact that reform has focused too much on the substantive aspects of healthcare, while ignoring the governance aspect of the sector.

Originality/value

As a result, governance has often been obstructed by interest groups inside the system, resulting in paralysis. The authors conclude by arguing that substantive reform of public organizations without an accompanying reassessment of the governance of these organizations are more likely to fail, compared to more comprehensive reform efforts.

Details

Journal of Health Organization and Management, vol. 30 no. 1
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 13 March 2020

Julinda Hoxha

This chapter investigates the origins of cross-sectoral collaboration by exploring when and why policy networks form within the Turkish health sector – a least likely case…

Abstract

This chapter investigates the origins of cross-sectoral collaboration by exploring when and why policy networks form within the Turkish health sector – a least likely case for network formation. The analysis presented here draws on information collected from a number of official documents, semi-structured interviews with professional experts, and two multi-stakeholder meetings. Timewise, networks entered the policy jargon during the introduction of the Health Transformation Program in 2003. Yet, the years between 2011 and 2015 were ground-breaking in producing concrete cross-sectoral collaborative instruments of policy making. The findings of the analysis reveal that policy networks form as a result of central government’s choice to devolve responsibility and expand the policy space with new issues and actors. Moreover, policy networks emerge not only during the times of policy change which has a reactionary, abrupt, and nature but also during the times of policy stability and legitimacy. These contextual factors are crucial in maintaining an atmosphere of trust among stakeholders, particularly between state and non-state actors. The refugee crisis and spreading securitization discourse in the post-2015 period explain the shifting policy and political agenda leading to public sector retrenchment from cross-sectoral projects within the field of health. This chapter intends to contribute to the literature of comparative public policy by examining the link between policy networks and policy change in addition to adding to the debates on network governance by exploring the processes of network formation. Finally, this chapter contributes to Turkish studies by examining the process of network formation within the Turkish health sector.

Details

Network Policy Making within the Turkish Health Sector: Becoming Collaborative
Type: Book
ISBN: 978-1-83867-095-5

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Article
Publication date: 1 March 1998

Robert H. Lee and Ronna Chamberlain

This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the…

Abstract

This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.

Details

Journal of Public Budgeting, Accounting & Financial Management, vol. 10 no. 4
Type: Research Article
ISSN: 1096-3367

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Article
Publication date: 28 January 2020

Anna Stephansen

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing…

Abstract

Purpose

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing neo-institutional perspective, it is suggested that scholars need to take a step back and analyze the interrelation between regulatory, organizational and professional norms (dimensions). This approach improves our understanding of the complex outcomes of health care reforms. To illustrate this point, the case of coordination reform in Norway is discussed. This reform has been one of the most complex health care reforms with ambitious goals of achieving perfectly integrated care between hospitals and municipalities. The analysis through the three sets of institutional norms (dimensions) provides more comprehensive understanding of the various outcomes of the reform. The conclusion is that in order to understand the vast complexity of the outcomes of different health care reforms, we need to carefully study the institutional characteristics of rules, clinical codes of conduct, organizational characteristics as well as interplay between them. Analysis based on the three dimensions, shows that the neo-institutional approach, is of highest relevance to understand the outcomes of the complex health reforms.

Design/methodology/approach

Discussion in this paper is inspired by author’s PhD dissertation that comprised a study of juridification, understood as legal regulation, in treatment practice in the field of specialized health services. Three dimensions described in this paper are derived from the analysis of two types of empirical material: legal regulations and administrative guidelines in the area of patients’ rights interviews with psychiatrists and psychologists in the region of Western Norway about how they practice the regulations. The aim of this empirical study was to explore the implications the new regulations have had for clinical practice after the patients’ rights regulations became binding for clinical reasoning in Norway. This paper presents a viewpoint that applies the three dimensions derived from the empirical analysis to the discussion about the outcomes of one of the most complex Norwegian health reforms, i.e. coordination re-form. It is argued that the observations can be relevant for the analysis of the implication of health reforms in general.

Findings

The observations presented in the discussion of the possible implications of regulations of coordination reform indicate the complexity and sometimes contradictory outcomes of health regulations. There is a complex interplay between the different kinds of regulatory tools, which might have different implications at different levels. The same regulations can both strengthen and weaken established institutional order. Implications of such processes need to be empirically explored and neo-institutional approach still is of highest relevance in helping scholars understand the complex outcomes of health regulations.

Practical implications

Outcomes of regulations will depend on the balance between regulations and other institutional dimensions. The significant aspect of it is that this balance between the dimensions is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

Originality/value

The institutional dimensions can be in different balance relation with each other. The point of departure in this paper is that the legal regulations have been strengthened, i.e. expanded with regard to the coordination in health services. This development has been called juridification. The outcomes of it will depend on the balance between regulations and other institutional dimensions at work. The significant aspect of it is that this balance is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

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Article
Publication date: 4 September 2009

Harri Raisio

The purpose of this paper is to examine the planning of the National Health reform – especially the “guarantee for care” reform within it – from the perspective of the…

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Abstract

Purpose

The purpose of this paper is to examine the planning of the National Health reform – especially the “guarantee for care” reform within it – from the perspective of the concept of wicked problems. This concept asserts that it is of the utmost importance to see the true level of complexity of the problems in order to survive them. The paper tries to the answer the question of how the planners of the health care reforms see the problems they are trying to solve.

Design/methodology/approach

This is an interview study. A total of 12 people who participated in the planning of the examined reforms at some level were interviewed. The interview method was a semi‐structured thematic interview. The research analysis is theory‐originated content analysis.

Findings

The hypothesis is that the planners of the examined reforms do not focus enough on the complexity of the problems they tried to solve. The research, however, shows that the wickedness of the problems was often noticed. Unfortunately it was not taken as seriously as it should have been. In other words, the planners mostly saw that the problems were very complex, but even then the solutions were only like solutions for tame problems or messes.

Originality/value

The paradigm shift from Newtonian science – which sees the world as a deterministic system – to a more complexity‐endorsing view is on its way. The world is a dynamic and open system, which cannot be controlled. The paper makes its own contribution, from the perspective of health care problems and reforms, to advance this paradigm shift.

Details

Journal of Health Organization and Management, vol. 23 no. 5
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 10 November 2005

Pirkko Vartiainen

Health care organizations function in multidimensional environments, and their organizational cultures are complex and demanding. Expectations for health care services are…

Abstract

Health care organizations function in multidimensional environments, and their organizational cultures are complex and demanding. Expectations for health care services are high: patients want the most effective and newest possible treatments, politicians demand accountable service production, and health care professionals require motivating and challenging work environments. All these goals and objectives, for example, can be at the root of wicked problems in health care management. Thus, this chapter aims to explore the wickedness of health care management through an analysis of Finnish and Swedish health care reforms. The aim of these reforms is to solve the problems encountered in health care systems and organizations. The concept of a ‘wicked issue’ can shortly be described as a problem that is difficult to identify and solve. The reasoning behind using the concept of wicked issue as a method for analysis here is the hypothesis that the concept helps to explain and understand the social complexity involved in health care management.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Article
Publication date: 13 August 2018

Yen-Han Lee, Timothy Chiang, Mack Shelley and Ching-Ti Liu

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government…

Abstract

Purpose

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.

Design/methodology/approach

Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.

Findings

The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.

Practical implications

The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.

Originality/value

This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

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