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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.

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.

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).

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.

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.

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.

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.

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.

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.

The paper is a commentary based on the literature.

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.

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.

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.

The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict).

A literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context.

The literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need; targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways.

This study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settings

The paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Machinery of government changes and budget strategy are powerful levers to drive reform in the public sector. The purpose of this paper is to describe the rationale, progress and challenges in the establishment of Western Australia's Mental Health Commission in 2010 with policy, planning and purchasing powers to drive reform.

This case study is based on the observations of the author who had a lead role in the establishment of the Commission over its first two years. It sets this reform in the context of the whole of government reforms as well as demands for reform from stakeholders within the mental health sector.

It is demonstrated that externally imposed change is often necessary to fundamental reform. However, it also comes with risks of alienation of key stakeholders in powerful roles and an under‐estimation of the factors that will hamper change. Central government support has been essential to the establishment of the Commission.

The paper relies on the observations of a key participant in the reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access.

The paper identifies some of the practical strategies that mitigate the risks associated with system change.

This reform has been useful to showcase a range of other social policy reforms demonstrating the opportunities that strong political leadership offers when linked to policy and administrative change.

This analysis of the progress of reform highlights a range of issues that can inform other governments and community stakeholders undertaking major reform in the public sector as well as particular issues for reform in mental health.

A new international orthodoxy has developed on health sector reform. The dominant theme of the orthodoxy is the alleged benefits of market style reforms for health development. This is shaping changes formulated, and being implemented, in the British NHS and other European health services (including Central and Eastern Europe), Latin America and a number of developing health systems in Africa and Asia. Sets out a ten‐point description of the orthodoxy. Contends that the orthodoxy is showing distinct signs of restricting the analysis and development of health management and planning. This is a matter for considerable concern as the adoption of market‐style reforms can generate unforeseen and, in some cases, negative consequences. There is clearly a need for strengthening management research and development as a basis for effective health sector reform.