Health Systems Reforms and Transformations: Insights from Country Studies

The Health System Reforms and Transformation: Insights from Country Studies is a series of six case studies from China, Turkey, Mexico, Brazil, Indonesia, and Thailand that trace the trajectory of health reforms and draw lessons in understanding key instruments that led to these shifts.   The papers study the development of  each country health system over the past decades in the context of the country’s political, social and economic transitions. They seek to draw lessons for health system strengthening, access and equity in health services, financial protection and improved health outcomes for lower and upper middle income countries  following the path to universal health care.

The papers study the development of country health systems over the past decades in the context of the country’s political, social and economic transitions. They seek to draw lessons for health system strengthening, access and equity in health services, financial protection and improved health outcomes for lower and upper middle income countries following the path to universal health care.

Read the case studies:

• Health System in Turkey: Reforms, Transformation and Challenges
  Turkey has demonstrated progress on the three dimensions of universal health coverage (financial protection, improved health outcomes and citizen satisfaction) by addressing fragmentation in the financing and provision system, improving accountability by performance based incentives, expansion and balanced distribution of the health workforce, and a focus on primary healthcare.
    
• Health System in People’s Republic of China (PRC): Reforms, Transformation and Challenges
  China attained universal coverage by first addressing breath and then depth of coverage. They went through a path of course correction after acknowledging that financing and provisioning were intricately linked to address equity and efficiency. They still face challenges defined by regional disparities and a hospital centric system that has raised cost of care. China’s experience underlines the importance of an ongoing assessment of health systems and reforms as a continuing and evolving process.
    
• Health System in Mexico: Reforms, Transformation and Challenges
  The separation of financing from provisioning was a key element of Mexico’s structural reforms, but was not leveraged for improving performance as the absence of conditionality for fund flows, which remained de-linked from results, failed to improve accountability or efficiencies in services.
    
• Health System in the Republic of Indonesia: Reforms, Transformations, and Challenges
  Indonesia’s journey towards universal health coverage has been defined by expanding the breadth and depth of coverage through insurance schemes. While there is an adequate presence of primary health services, barriers towards successful UHC and increasing deficits can be attributed to a large private sector, the voluntary nature of insurance for the informal sector and disparities in distribution of resources between the main and remote islands.
    
• Health System in Brazil: Reforms, Transformation and Challenges
  Brazil has made consistent progress in achieving UHC through decentralisation; integration of healthcare activities under the stewardship of the MoH, thereby regulating the private sector; and a greater emphasis on primary care (constituting family health team). However, challenges remain in terms of inequitable distribution of resources and persistent utilization of private facilities.
   
• Health System in the Kingdom of Thailand: Reforms, Acheivements and Challenges
  When Thailand made a political and policy decision to universalise health care in 2002, it had already created a strong base of primary health services and human resources over which they expanded financial protection to cover the entire population. Involving multiple stakeholders, including citizen groups, in designing health systems; purchaser-provider split; comprehensive benefits from preventive to curative services and; institutionalising monitoring and accountability mechanisms have been critical to achieving universal access.