[EQ] Effective Ways to Realise Policy Reforms in Health Systems

Effective Ways to Realise Policy Reforms in Health Systems

Jeremy Hurst

Health Working Papers - OECD Health Working papers No. 51

Available online [33p.] at: http://www.olis.oecd.org/olis/2010doc.nsf/ENGDATCORPLOOK/NT00000F96/$FILE/JT03280896.PDF

“………Sometimes it is argued that the content of a reform is less important in determining whether or not it receives public and legislative approval than the timing of the proposal; the way in which the reform is presented; the discussions with stakeholders; and a multitude of other factors.

 

The OECD has a crosscutting project on these issues, entitled Making Reform Happen. A number of OECD directorates are considering the factors lying behind successful implementation of reforms in their different policy areas, including tax, environment, agriculture, trade, competition, education, health, pensions, product markets and labour markets.

 

This paper is a contribution to the wider OECD project. It is based on evidence from the countries which have seen their health systems reviewed by the OECD in recent years, and on a selected review of the literature. It considers four issues in particular, these being the ones used across all the different reform areas covered by the Making Reform Happen project:

• The existence of appropriate institutions to support reforms from decision to implementation.

• The impact on, and reactions of, those affected by the reforms.

• Reform agendas, timing and interactions across different policy areas.

• The role of evidence and international organisations to sustain reforms.

It concludes that a number of stages of reform need to be implemented before a reform can be said to be successful; failure in one of them will generally lead to failure of the reform. Issues particular to the health sector include:

• The role of the professional monopolists who provide health services.

• The role of information and evidence.

• The role of international comparisons of health system performance.

• A clear diagnosis and a compelling design for a reform.

• Taking advantage of political ‘windows of opportunity’.

• Communication and engagement between the proponents of reforms and other key stakeholders –especially those holding veto powers.

• Use of incentives, to align the interests of stakeholders with the intentions of the reform.

• Securing sufficient resources to ‘oil the wheels of change’.

However, in some cases there may be tradeoffs between: maximising the success and sustainability of health system reforms; maximising the speed at which they are carried out; and minimising the resources that have to be invested in their implementation.

There may be a role for the OECD in continuing to look at what works and what does not work in health policy – and what are the determinants of success in health system reforms…..”

 

Content:

Introduction

The need for reforms to improve the performance of health systems

The design and implementation of health system reforms

Factors which can help or hinder health system reform

The availability of information, evidence and analysis

Political leadership and political possibilities

The use of incentives and disincentives

The availability of resources

Case studies

Finland

Korea

Mexico

Switzerland

Turkey

Discussion

Information, evidence and analysis

Political leadership and political possibilities

Incentives

Resource availability

Conclusions

 

 

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