Abstract
Health sector reform: experiences in ten countries This report aims to synthesize lessons derived from health sector reform experiences in ten countries, namely, Germany, United Kingdom, Australia, New Zealand, Japan, Republic of Korea, Republic of China (Taiwan), Singapore, Malaysia, and the United States. The main source of data for the synthesis comes from reports on health sector reform of these ten countries commissioned by the Health Systems Research Institute. Other sources include journal articles and discussion with academicians from some countries. Analysis of the structural aspect of reform addresses 1) overall structure of the health system, 2) benefits and choices available to, and burden borne by the consumers/ patients, 3) provider characteristics and payment mechanisms, 4) insurer/ fund characteristics, sources of fund, number and roles of insurer, and 5) intermediate system outcomes. Policy process model is used as the framework for comparative analysis of reform process. Lessons on the policy processes in each of the following policy stages are compared and contrasted: 1) agenda building, 2) policy formulation, 3) policy adoption, and 4) policy implementation. Experiences from these ten countries indicate that countries succeeded in instituting universal coverage of health care all employ compulsory insurance. While systems managed by a single insurer or insurance fund are often found to be less responsive to client needs, those managed by multiple insurers suffer from problems such as cream skimming, distribution of risk among insurers, and system inefficiency. Appropriate rules are needed to ensure overall equity, quality, and efficiency of insurance system(s) in a country. Insurer should be a prudent purchaser, playing active roles in selecting, negotiating with providers, and monitoring quality of care. Payment mechanisms can be designed in such a way that overall costs are controlled, while health promotion and preventive services are promoted. Health sector reforms taken place in these countries in the past century had two main objectives: expansion of insurance coverage and cost containment. Reform processes in most countries culminated in the enactment of laws. Experiences in some countries show that simply passing insurance laws does not always lead to the desired outcome. Implementation of policy is no less important than policy formulation and adoption for the accomplishment of reform objectives. Factors affecting the success of reform process include the degree the reform initiatives are in accordant with societal values, whether a comprehensive or a piecemeal approach to reform is employed, economic condition at the time reform movement took place, relative political power among the various stakeholders, political mobilization of the movement, development of technical capability for implementing reform, and the effectiveness of policy communication.
