Notwithstanding such breadth and variety, common reform themes emerge—along with similar policies, objectives and obstacles. Unfortunately, the well-meaning plans currently presented to Congress are the wrong therapy because they mistake the symptoms for the underlying disease. A final ‘model’ system is also described by Reid; the ‘Out-of-Pocket’ model in which the care is provided on a cash basis—those without cash generally go un-served or depend on intermittent and episodic acute care in emergency rooms or charity clinics and hospitals. While Indonesia still faces many challenges, including a mounting NCD burden, say Sophia Hermawan and Brette Blakely, the insurance scheme and a supportive regulatory environment set a “promising tone”. S What impact, though, have these numerous and often costly restructures, measures and initiatives had on the quality of care and the safety of patients? Although insurance premiums have gone up for some, reports by the U.S. Department of Health and Human Services cite economic benefits for states and estimate that with more Americans insured, hospitals will face less uncompensated care, which accounted for billions of dollars in 2013. Doctors and hospitals are mostly private. C Keeping these promises will be another matter for another time. Politics – defined classically as who gets what, when and how by Lasswell – affects the origins, formulation, and implementation of public policy in the health sector. It is not trivial to determine whether reforms have led to sustained and positive outcomes. T T.R. The main governmental support systems for health care are bordering on insolvency and without dramatic changes will be ‘bankrupt’ in the next decade. Health care 2020: reengineering health care delivery to combat chronic disease. But rural and urban Indian reform programmes have achieved significant results: deaths from kala-azar disease have fallen 21.2%, from malaria 45.2%, microfilaria 26.7% and dengue fever 52%. The escalating costs are fueled in large part by over abundant use of expensive high-technology, new and costly brand-name pharmaceuticals (including drugs that basically replicate the effects of already available drugs), limits on the availability of generic drugs and the accelerating aging of the society at large. The experiences this book describes offer lessons for reformers. Search for other works by this author on: Canon Institute of Global Studies, 11th Floor, ShinMarunouchi Building, 5-1 Marunouchi 1-chome, HSMC, Park House, University of Birmingham, Department of Surgery & Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 251 E. Huron, Department of Health Policy and Management, Harvard University, 677 Huntington Avenue, International Society for Quality in Health Care (ISQua), Joyce House, 8-11 Lombard Street East, Getting Health Reform Right: A Guide to Improving Performance and Equity, Healthcare Reform: Learning from International Experience (Leadership and Management in Education), Healthcare Reform, Quality and Safety: Perspectives, Participants and Prospects in 30 Countries, Action Evaluation of Health Programmes and Changes—A Handbook for a User-Focused Approach, Evaluating Improvement and Implementation for Health, Why system inertia makes health reform so difficult, Implementing culture change in health care: theory and practice, The stepped wedge trial design: a systematic review. Throughout the debate leading to enactment of the new law intense lobbying efforts by stakeholders (organized medicine, hospital associations, insurance entities, pharmaceutical companies, state and local government leaders, constituency groups, labour unions and the like) shaped the structure and complexity of the final legislation. For the employed, under age 65 years it is like Germany (or France and Japan) except most insurance plans are for-profit (The new law puts a ‘cap’ on administraive cost); for the over 65 year age group, it is like Canada (or South Korea or Taiwan); for the Native Americans, Military or Veterans it is like the UK (and Cuba); and for the unemployed and uninsured it is like many countries that do not have an organized system of public health insurance, such as India, most parts of China and in equatorial Africa. Linear cause-and-effect logic (let us do reform X, which will realize benefit Y) rarely holds. No effective plans for controlling ever-spiraling upward costs have yet been put in place—the new law in America is no exception. Its individual components are not well integrated. What links existed were weak and situation dependent. Selected delegates were asked to give a talk on their country, and then invited to contribute a chapter. The Italy chapter by Americo Cicchetti, Sylvia Coretti and Valentina Iacopino describes a sophisticated health system separated into regions, based on a Beveridge model of universal access and principles of equity (like Australia, New Zealand and other OECD systems). J Community Health 9: 196–205. However, we found the measures they adopt share many features. the Kaiser Permanente System); and (vi) a conglomeration of locally supported (through taxation of the citizens) public hospitals and clinics, largely serving the poor and the uninsured (including non-citizens). inpatient and rehabilitation care. One of the most striking aspects of the long and rancorous debate over health care reform in America was how the health systems in other countries were characterized and in many instances defamed in the media and in ‘town-hall’ style gatherings. Health systems are continually being reformed. The great generational debate on how to reform the health care system in America came to a dramatic conclusion late in the evening of 21 March 2010 when the House of Representatives approved (by a vote of 219 to 212) a previously approved Senate version of health reform legislation.1 Two days later, President Obama signed the landmark legislation into law and became the first President since Lyndon Johnson in 1965 to accomplish such a major change in the American health care.2 Clarion calls for repeal and lawsuits over its constitutionality appeared quickly after the passage of this historic reform effort. There was no funding specific to this project. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. For Permissions, please email: journals.permissions@oxfordjournals.org, Mitral valve ‘kissing lesion’ in Libman–Sacks endocarditis, Pseudosacculations in CT enterography: a diagnostic clue to Crohn’s disease, Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, seven-day working, and the effect of COVID-19, Characteristic honeycomb sign in a hepatic abscess secondary to melioidosis, American perceptions of other health care systems, Receive exclusive offers and updates from Oxford Academic, Decreased risk of intracerebral hemorrhage among patients with milder allergic rhinitis. These pose obstacles to reform. Of all of these, the Bismarck model provides the greatest choice of providers except when insurance and care is provided under one corporate umbrellas as is the case in some parts of Japan. Medicare spending varies widely in America depending on health status, income level and other regional factors.3 A promise to slow the projected growth of the Medicare program may delay insolvency, but will be difficult to actually accomplish. This fragmentation inhibits transparency; aggregated data sets to analyse the system are lacking, as is overarching systems thinking, say chapter writers Holger Pfaff, Tristan Gloede and Antje Hammer. Most studies suggest that reforms—including the largest restructure in the history of the NHS, new hospital star ratings and networks of “collaboratives”—have helped improve productivity, quality and safety, with fewer deaths from cancer and cardiovascular disease now recorded. Elsewhere in Scandinavia, the impacts of reform are less clear. Am J Med. C The USA is not close to universal coverage, but the ACA has extended insurance to ~20 million previously uninsured people—including historic increases in coverage for low-wage workers and others long left out of the system [8]. Citizens of Canada sacrificed immediate access to a provider of their choice for the assurances that everyone would be covered but not necessarily at their beck and call. By Gaby Galvin , Staff Writer Feb. 7, … Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia. There is a “universal aim … towards enhancing the ability to deliver quality healthcare and thereby improve the health of society” [3]. Across South America, concerns have been expressed about national and institutional cultures as obstacles to reform. Prevention often takes a distant third place behind diagnosis and treatment in priorities for care. Qingyue Meng and colleagues assess what China’s health system reform has achieved and what needs to be done over the next decade The Chinese central government started a first round of health system reform in 1996. Non-Americans view the American system as wasteful of precious resources, full of redundant capacity, woefully insufficient in terms of access to primary care, only average in overall quality compared to cost (poor in value) and unconscionably out of step with the industrialized nations of the world by denial of the fundamental right to affordable health care for all of its inhabitants. Healthcare Reform, Quality and Safety draws together scholarship from lower- and middle-income nations as well as OECD (Organisation for Economic Cooperation and Development) countries. And South Africa not only carries a quadruple burden of disease—HIV/AIDS and tuberculosis, maternal and infant mortality, non-communicable diseases (NCDs), and violence and trauma—but faces hurdles that include “unacceptably high levels of fraud and theft, top-heavy management and administration structures, and an excessively hospi-centric and specialist focus”, according to Stuart Whittaker, Carol Marshall and Grace Labadarios [3]. The American hybrid system is viewed by many as fragmented, chaotic, difficult and complex to navigate, and harboring some disturbingly unfair insurance practices. *Based on a Lecture given at the John Radcliffe Hospital, University of Oxford on 6 October 2009. One conclusion of Healthcare Reform, Quality and Safety is that we cannot escape the possibility that in less wealthy countries (and wealthier countries dogged by inequities, for that matter), we may be looking for solutions in the wrong place. As section editor Russell Mannion reports, England, Sweden and Norway have employed financial incentives to boost the performance of healthcare providers, while England and Sweden have introduced pro-market reforms premised on competition and choice. Referencing the Patient Protection and Affordable Care Act (P.L. A third model also arose in the post-WW-II period in Canada, created first by Thomas ‘Tommie’ Douglas in the province of Saskatchewan in 1945 and Canada-wide in 1961 called Medicare. Our central point, however, remains: in all countries, rich and poor alike, effective, independent evaluation of reform initiatives is currently lacking. Ye… If health systems around the world seem to have been undergoing almost continuous reform over the past two decades, that is probably because they have. Payment rates currently in Medicaid are so low than many doctors and hospitals eschew participation, as is their right. Meanwhile, in Brazil, a “strong punitive approach … often impedes the development of a blameless culture”, say the chapter authors. This overview examines the issues raised in the debate, perceptions of health care systems on a global basis, provides some perspectives on the reform of health care systems and examines some of the realities underlying these changes for the future of health care in America. By contrast, chapter authors in our compendium of 30 countries found the reformers they report on optimistic that their reforms would make a difference. Status of Diabetic Neuropathy in Korea: A National Health Insurance Service-National Sample Cohort Analysis (2006 to 2015). Each of the 30 countries has adopted a different mix of measures, and each thinks its reforms are unique. In 2012, events causing patient harm or contributing to death, or requiring intervention or a longer hospital stay, fell to 13.9%, from 16.1% in 2011. 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