Common patterns and drivers of healthcare system reforms across the OECD nations

Abstract

Abstract Background Changing health care needs, growing public expectations for high quality and cost-effective care, a burned out and strained healthcare workforce, and market competitions are pushing countries to re-evaluate the efficiency, sustainability, and performance of their health systems. The aims of this study were to: 1) identify the prominent drivers of reforms and 2) examine the common patterns of health system reforms across multiple dimensions.Methods We conducted a targeted search of grey and peer-reviewed literature focusing on health system reforms across the 38 Organization for Economic Cooperation and Development (OECD) member countries. A thematic framework was developed by adapting an existing health system framework expanded to five dimensions: 1) financing; 2) population coverage; 3) governance; 4) service delivery; and 5) service coverage. Data were indexed and charted deductively by a single reviewer (NVivo 12).Results Reforms were most often undertaken at times of economic crises (e.g., recession, war), changes to the nation’s political climate (e.g., change in political party or system), or a drastic change in population needs (e.g., aging population, epidemic). Despite a variety in evolutionary paths to present day health systems, some common patterns emerged across the five dimensions with reform continual in most nations.Conclusion Health system reforms have historically been driven by the economic, political, and social context; a context similar to the current one. Therefore, policy makers could leverage the current context to call for structural reform to healthcare systems.