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1Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies, Tehran, Iran
2Department of Public Health, School of Health, Larestan University of Medical Sciences, Larestan, Iran
3Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
4Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
Copyright © 2023 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Adverse cost impacts of health services: Reform policies such as expensive hospital-based and specialized healthcare services; irrational use of medicines, medical equipment and paramedical services; and the fee-for-service payment method or reliance of workers such as doctors on the sale of drugs and technologies for income have inflated employer health costs and triggered an explosion in pharmaceutical and equipment costs [7,24,35,43,46,47]. The need for coordinated and integrated care, along with a dysfunctional referral system, has resulted in the overutilization of healthcare services, most of which were reimbursed by the insurance funds but were challenging to afford [24]. A major factor adversely impacting the cost of healthcare was the funding mechanism of reducing the cooperative expenditures and physician workloads with little public monitoring and regulation of healthcare services provided by doctors and pharmacists [7,12,24,34,35,40,46].
Decreased access for the poor population and unaffordable services: Despite efforts to provide and distribute resources fairly, problems with access to services have not necessarily been rectified, and service coverage has not become more equitable [17]. This has occurred due to a focus on specific financing processes or increasing the role of the private sector, high-deductible insurance policies focused on hospital and curative services instead of preventive care, increased differences between urban and rural areas, and social class disparities [7,23]. Publicly insured patients often wait excessively long. In many countries, health insurance coverage rates remain low, primarily due to unaffordability and a lack of health insurance infrastructure [7,17,25,29,39,44].
Dissatisfaction, lack of motivation, and a sense of injustice among employees [42] have led to more consequences, such as increased inter-institutional migration in various forms [7,25]. Poor economic status and unclear rights and responsibilities among government employees [13] are consequences of lack of attention to the working conditions of employees [18], increased workload and job stress [7], lack of adequate income guarantee and job security, aggravated or unresolved promotional and career structure problems preceding reform [42], fear of the unknown and concern [30], sense of being caught in the middle of the financial shortcomings of government, and high expectations created by reform promises [42].
DATA AVAILABILITY
All the data analyzed and reported in this paper were from published literature, which is already in the public domain.
CONFLICT OF INTEREST
The authors have no conflicts of interest associated with the material presented in this paper.
FUNDING
None.
AUTHOR CONTRIBUTIONS
Conceptualization: Khalilnezhad R, Bayat M. Data curation: Fattahi H, Khodadost M, Ghasemi Seproo F, Shokri A. Formal analysis: Fattahi H, Khodadost M, Ghasemi Seproo F, Shokri A. Funding acquisition: None. Methodology: Khalilnezhad R, Khodadost M, Bayat M. Project administration: Bayat M. Visualization: Ghasemi Seproo F, Younesi F. Writing – original draft: Ghasemi Seproo F, Younesi F, Khalilnezhad R. Writing – review & editing: Bayat M, Kashkalani T, Khalilnezhad R, Fattahi H, Khodadost M, Ghasemi Seproo F, Shokri A, Younesi F.
Study | Title | Abstract | Problem formation | Purpose or research question | Qualitative approach & research paradigm | Researcher characteristics & reflexivity | Context | Sampling strategy | Ethics pertaining to human participants | Data collection methods | Collection instruments & technology | Units of study | Data processing | Data analysis | Techniques to enhance trustworthiness | Synthesis & interpretation | Links to empirical data | Integration with prior work transferability | Limitations | Conflict of interest | Funding | Of a total possible score of 21 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Adinolfi [12] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 15 | ||||||
Al-Hamadani et al. [13] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 16 | |||||
Ashton [14] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Aviram et al. [15] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 14 | |||||||
Bali et al. [16] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 14 | |||||||
Bener et al. [17] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 12 | |||||||||
Bernal et al. [18] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 16 | |||||
Bossest et al. [19] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Contandriopoulos et al. [20] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 11 | ||||||||||
Dilly [21] | √ | √ | √ | √ | √ | √ | √ | √ | 8 | |||||||||||||
Villalobos Dintrans [22] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 16 | |||||
Dong et al. [23] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 13 | ||||||||
Doshmangir et al. [24] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 15 | ||||||
Fleury et al. [25] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Gabriele et al. [26] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 14 | |||||||
Green [27] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 15 | ||||||
Hacker [28] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Harbage et al. [29] | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||||
Homedes et al. [7] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 12 | |||||||||
Hurley et al. [30] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 14 | |||||||
Johnson [31] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 13 | ||||||||
Kay et al. [32] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 10 | |||||||||||
Künzler [33] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 11 | ||||||||||
Kutzin et al. [34] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 11 | ||||||||||
Lee [35] | √ | √ | √ | √ | √ | √ | √ | 10 | ||||||||||||||
Maynard [36] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 11 | ||||||||||
Meng et al. [37] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 12 | ||||||||||
Navarro [38] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Oberlander [9] | √ | √ | √ | √ | √ | √ | √ | √ | 8 | |||||||||||||
Paul-Shaheen [39] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 15 | ||||||
Rothman [40] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Sager et al. [41] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 10 | ||||||||||||
Ssengooba et al. [42] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 17 | ||||
Swenson et al. [43] | √ | √ | √ | √ | √ | √ | √ | 8 | ||||||||||||||
Talukder et al. [44] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | ||||||||||||
Tang et al. [45] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 14 | |||||||
Xin [46] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 10 | ||||||||||
Webber [47] | √ | √ | √ | √ | √ | √ | √ | √ | 9 | |||||||||||||
Waddan et al. [48] | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 12 | |||||||||
Whibley [49] | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 |
No. | Study | Study location | Setting (level of reform conducted) | Study design1 | Document type2 | Data collection method(s)3 | Themes4 | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | |||||||
1 | Adinolfi, 2014 [12] | Italy | National health system | Qualitative | Journal article | √ | √ | √ | √ | √ | √ | √ | |
2 | Al-Hamadani et al., 2019 [13] | Iraq | Subnational health system | Qualitative | Journal article | Unstructured | √ | √ | √ | √ | √ | ||
3 | Ashton, 2001 [14] | New Zealand | National health system | Qualitative | Journal article | Not reported | √ | √ | √ | √ | |||
4 | Aviram et al., 2007 [15] | Israel | National health system | Qualitative | Journal article | Documents and interviews | √ | √ | √ | √ | √ | √ | |
5 | Bali, 2015 [16] | India | National health system | Qualitative | Journal article | Interview and documentary analysis | √ | √ | √ | ||||
6 | Bener et al., 2019 [17] | Turkey | National health system | Review | Journal article | Documentary analysis | √ | √ | √ | √ | √ | √ | |
7 | Bernal et al., 2014 [18] | Colombia | National health system | Quantitative | Journal article | Q methodology | √ | √ | √ | √ | |||
8 | Bossest et al., 2000 [19] | Chile, Colombia, and Bolivia | National health system | Qualitative | Research report | Not reported | √ | √ | |||||
9 | Contandriopoulos et al., 2010 [20] | Canada | Quebec health system reform | Qualitative | Journal article | Documentary analysis | √ | √ | √ | √ | |||
10 | Dilly, 2003 [21] | USA | National health system | Qualitative | Research report | Documentary analysis | √ | √ | √ | √ | √ | ||
11 | Villalobos Dintrans, 2019 [22] | Chile | National health system | Qualitative | Journal article | Document review and interviews | √ | √ | √ | ||||
12 | Dong et al., 2014 [23] | China | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | √ | √ | √ | ||
13 | Doshmangir et al., 2019 [24] | Iran | National health system | Review | Journal article | Documentary analysis | √ | √ | √ | √ | √ | √ | |
14 | Fleury et al., 2000 [25] | Argentina, | National health system | Qualitative | Research report | Documentary analysis | √ | √ | √ | √ | √ | √ | |
15 | Gabriele et al., 2014 [26] | Italy | National health system | Qualitative | Journal article | Documentary analysis | √ | ||||||
16 | Green, 2000 [27] | Thailand | National health system | Qualitative | Journal article | Interview and documentary analysis | √ | ||||||
17 | Hacker, 2001 [28] | USA | National health system | Qualitative | Journal article | Not reported | √ | √ | |||||
18 | Harbage et al., 2008 [29] | USA | California health reform | Qualitative | Research report | Documentary analysis | √ | √ | √ | √ | √ | √ | |
19 | Homedes et al., 2005 [7] | Latin America, Chile, Colombia | National health system | Qualitative, case study | Journal article | Documentary analysis | √ | √ | √ | √ | |||
20 | Hurley et al., 2004 [30] | Australia | National health system | Case study | Journal article | Phone interview and documentary analysis | √ | √ | √ | √ | |||
21 | Johnson, 2009 [31] | USA | National health system | Qualitative | Thesis | Documentary analysis | √ | √ | √ | √ | |||
22 | Kay et al., 2015 [32] | Australia | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | |||||
23 | Künzler, 2016 [33] | Kenya | National health system | Case study | Journal article | Documentary analysis | √ | √ | √ | ||||
24 | Kutzin et al., 2010 [34] | Central and Eastern Europe | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | |||||
25 | Lee, 2003 [35] | South Korea | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | √ | √ | |||
26 | Maynard, 1994 [36] | UK | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | √ | √ | |||
27 | Meng et al., 2019 [37] | China | National health system | Review | Journal article | Documentary analysis | √ | √ | |||||
28 | Navarro, 2008 [38] | USA | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | |||||
29 | Oberlander, 2003 [9] | USA | National health system | Qualitative | Documentary analysis | √ | √ | ||||||
30 | Paul-Shaheen, 1998 [39] | USA | Seven states of the USA | Qualitative | Journal article | Interviews and literature review | √ | √ | √ | √ | |||
31 | Rothman, 1993 [40] | USA | National health system | Review | Journal article | Documentary analysis | √ | √ | √ | ||||
32 | Sager et al., 1993 [41] | USA | National health system | Qualitative | Research report | Documentary analysis | √ | √ | |||||
33 | Ssengooba et al., 2007 [42] | Bangladesh, Uganda | National health system | Qualitative and quantitative | Journal article | Focus group discussion | √ | √ | √ | √ | |||
34 | Swenson et al., 2002 [43] | USA | National health system | Qualitative | Journal article | Not reported | √ | √ | √ | √ | |||
35 | Talukder et al., 2008 [44] | Bangladesh, Pakistan | National health system | Qualitative | Journal article | Focus group discussion with experts and documentary analysis | √ | √ | √ | √ | |||
36 | Tang et al., 2017 [45] | China | Subnational health system | Mixed methods | Journal article | Questionnaires and interviews | √ | √ | √ | √ | |||
37 | Xin, 2016 [46] | China | National health system | Review | Journal article | Documentary analysis | √ | √ | √ | √ | √ | ||
38 | Webber, 1995 [47] | USA | National health system | Review | Journal article | Not reported | √ | √ | √ | √ | √ | ||
39 | Waddan, 2006 [48] | USA | National health system | Qualitative | Journal article | Documentary analysis | √ | √ | √ | ||||
40 | Whibley, 2019 [49] | Finland | National health system | Review | Journal article | Not reported | √ | √ |
1 Qualitative/mixed methods.
2 Journal article, thesis, government report, research report, or conference paper.
3 Focus groups, interviews, participant observation, documentary analysis, literature review, or not reported.
4 Themes: 1=reforms initiators’ attitudes and knowledge; 2=faintness of political support; 3=lack of interest group support; 4=insufficient comprehensiveness of the reform; 5=problems related to the implementation of the reform; 6=harmful consequences of reform implementation; 7=political, economic, cultural, and social conditions of the society in which reform takes place.