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. 2023 Mar;56(2):128-144.
doi: 10.3961/jpmph.22.394. Epub 2023 Mar 14.

Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis

Mahboubeh Bayat  1 , Tahereh Kashkalani  1 , Mahmoud Khodadost  2 , Azad Shokri  3 , Hamed Fattahi  4 , Faeze Ghasemi Seproo  1 , Fatemeh Younesi  1 , Roghayeh Khalilnezhad  1   4
Affiliations

Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis

Mahboubeh Bayat et al. J Prev Med Public Health. 2023 Mar.

Abstract

Objectives: The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms.

Methods: In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment.

Results: After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators' attitudes and knowledge; (2) weakness 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; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place.

Conclusions: Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

Keywords: Failure; Health care reform; Systematic review.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

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Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of search and screening process.
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References

    1. Cassels A. Health sector reform: key issues in less developed countries. J Int Dev. 1995;7(3):329–347. - PubMed
    1. Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002;54(8):1255–1266. - PubMed
    1. Agrawal JR, Huebner J, Hedgecock J, Sehgal AR, Jung P, Simon SR. Medical students’ knowledge of the U.S. health care system and their preferences for curricular change: a national survey. Acad Med. 2005;80(5):484–488. - PubMed
    1. World Health Organization Health care systems in transition: Lithuania. 2000. [cited 2022 Mar 7]. Available from: https://apps.who.int/iris/handle/10665/108334 .
    1. Oberlander J. Unfinished journey--a century of health care reform in the United States. N Engl J Med. 2012;367(7):585–590. - PubMed

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