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

Bayat Mahboubeh; Kashkalani Tahereh; Khodadost Mahmoud; Shokri Azad; Fattahi Hamed; Ghasemi Seproo Faeze; Younesi Fatemeh; khalilnezhad Roghayeh

doi:10.3961/jpmph.22.394

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자료유형: 학술저널

저자정보: Bayat Mahboubeh (Ministry of Health & Medical Education Center for Health Human Resources Research and Studies T) Kashkalani Tahereh (Ministry of Health & Medical Education Center for Health Human Resources Research and Studies T) Khodadost Mahmoud (Department of Public Health School of Health Larestan University of Medical Sciences Larestan Iran) Shokri Azad (Social Determinants of Health Research Center Research Institute for Health Development Kurdistan) Fattahi Hamed (Health Management and Economics Research Center Iran University of Medical Sciences Tehran Iran) Ghasemi Seproo Faeze (1 Ministry of Health & Medical Education Center for Health Human Resources Research and Studies) Younesi Fatemeh (Ministry of Health & Medical Education Center for Health Human Resources Research and Studies T) khalilnezhad Roghayeh (Ministry of Health & Medical Education Center for Health Human Resources Research and Studies T)

저널정보: 대한예방의학회 예방의학회지 예방의학회지 제56권 제2호

발행연도: 2023.3

수록면: 128 - 144 (17page)

DOI: 10.3961/jpmph.22.394

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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.

#Health care reform #Failure #Systematic review

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Bayat Mahboubeh

소속기관 Ministry of Health & Medical Education Center for Health Human Resources Research and Studies T