title: How to do better health reform: a snapshot of change and improvement initiatives in the health systems of 30 countries.
abstract: Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries. We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context-that is, in low-, middle- and high-income countries-Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort-that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message.
authors.affiliation: Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.affiliation: Canon Institute of Global Studies, 11th Floor, ShinMarunouchi Building, 5-1 Marunouchi 1-chome, Chiyoda-ku, Tokyo 100-6511, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham, B15 2RT, UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Mannion
authors.affiliation: Department of Surgery & Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 251 E. Huron, Galter 3-150, Chicago, IL 60611, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Health Policy and Management, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA.|International Society for Quality in Health Care (ISQua), Joyce House, 8-11 Lombard Street East, Dublin D02 Y729, Ireland.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.affiliation: Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia.|International Society for Quality in Health Care (ISQua), Joyce House, 8-11 Lombard Street East, Dublin D02 Y729, Ireland.
authors.forename: Cliff
authors.initials: C
authors.lastname: Hughes
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D018166:Health Care Reform / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D061214:Patient Safety; D011785:Quality Assurance, Health Care