Key Reforms in Health Systems in Europe, the United States and Canada in 2022 and 2023

Background and Objectives

The Authority for Strategic and Economic Planning in the Ministry of Health asked the Myers-JDC–Brookdale Institute to review the main reforms and policy changes implemented in the health systems of Europe, the United States (US) and Canada with the goal of identifying the main issues and trends that were on the policy agenda in these healthcare systems in 2022–2023.

Method

The review used qualitative methods based on text analyses of data gathered by researchers of the Health System and Policies Monitor (HSPM). The analysis was carried according to the WHO’s analytical framework of “Health Systems Building Blocks”, in which each reform was classified according to one of the six building blocks: Service Delivery; Health Workforce; Health Information Systems; Medical Products, Vaccines and Technologies; Health System Financing; and Leadership and Governance. This analytical framework is widely accepted in the literature on healthcare systems worldwide and is used to understand the functions, goals and outcomes of healthcare systems.

Main Findings

This review examined 87 reforms carried out in 32 countries in Europe, the US and Canada. HSPM researchers selected the main reforms in those countries, which indicated the most urgent issues on their agendas, and the way they are being addressed. Most of the reforms were classified as belonging to two of the building blocks: Service Delivery and Health System Financing. The building blocks with the fewest reforms were Health Information Technologies and Medical Products, Vaccines and Technologies. The reforms involved diverse populations: residents of the periphery, pregnant women, people with mental health difficulties, complex patients and end-of-life patients. We identified several policies that are common in many countries: investment in the health workforce, mental health, home care and hospital-at-home services, health promotion, and primary and secondary care. Another issue which some of the countries reviewed had in common was the development of strategic plans in the wake of the Covid-19 pandemic.

Discussion

Most of the reforms in the review aimed at achieving two health system goals: improving access to care and quality of care. Improving access to care included improving availability by increasing the productivity of the existing workforce; by increasing the pool of suppliers; and by broadening public health insurance coverage to promote financial protection. The reforms aimed at improving quality of care focused on improving patient centered care; improving organizational infrastructure; improving governance; and changing the payment mechanisms to include performance-based payments. In addition, countries are making plans to prepare for future crises related to climate change and in response to the COVID-19 pandemic.

Conclusion

The analytical framework enables the use of uniform terminology and allows the identification of trends in healthcare reforms. By classifying the reforms according to the strategies for response and improvement by building blocks, we identify how countries aim to achieve their health system’s goals and outcomes, namely high-quality and accessible care.