Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis

  • Mahboubeh Bayat (Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies) ;
  • Tahereh Kashkalani (Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies) ;
  • Mahmoud Khodadost (Department of Public Health, School of Health, Larestan University of Medical Sciences) ;
  • Azad Shokri (Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences) ;
  • Hamed Fattahi (Health Management and Economics Research Center, Iran University of Medical Sciences) ;
  • Faeze Ghasemi Seproo (Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies) ;
  • Fatemeh Younesi (Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies) ;
  • Roghayeh Khalilnezhad (Ministry of Health & Medical Education, Center for Health Human Resources Research and Studies)
  • Received : 2022.09.03
  • Accepted : 2023.03.05
  • Published : 2023.03.31
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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

Acknowledgement

The Center for Health Human Resource Research and Studies (CHHRRS) of the the Ministry of Health and Medical Education (MOHME) in Iran supported this study.

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