Health Systems and Reform Journal

​​Explore this article for more insights on CMH systems’ crucial role in the recent pandemic and their potential in future health emergencies! Read more here: bit.ly/3Uew1Wp

➡️ CMH systems and services tended to disproportionately exclude marginalized groups, such as individuals from low-income backgrounds, ethnic minorities, those with limited literacy, and migrants in vulnerable living conditions.

➡️ Quality of CMH care was influenced by resourcing and capacity, strength of connections across service providers within the CMH system, availability of customized care, and ease of access.
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➡️CMH systems acted as safety nets and networks: They adapted to fill gaps in the broader mental health ecosystem.

➡️The trust previously established with CMH long-term service providers enabled service users to adopt unfamiliar therapeutic interventions like telehealth.
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In their article, Cheryl Sim Su Ling, PV Asharani, Mythily Subramaniam, and Huso Yi carried out a systematic review and meta-ethnography to answer these questions. These are their key findings:

What was the role of community mental health (CMH) systems and services during the #COVID-19 pandemic? What were the key dynamics observed within CMH systems during this time? And what factors influenced the quality of their services?

Find out here🧵

By targeting upstream causes and system-wide reforms, DAH can help countries transform their health system. Read more: bit.ly/40GYaJB

Even as global health funding declines, DAH can still play a catalytic role:

➡️Support reforms in service delivery and financing
➡️Strengthen data systems
➡️Incentivise prevention and early detection
➡️Align aid with country priorities

The authors argue that tackling NCDs means moving to integrated, continuous & proactive care, while addressing underlying risk factors like diet, activity and environment.

This requires action beyond the health sector👇

NCDs like type 2 diabetes reveal gaps in health systems: long latency, chronic care needs and complex causes make them harder to tackle than acute illnesses.

Prevention is limited, screening is sporadic, and care is often fragmented, leading to late diagnoses and higher costs👇

How can development assistance for health evolve to better address the growing challenge of non-communicable diseases?

William Savedoff, Abdo S. Yazbeck, David H. Peters & Son Nam Nguyen explore this question through the lens of type 2 diabetes🧵

In brief, the findings suggest that the centralized procurement program led not only to a reduction in procurement prices, but also to decreased overuse of these expensive medical products. Read more here: bit.ly/3KYGTDy

➡️ The probability of AMI patients receiving PCI with stents has decreased, with the decrease in the use of two or three stents being more significant than that of the use of a single stent

➡️ Centralized procurement directly generated a reduction in the medical expenditure in cases of AMI

➡️ There has been an increase in the probability of AMI patients receiving PCI with balloons or coronary artery bypass grafting (CABG) 👇

The study focused on a specific city of China and it specifically evaluated the impact of centralized procurement on treatment costs and patterns for acute myocardial infarction (AMI) patients. These are some of their key findings:

In 2020, China's National Healthcare Security Administration expanded the centralized procurement program to include high-value medical consumables like coronary stents. Weiyan Jian, Shanshan Huo, Lanyue Zhang & Wuping Zhou studied the impact of this program🧵

➡️Enforcement of consolidation legally started in July 2000 and financial consolidation of the trusts was finally achieved in 2003

Read the full article for a detailed stakeholder analysis of each of the phases!

bit.ly/3T9hQ5b

Policy adoption phase (1990-2003)

➡️Supporters formed coalitions to advocate for consolidation, while economic challenges increased pressure for reform
➡️The National Health Insurance Act, mandating full consolidation, was passed in 1999 under President Kim Dae-jung
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Agenda-setting phase (1980-1989)

➡️The idea of consolidation was first proposed in 1980 by Minister of Health Chun Myung-ki, but was rejected by President Chun Doo-hwan
➡️In 1989, the National Assembly passed a consolidation bill. However, it was vetoed by President Roh Tae-woo
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South Korea stands out as one of the few countries to successfully consolidate its national risk pools into a single-payer health insurance system.

Here are key aspects of the agenda-setting and policy adoption phases that made this transformation possible🧵

Read more: bit.ly/3Yp0N2m

➡️Capitation: ensures timely payments and predictable budgeting, encouraging cost-effective services with low administrative overhead. However, lacks clarity in rate calculations, transfers administrative burdens to providers, and risks under-provision of services

➡️Fee-for-service: incentivizes high-quality care and provides financial flexibility, yet escalates costs, incurs payment delays, and imposes a heavy administrative burden

➡️Performance-based financing: drives quality and equity but is administratively burdensome and costly👇

Their findings reveal that in Ethiopia PPMs have had both positive and negative impacts:

➡️Line-item budgets: offer predictable funding and no payment delays, but suffer from rigidity, resource insufficiency, and inability to retain unused funds
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How can low-income countries design provider payment mechanisms (PPMs) that advance #UHC goals?

Mideksa Koricho and colleagues examined this question by exploring the impact of Ethiopia's PPMs on equity, efficiency, quality of care, and financial sustainability🧵

Read the full article here: bit.ly/47WonGr

Lessons about China’s accountability system

🔹Enabled consistent nationwide policy implementation
🔹Prioritized containment over economic support
🔹Led to potential over-enforcement of containment measures
🔹Highlighted the need for balanced policy goals in crisis management

🔹Impacted even provinces without new outbreaks
🔹Stronger effects in nearby provinces
🔹Motivated officials through fear of punishment, not just promotion

Their findings revealed several effects of accountability events (disciplinary actions initiated by higher-level government officials against lower-level officials) on COVID-19 response

🔹Increased containment measures, decreased economic support👇

China's zero-COVID strategy lasted an impressive three years.

In their recent study, Bingqing Guo and Karen Ann Grépin examine how China's administrative accountability system influenced this prolonged adherence🧵