Dagens FSV-oversigt: All things being equal: does it matter for equity how you organize and pay for health care? A review of the international evidence.
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Dagens #fsvoversigt:
All things being equal: does it matter for equity how you organize and pay for
health care? A review of the international evidence.
Int J Health Serv. 2014;44(3):457-77
Authors: Bambra C, Garthwaite K, Hunter D
Abstract
Over the last 25 years, the health care systems of most high-income countries
have experienced extensive--usually market-based--organizational and financial
reforms. The impact of these system changes on health equity has been hotly
debated. Examining evidence from systematic reviews of the effects of health
care system organizational and financial reforms will add empirical information
to this debate, identify any evidence gaps, and help policy development.
Systematic review methodology was used to locate and evaluate published
systematic reviews of quantitative intervention studies (experimental and
observational) of the effects on equity in health care access and/or health
status of health care system organizational and financial reforms (system
financing, funding allocations, direct purchasing arrangements, organization of
service provision, and health and social care system integration) in
high-income countries. Nine systematic reviews were identified. Private
insurance
and out-of-pocket payments as well as the marketization and privatization of
services have either negative or inconclusive equity effects. The evidence base
on the health equity effects of managed care programs or integrated
partnerships between health and social services is inconclusive. There were no
relevant studies located that related to resource allocation reforms. The
systematic review-level evidence base suggests that financial and
organizational health care system reforms have had either inconclusive or
negative impacts on health equity both in terms of access relative to need and
in terms of health outcomes.
PMID: 25618985 [PubMed - indexed for MEDLINE]
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Dette abstract er hentet via PubMed fra National Library of Medicine, USA
(http://www.ncbi.nlm.nih.gov/About/disclaimer.html).
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