Stewardship and health systems strengthening: An overview

Brinkerhoff, Derick W.; Cross, Harry E.; Sharma, Siddharth; Williamson, R. Taylor

doi:10.1002/pad.1846

Cited by 30 publications

(27 citation statements)

References 10 publications

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“…In health policy, removal of user fees tends to increase access to health services in countries in early stages of development, particularly for those more vulnerable (Hangoma, Robberstad, & Aakvik, 2018). Also, there are ways countries can better steward their health systems to be more effective in the use of resources and the achievement of health outcomes (Brinkerhoff, Cross, Sharma, & Williamson, 2019;Chan et al, 2019).…”

Section: Final Remarksmentioning

confidence: 99%

The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions

et al. 2020

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As countries turn wealthier, some health indicators, such as child mortality, seem to have well-defined trends. However, others, including cardiovascular conditions, do not follow clear linear patterns of change with economic development. Abnormal blood pressure is a serious health risk factor with consequences for population growth and longevity as well as public and private expenditure in health care and labor productivity. This also increases the risk of the population in certain pandemics, such as COVID-19. To determine the correlation of income and blood pressure, we analyzed time-series for the mean systolic blood pressure (SBP) of men's population (mmHg) and nominal Gross Domestic Product per capita (GDPPC) for 136 countries from 1980 to 2008 using regression and statistical analysis by Pearson's correlation (r). Our study finds a trend similar to an inverted-U shaped curve, or a 'Heart Kuznets Curve'. There is a positive correlation (increase GDPPC, increase SBP) in low-income countries, and a negative correlation in high-income countries (increase GDPPC, decrease SBP). As country income rises people tend to change their diets and habits and have better access to health services and education, which affects blood pressure. However, the latter two may not offset the rise in blood pressure until countries reach a certain income. Investing early in health education and preventive health care could avoid the sharp increase in blood pressure as countries develop, and therefore, avoiding the 'Heart Kuznets Curve' and its economic and human impacts.

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Section: Final Remarksmentioning

confidence: 99%

The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions

et al. 2020

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“…23 of 2014 it also has been explained that the determination of the specialist doctors' placement and specialist dentists for regions who are unable and uninterested is a matter of the central government (Governement Republic of Indonesia, 2014). However, the policies regarding incentives and facilities for physicians in remote areas vary on the capabilities of the region (Aziz, 2016;Brown, 2020;Brinkerhoff, Cross, Sharma, & Williamson, 2019).…”

Section: National Policy Indicators and Their Application In The Regionsmentioning

confidence: 99%

The Needs Fulfillment of Medical and Specialist Doctors in West Nusa Tenggara, Indonesia

et al. 2021

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nasional terkait insentif dan fasilitas. Kebijakan Pemerintah Daerah dinilai belum cukup signifikan untuk meningkatkan ketersediaan dokter dan dokter spesialis, terutama dari sisi mekanisme advokasi. Hal ini berdampak pada minimnya minat dokter dan dokter spesialis untuk ditempatkan di daerah terpencil. Lingkungan kebijakan untuk memenuhi kebutuhan dokter spesialis di Nusantara Tenggara Barat (NTB) cukup kondusif dan mendukung. Masih perlu perbaikan mekanisme koordinasi antarlembaga dan penyediaan jalur advokasi yang sangat penting untuk mendukung efektivitas pemenuhan kebutuhan kebijakan dokter spesialis. This open access article is under the CC-BY-SA license.

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“…IJN's experience also demonstrates the potential stewardship role for the state in managing new organizational forms to realize efficiency gains from competition. 20 In the past, IJN has been described as a 'price bulwark' against uncontrolled pricing by private sector cardiovascular and thoracic services by providing a pricing benchmark and credible competition with private hospitals. A widely cited report from 2008, one of few available comparisons of IJN pricing, compared typical prices for heart procedures at IJN and another premier private hospital which had unsuccessfully sought a stake in IJN Holdings Sdn Bhd.…”

Section: Competition and Cost Efficiencymentioning

confidence: 99%

Hybrid Organizations in Health Systems: The Corporatization of Malaysia’s National Heart Institute

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Yusoff

et al. 2020

Health Systems & Reform

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Health system reforms across high-and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.

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Stewardship and health systems strengthening: An overview

Cited by 30 publications

References 10 publications

The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions

The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions

The Needs Fulfillment of Medical and Specialist Doctors in West Nusa Tenggara, Indonesia

Hybrid Organizations in Health Systems: The Corporatization of Malaysia’s National Heart Institute

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