Journal of Preventive Medicine and Public Health

Systematic Review

Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis: Mahboubeh Bayat, Tahereh Kashkalani, Mahmoud Khodadost, Azad Shokri, Hamed Fattahi, Faeze Ghasemi Seproo, Fatemeh Younesi, Roghayeh khalilnezhad; J Prev Med Public Health. 2023;56(2):128-144. Published online March 14, 2023; DOI: https://doi.org/10.3961/jpmph.22.394

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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.

Summary

Citations

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Comparative Study

Estimating the Cost Saving Due to the Effect of Kremezin in Delaying the Initiation of Dialysis Treatments among Patients with Chronic Renal Failure.: Hye Young Kang, Woohyun Cho, Sunmi Lee, Hyung Jong Kim, Ho Yong Lee, Tae Wook Woo; J Prev Med Public Health. 2006;39(2):149-158.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. METHODS: We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. RESULTS: The present value of cumulative cost savings per patient with CRF from the societal perspective would be 18,555,000~29,410,000 Won or 72,104,000~112,523,000 Won if Kremezin delays the initiation of dialysis by 1 or 4 years. CONCLUSIONS: The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.; Summary

English Abstract

Factors Affecting Re-smoking in Male Workers.: Jin Hoon Yang, Hee Sook Ha, Sin Kam, Ji Seun Lim, Yune Sik Kang, Duk Hee Lee, Byung Yeol Chun; J Prev Med Public Health. 2005;38(2):208-214.

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Abstract PDF: OBJECTIVES
This study was performed to examine the factors affecting re-smoking in male workers. METHODS: A self-administrated questionnaire survey was conducted during April 2003 to examine the smoking state of 1, 154 employees of a company that launched a smoking cessation campaign in1998. Five hundred and eighty seven persons, who had stopped smoking for at least one week, were selected as the final study subjects. This study collected data on smoking cessation success or failure for 6 months, and looked at the factors having an effect on resmoking within this period. This study employed the Health Belief Model as its theoretical basis. RESULTS: The re-smoking rate of the 587 study subjects who had stopped smoking for at least one week was 44.8% within the 6 month period. In a simple analysis, the resmoking rates were higher in workers with a low age, on day and night shifts, blue collar, of a low rank, where this was their second attempt at smoking cessation and for those with a shorter job duration (p< 0.05). Of the cues to action variables in the Heath Belief Model, re-smoking was significantly related with the perceived susceptibility factor, economic advantages of smoking cessation among the perceived benefits factor, the degree of cessation trial's barrier of the perceived barriers factor, smoking symptom experience, recognition of the degree of harmfulness of environmental tobacco smoke and the existence of chronic disease due to smoking (p< 0.05). In the multiple logistic regression analysis for re-smoking, the significant variables were age, perceived susceptibility for disease, economic advantages due to smoking cessation, the perceived barrier for smoking cessation, recognition on the degree of harmfulness of environmental tobacco smoke, the existence of chronic disease due to smoking and the number of attempts at smoking cessation (p< 0.05). CONCLUSION: From the result of this study, for an effective smoking ban policy within the work place, health education that improves the knowledge of the adverse health effects of smoking and the harmfulness of environmental tobacco smoke will be required, as well as counter plans to reduce the barriers for smoking cessation.; Summary

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