| Wenzl et al., 20172727 Wenzl M, Naci H, Mossialos E. Health policy in times of austerity-A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008. Health Policy 2017; 121(9):947-954.. Health policy in times of austerity-A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008 (E/II) |
It demonstrates the difficulty of assessing the future effects of proposed policies regarding coverage and access to health services; short-term cost cutting does not always mean long-term efficiency. |
Can the analysis of public policies be performed in relation to their future effects on social values, objectives of health systems? |
There is great difficulty in determining future effects on equity, effectiveness and efficiency, but it also demonstrates that few governments perform such analyses when formulating and implementing policies in times of crisis. |
| Bevan et al., 20102828 Bevan G, Helderman JK, Wilsford D. Changing choices in health care: implications for equity, efficiency and cost. Health Econ Policy Law 2010; 5(3):251-267.. Changing choices in health care: implications for equity, efficiency and cost (R/III) |
It correlates technical and allocative efficiency, together with the achieved results, with the necessary central control of costs by the government and some competition to increase quality. To promote equity, the insurance needs to be integrated with service provision. |
How to promote a balance between equity, efficiency and costs in health? |
The authors suggest that some degree of competition and choice, preferably driven by GPs, increases quality, without excesses, so as not to compromise costs. At the same time, equity in access may be accompanied by inequities in health outcomes. |
| Vrangbaek et al., 20122929 Vrangbaek K, Robertson R, Winblad U, Van de Bovenkamp H, Dixon A. Choice policies in Northern European health systems. Health Econ Policy Law 2012; 7(1):47-71.. Choice policies in Northern European health systems (E/II) |
Unanimous association between efficiency and power of choice, followed by improved quality of health care, especially when GPs choose the services. As for equity, only the UK believed in this assumption. |
Has policy-making on the choice of providers showed a convergence in northern Europe? |
The convergence occurred more at the discourse level, in relation to consumer's rights (empowerment and market competition). |
| Burström, 20091212 Burström B. Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden. Inter J Health Serv 2009; 39(2):271-285.. Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden (R/III) |
It associates technical and allocative efficiency, according to health needs, with equity as the central objective of the Swedish health system, non-compatible with health choices, in a broad and nonregulated way. |
The question is, Can whether market-driven reforms promote increased efficiency with equity? |
Free choices did not improve efficiency, and reduced equity, as providers were free to offer their services unrelated to health needs. |
| Fotaki, 20103030 Fotaki M. Patient choice and equity in the British National Health Service: towards developing an alternative framework. Sociol Health Illn 2010; 32(6):898-913.. Patient choice and equity in the British National Health Service: towards developing an alternative framework. (T/IV) |
Horizontal equity and efficiency were positively associated. In the UK, the freedom of choice is gaining space and resulting in the speech for increased equity. |
Relating freedom of choice to equity. |
Different paths have been shown towards the provision of multiple services and equity, since it does not address the causes of inequities and, often, this freedom is not recognized or enjoyed by individuals |
| Kreisz e Gericke, 20103131 Kreisz FP, Gericke C. User choice in European health systems: towards a systematic framework for analysis. Health Econ Policy Law 2010; 5(1):13-30.. User choice in European health systems: towards a systematic framework for analysis (T/IV) |
Association between efficiency and equity, in the systemic, supply and demand dimensions. It points out that freedom of choice can reduce efficiency, reducing the quality of health. |
Is freedom of choice a guaranteed mechanism for increasing efficiency and promoting equity? |
Most of the time, it is not. On the contrary, it can increase costs and end up reducing choices. |
| Kim et al., 20163232 Kim Y, Oh DH, Kang M. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach. Int J Health Plann Manage 2016; 31(4):537-553.. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach (E/II) |
The analysis is performed by the efficiency/productivity bias, focused on the effectiveness results and, at least, there are adjustments for income and globalization inequalities, representing equity. |
In the studied decade (2002-12), have there been changes in the productivity of the countries? In what sense? |
There was a balance between efficiency and technology, and some countries stood out in terms of innovations, such as South Korea, Japan, the USA. |
| Wan YC e Wan YI, 20103333 Wan YC, Wan YI. Achievement of equity and universal access in China's health service: A commentary on the historical reform perspective from the UK National Health Service. Glob Public Health 2010; 5(1):15-27.. Achievement of equity and universal access in China's health service: A commentary on the historical reform perspective from the UK National Health Service (T/IV) |
Indirectly, with regard to allocative efficiency and equity in financing, as well as the quality of health care. |
How can the NHS experience help the Chinese health system to seek greater equity and access to health? |
In part, it was possible to demonstrate the NHS's hits and misses, but the political and economic contexts are quite different. |
Nwagbara e Rasiah, 20153434 Nwagbara VC, Rasiah R. Rethinking health care commercialization: evidence from Malaysia. Global Health [periódico da Internet]. 2015 Nov [acessado 2018 Out 20]; 11(44): [cerca de 8 p.]. Disponível em: https://globalizationandhealth.biomedcentral.com/track/pdf/10.1186/s12992-015-0131-y
https://globalizationandhealth.biomedcen...
. Rethinking health care commercialization: evidence from Malaysia (E/II) |
It correlates technical efficiency and technical quality of care, at the intermediate level, for public health services. |
Has the commercialization of health in Malaysia been useful for increasing efficiency in public health services? |
No, there was a displacement of the workforce and more complex equipment, reducing the efficiency of public hospitals. |
| Ferreira e Mendes, 20182323 Ferreira MRJ, Mendes AN. Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico. Ciên Saude Colet 2018; 23(7):2159-2170.. Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico (R/IV) |
The approach does not expand the association between technical efficiency and equity in access, but points out that efficiency was not achieved through privatization. |
To analyze the implicit and explicit mechanisms of commercialization of supply and financing and their consequences on access and equity of the systems. |
It demonstrates the negative effects of the used mechanisms, which need constant adjustment, in order not to destroy health systems as originally designed. An important point is the shift in the search for efficiency among service providers. |
| El-Idrissi et al., 20082222 El-Idrissi DZE, Miloud K, Belgacem S. Constraints and obstacles to social health protection in the Maghreb: the cases of Algeria and Morocco. Bull World Health Organ 2008; 86(11):902-904.. Constraints and obstacles to social health protection in the Maghreb: the cases of Algeria and Morocco (T/IV) |
Relationship between social inequality (Gini index), inefficiencies in systems and inadequate health outcomes (low effectiveness). |
To present the challenges of these countries in achieving satisfactory health reform outcomes. |
Fragmentation of services and privatization makes universal access very difficult; the insurance format harms the unemployed and informal workers. |
| Scheunemann e White, 20113535 Scheunemann LP, White DB. The Ethics and Reality of Rationing in Medicine. Chest 2011; 140(6):1625-1632.. The Ethics and Reality of Rationing in Medicine (R/IV) |
Association between horizontal equity and efficiency and the rule to save people. |
Is it feasible to perform medical rationing in order to hold society responsible or legitimize the choices that have been made, considering the ethical principles? |
Most of the time, it is not. The unbearable weight of decisions placed upon the collective does not allow these decisions, especially when they are identified cases. The important thing is that there is procedural justice: transparency and social participation, among others. |
| Halkos e Tzeremes, 20113636 Halkos GE, Tzeremes NG. A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: an application to Greek prefectures. Health Policy 2011; 103(1):73-82.. A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: an application to Greek prefectures (E/II) |
It did not analyze equity, only inequalities. The assessed efficiency is focused only on intermediate results. |
Has the health reform brought greater efficiency? |
There were problems with decentralization, both in relation to resource allocation and regional administration; economic growth has not brought efficiency; the existence of urban hospitals was a positive factor. |
Esteves, 20123737 Esteves RJF. The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia. Int J Equity Health [periódico da Internet]. 2012 Fev [acessado 2018 Out 20]; 11(6):[cerca de 16 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22296659
https://www.ncbi.nlm.nih.gov/pubmed/2229...
. The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia (E/II) |
Association between technical efficiency and health outcomes. Equity can be analyzed in relation to the comparison with LA and Caribbean averages. |
Have the health outcomes improved with sustainability after the health reforms in Brazil and Colombia? |
No decisive and continuous improvements have been demonstrated; there was even a setback in Colombia. The explanation would be the inequities in access to care and income, underfinancing and economic crises. |
| Senkubuge et al., 20143838 Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action 2014; 7:23568.. Strengthening health systems by health sector reforms (R/III) |
Shift in the pursuit of efficiency in the reforms to achieve equity and effectiveness regarding the vulnerable groups and health outcomes. |
To evaluate the effects of reforms on system elements according to their macro functions. |
Reforms must be holistic and gradual, ensuring society's participation, with the sharing of information, paying particular attention to health access for vulnerable groups. |
Source: the authors.
Source: the authors
Source: the authors.