Toward Equity under Health System Reform; A Systematic Review

Abstract

Background: To improve health equity, many countries have undergone consistent health sector reforms during the two past decades although most of them still have some challenges ahead. Objectives: This systematic review aimed to determine the impact of health system reforms on inequities and social determinants of health (SDOH) since the year 2000. Methods: PubMed, Scopus, and Google Scholar databases were utilized to conduct a literature search of related records from January 2000 to August 2014. Out of 1,559 published articles, 29 were selected according to specified inclusion and exclusion criteria. Results: Almost all investigated countries have considered financial interventions to address increases in governmental health expenditures and implement universal health coverage. While most countries stressed in-patient or outpatient care, primary care is often disregarded in many health system reforms. Although the aforementioned reforms have been somewhat successful, several socioeconomic groups continue to experience health inequities. Conclusions: These results illustrate the vital role that socioeconomic and political determinants play in the success of studied reforms. Furthermore, emphasizing primary health care, implementing reforms in a stepwise and well-monitored manner, and utilizing quality control mechanisms can mitigate health inequity.