Open research questions in Healthcare Systems and Reforms
420 gap statements mined from Healthcare Systems and Reforms papers in our 7.9M-paper local library, which holds 2,670 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.
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What the literature leaves open
By identifying studies based on outcomes rather than intervention type, it offers a systematic and balanced view of what has and has not been studied for its effect on financial protection. Outcome measurement varies widely across studies, complicating comparisons. The included studies varied widely in design; 70% were observational, 25% quasi-experimental, and only 5% experimental.
Assessing intervention effects on healthcare-related financial protection in low- and middle-income countries: a rapid evidence review · 2026 · DOIThe latter could at least in part be explained by the finding that on-budget ODA+ for health also displaces GHE-S (measured per GDP) with a negative elasticity of a comparable magnitude, although associations with other health financing sources were not investigated.
Aid, debt, International Monetary Fund conditionalities and domestic health financing in low- and middle-income countries · 2026 · DOITogether, the findings suggest that connectivity alone is insufficient to improve UHC; its contribution likely depends on financing, governance, health-system organization, interoperable implementation, workforce readiness, trustworthy communication, and equitable access.
Health financing, digital connectivity, and universal health coverage: a country-year panel study · 2026 · DOIThere is a lack of understanding of the effectiveness of health insurance in reducing hospitalization expenses across different groups of illness severity. The paper identifies a gap in the literature regarding the use of finite mixture models in examining health insurance coverage.
The Dynamics of Hospitalization Expenses and Health Insurance: A Finite Mixture Model Approach · 2026 · DOIThe comparative role of different UHC models in shaping the effectiveness of government healthcare expenditure has been understudied. Prior studies have focused on aggregate government spending, but the structural decomposition of UHC types is lacking. The study aims to address this gap by examining the heterogeneous effects of UHC models.
Comparing universal health coverage models: an analysis of policy transmission efficiency in SAARC and ASEAN countries · 2026 · DOIFifth, discharge EQ-5D-5L assessments provide limited information about sustained recovery, and responsiveness and ceiling effects were not directly evaluated.
Aligning insurance payment with public value: outcome-based payment for traditional Chinese medicine advantage diseases under China’s DRG/DIP reform · 2026 · DOIExisting survey indicators capture perceived access barriers but are influenced by subjective factors. There is a need for objective, comparable data to measure affordability-driven unmet pharmaceutical need. The paper identifies a gap in the current methods used to evaluate financial protection, which rely mainly on catastrophic health expenditure and unmet need.
From catastrophic health expenditures to the cost of unmet needs: New metrics for pharmaceutical access in vulnerable populations · 2026 · DOIFuture studies could consider employing more rigorous research designs, such as quasi-experimental approaches or natural experiments, and incorporate data from control cities to generate stronger empirical evidence or integrate econometric and machine learning approaches to strengthen both inference and prediction.
The Impact of DRG-Based Payment Reform on Inpatient Healthcare Utilization: Evidence from a Natural Experiment in China · 2025 · DOIGiven that hospital care absorbs the largest share of health expenditure internationally, a clear and effective financing mechanism is needed, capable of controlling costs and rewarding continuous quality improvement.
The Reform That Was Never Completed: Why Greece Must Redesign Its Health Financing Architecture · 2025 · DOIIt inhibits access to care among those unable to pay, particularly the poor and disadvantaged populations, and exhibits long and complex registration requirements and processes; is insufficiently funded; has unaffordable premiums; and the health provider factors, such as availability and accessibility of healthcare facilities, continue to contribute to low uptake and stagnation of the SHIs/NHIs in Africa.
There is limited information on the allocation and expenditures of various healthcare programs and activities, as well as the equity implications of different healthcare financing mechanisms. This gap hinders effective policy analysis and discussions on healthcare financing. Future research should focus on the allocation and expenditure of health programs, equity in financing, and the delivery of healthcare services.
To address policy fragmentation, eye health should be incorporated into national health policies and budgets, creating a structured framework that aligns with broader health system objectives and resources. This includes enhancing outreach programs and integrating eye care into primary health care (PHC) services, which can improve accessibility and affordability for patients.
Perceptions and Experiences of Key Informants in Eye Health on the Implementation of Eye Care Health Promotion Interventions in South Africa · 2024 · DOIThe financial modelling of potential pathways is indicative rather than definitive, as reliable data on private sector costs, margins, and capital flows in India remain scarce.
To strengthen financial protection for older adults, a phased policy approach is warranted.
Financial protection in flux: longitudinal evidence on out-of-pocket spending among middle-aged and older Mexicans during the ‘Seguro Popular’–INSABI transition · 2026 · DOIHowever, current research evaluating the effectiveness of China’s DRGs reform lacks a value-based oriented approach to healthcare and has not yet explored whether different types of diseases and population characteristics will affect policy implementation.
Association Between China’s DRG Reform and Value-Based Healthcare Orientation: Evidence From Inpatients With Acute Myocardial Infarction and Cancer in Tertiary Hospitals in Western China · 2026 · DOIFuture research should explore how institutional frameworks can be adapted to support resilient health systems in LMICs.
Institutional Dynamics of Health System Strengthening in Low- and Middle-Income Countries: A Review of Governance Mechanisms and Reform Challenges · 2026 · DOIFuture research should explore how purchasing models interact with diverse health system characteristics to inform system-specific reforms.
Active Purchasing: Empirical Insights from the Dutch Healthcare System and Lessons for Low- and Middle-Income Countries; Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands" · 2025 · DOIFuture research should explore strategies for better alignment of multiple funding streams, such as unified purchasing with blended payment models or clearer functional differentiation.
Effects of Hospital Payment Reform of Government Budget Allocation and Social Health Insurance in a Pilot in China · 2025 · DOIHowever, the impact of critical illness insurance (CII) on consumption inequality remains underexplored.
The present healthcare financing system is insufficient in cushioning the chronically ill and the poor.
In the short term, the Ministry of Health and state health authorities should publicly finance a prioritized essential package, waive fees for high-priority maternal and child services, subsidize poor and rural households, and begin licensing and price regulation of private providers and medicine markets (3).
Out-of-pocket health expenditures as a barrier to healthcare access, financial protection, and progress toward universal health coverage: a narrative review from Somalia · 2026 · DOICommunity health centers (and stations) and village clinics Table 16 shows that, for community health centers, the coefficients on all outcome variables are positive but not statistically significant. In contrast, for village clinics, the coefficient on per capita visits is 0.209 and is significant at the 5% level (p < 0.05).
Nonlinear association between provincial implementation intensity of county-level medical communities and patient flow patterns · 2026 · DOIFurther research on the comparative role of different UHC models in shaping the effectiveness of government healthcare expenditure. Investigating the impact of UHC on healthcare outcomes in other regions. Examining the effects of different UHC models on financial protection and health outcomes.
Comparing universal health coverage models: an analysis of policy transmission efficiency in SAARC and ASEAN countries · 2026 · DOIFurther research is needed to examine the effectiveness of the SSE in reducing unmet pharmaceutical need, - Studies should investigate the impact of affordability pressures on health outcomes for older adults, - Research should explore the generalizability of the expenditure-gap method to other…
From catastrophic health expenditures to the cost of unmet needs: New metrics for pharmaceutical access in vulnerable populations · 2026 · DOIThis could include strengthening public health systems in addition to health insurance schemes to create a comprehensive UHC strategy, looking into innovative financing mechanisms and improving efficiency in existing systems to ensure the long-term sustainability of UHC programs, developing mechanisms to ensure the poorest and most vulnerable populations are not left behind, and fostering partnerships…
Most-cited papers in Healthcare Systems and Reforms
- Poverty and Access to Health Care in Developing Countries · Annals of the New York Academy of Sciences · 2008 · 1,198 citations
- Socioeconomic Inequalities in Health · JAMA · 1993 · 910 citations
- The Danish National Health Service Register · Scandinavian Journal of Public Health · 2011 · 767 citations
- Care‐Needs Certification in the Long‐Term Care Insurance System of Japan · Journal of the American Geriatrics Society · 2005 · 635 citations
- Overcoming barriers to health service access: influencing the demand side · Health Policy and Planning · 2004 · 624 citations
- Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery · Health Services Research · 2012 · 606 citations
- Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 · The Lancet · 2020 · 534 citations
- Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage · Health Policy and Planning · 2008 · 502 citations
- Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey · American Journal of Public Health · 2006 · 462 citations
- Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review · Health Policy and Planning · 2014 · 449 citations
Most recent work
- Health financing inequality in fragmented health systems: evidence from Mexico, 2000–2023 · International Journal for Equity in Health · 2026
- Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in India: A Multicentre Cross-Sectional Survey · Global Heart · 2026
- Financial protection and healthcare utilization for low-income populations under China’s multi-tiered health financing system: a cross-sectional study in an Eastern city · BMC Health Services Research · 2026
- From individual burden to social risk pooling: drivers of the declining out-of-pocket health expenditure share in China (2009–2024) · International Journal for Equity in Health · 2026
- Urban-rural medical insurance integration and universal health insurance coverage in China: A quasi-experimental study · Economics & Human Biology · 2026
- Pleading Poverty — Related-Party Payments and Health Care Entities’ Financial Health · New England Journal of Medicine · 2026
- Understanding informal payments in the health sector in Malawi: results of a multidistrict household survey · Health Policy and Planning · 2026
- Economic changes and public health resources associated with satisfaction toward the state health service system among older adults under the Universal Coverage Scheme across 77 provinces in Thailand, 2017–2024 · International Journal for Equity in Health · 2026
- Beyond income: Multilevel medical security and relative deprivation–Evidence on rural household growth after health shocks · Economic Analysis and Policy · 2026
- What shapes trust in healthcare? Socio-economic and structural determinants of trust in formal and traditional health providers across 111 countries · SSM - Population Health · 2026
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