فهرست نشریات علمی دسترسی آزاد ایران

Background and Objectives: The COVID-19 pandemic has had a profound impact on healthcare systems worldwide, exposing vulnerabilities and highlighting the urgent need for healthcare reforms. While high-income countries have played a prominent role in the global response, it is essential to recognize the unique challenges encountered by middle-income countries. This study seeks to identify and analyze health system reforms in upper-middle-income countries in response to the COVID-19 pandemic.   Methods: Data related to the characteristics of implemented health system reforms of 25 countries with upper-middle-income levels were collected by a systematic search of PubMed, Science Direct, and Cochrane Library were searched. The control knob structure is used to analyze the experiences of the countries in response to COVID-19 pandemic.   Results: Fourty-six studies met the inclusion criteria. The most frequent reforms were related to financing arrangements and organizational structure. Twenty-four countries conducted national-wide health system reforms while one country implemented a regional reform. The reforms followed pro-poor strategies to increase access to primary health services through the extension of public fiscal space and fairer distribution of resources. Fourteen countries out of 25 have received financial and technical support from international agencies. Most of the reforms that financially depend on the public budget are faced with budget deficits and weak implementation especially in building hospitals in suburban areas, expanding population coverage, and providing affordable medical services. The countries that have not implemented evidence-informed reforms and ignored global experiences, are eventually faced with reduced patients’ access to essential health services and stronger pressure on providers in terms of working time and salaries.   Conclusion: The most important success factors of the health system reform due to COVID-19 are a sustainable financing system, a strong information system for monitoring and evaluation, inclusive policy-making processes, and good inter-sectoral coordination and governance of the health system.