Table 3 Eight examples of country-level reform or improvement [7]

Argentina

Population: 44,494,502

Implementation of various quality and safety initiatives including the Categorising Authorization Program, National Program of Quality Assurance of Healthcare, and the National Program of Epidemiology and Hospital Infection Control

• Financing by World Bank and national and provincial governments

• Unification of licencing rules

GDP per capita, PPP: $20,567.30

• External quality and patient safety evaluations

• Reduction of treatment variability

Life expectancy at birth (both sexes): 76.7 years

• Contribution from specialised scientific societies

• Healthcare coverage for pregnancy, childbirth, postpartum care and paediatric care

• Pay-for-performance strategy

Expenditure on health as a proportion of GDP: 7.5%

• Training initiatives on quality and patient safety

• Healthcare coverage for adolescents and women

Estimated inequity, Gini Index: 40.6%

Brazil

Population: 209,469,333

Launch of Proqualis—a website featuring relevant and current publications about Quality Improvement (QI) initiatives, social media platforms, and QI tools and strategies

• Organisation of website and editorial policy allowing for easy retrieval of information

• Provision of relevant and reliable QI information to consumers

GDP per capita, PPP: $16,068.02

• Standardised terminology via a glossary of terms

• Increased access to QI information for health professionals and managers

Life expectancy at birth (both sexes): 75.7 years

• Publications specify the relevance to the Brazilian context

• Improved access to tools and strategies to support QI for health professionals

Expenditure on health as a proportion of GDP: 11.8%

• All materials are free to access

• Information accessible on tablets and mobile phones

• Increased communication through social media platforms

Estimated inequity, Gini Index: 53.3%

India

Population: 1.35 billion

Introduction of Universal Health Coverage through a public-private partnership model

• Support from private healthcare providers and insurance companies

• More accessible, affordable, safe and appropriate health services

GDP per capita, PPP: $7761.60

• More than 50% of India’s population covered by health insurance

Life expectancy at birth (both sexes): 68.8 years

• Financial protection to families living below the poverty line

Expenditure on health as a proportion of GDP: 3.7%

Estimated inequity, Gini Index: 35.7

Jordan

Population: 9,956,011

Formation of the Health Care Accreditation Council—a national healthcare accreditation agency

• Start-up funding from USAID

• Development of international accepted standards

• Employee training though consultation and education departments

GDP per capita, PPP: $9347.94

• Development of health professionals’ capacity to improve quality and patient safety

Life expectancy at birth (both sexes): 74.5 years

• Application of a total quality management philosophy to encourage sustainable change

• Increased use of family planning methods by clients

Expenditure on health as a proportion of GDP: 5.5%

• More effective management of certain conditions, e.g. diabetes

• Improved leadership commitment, employee involvement and teamwork

Estimated inequity, Gini Index: 33.7

• Increased consumer satisfaction

• Influenced the Ministry of Health to increase its Quality Department budget and personnel

Rwanda

Population: 12,301,939

Establishment of Community-based health insurance

• Nationwide initiative

• 90% coverage of population

• Strong and sustained political commitment

GDP per capita, PPP: $2253.52

• Improved access to health services

• Financial investment from the government

Life expectancy at birth (both sexes): 67.5 years

• Improvements in healthcare utilisation

• Legislative support

• Consensus from the population that healthcare access should be equitable and affordable

• Reduction of financial catastrophe and impoverishment due to out-of-pocket costs

Expenditure on health as a proportion of GDP: 6.8%

• Introduction of a stratification system based on individual assets

• Improvement of health indicators, e.g. reduced maternal mortality and under 5 years’ deaths

Estimated inequity, Gini Index: 43.7

Spain

Population: 46,723,749

Advancement of the Spanish National Transplant Organization (ONT)

• Existing legal, organisational and technical frameworks

• Increase in the number of patients receiving transplants

GDP per capita, PPP: $40,854.58

• Coordination of donor activities at the national, regional and hospital level

• Increased organ donation rates

Life expectancy at birth (both sexes): 83.3 years

• Highest deceased donation rates for a large country

• Employment of transplant coordinators to facilitate identification and referral of possible donors

• Donation rates above that of the European Union or USA

Expenditure on health as a proportion of GDP: 9.0%

• Training of professionals in organ donation

• Development of a positive public attitude towards organ donation though mass media and an open communications policy

Estimated inequity, Gini Index: 36.2%

• Hospital reimbursements for donations and transplantation activities

Taiwan

Population: 23,508,428

Adoption of health information technology, e.g. USB-based electronic personal health record system, MyHealth Bank website, replacement of paper-based ID cards with smart card, and cloud-based systems

• Single-payer system

• Cost-effectiveness, e.g. reduction in administrative costs

• Development of security mechanisms to protect consumers’ privacy and information

GDP per capita, PPP: $47,800

• More efficient, streamlined processes

Life expectancy at birth (both sexes): 80.1 years

• Improved quality of information

• Improved medication safety

Expenditure on health as a proportion of GDP: 6.2%

• Enhanced collaboration and information transfer between providers

Estimated inequity, Gini Index: 33.8%

• Unified public health and clinical medicine information systems

• Engagement of consumers in their own care

• Reduction of fraud

• Continuity of care

West Africa (Guinea, Liberia and Sierra Leone)

Total population: 24,883,449

Application of quality improvement efforts in Ebola-effected countries

• Emphasis on recovery processes

• Knowledge sharing between

GDP per capita, PPP: $1846.67*

• Systematic post-disaster needs assessments

• Ebola-affected countries

Life expectancy at birth (both sexes): 58.61*

• Focus on infection prevention and control, and health worker protection

• ‘Global pool of knowledge’

• Demonstration of a model to combat Ebola with application to other infectious diseases

Expenditure on health as a proportion of GDP: 10.54%*

• Community input

• Clearly articulated vision for universal health coverage

• Strong leadership and guidance

Estimated inequity, Gini Index: 33.6*