Health Equity as a Challenging Goal for Policymakers: A Systematic Review

The ultimate goal of every health system is to maintain and promote community health by ensuring the equitable utilization of health services. In recent years, many countries have undergone health sector reform to improve health equity, but most continue to face challenges ahead. This study reviewed the effects of health system reform on reducing health inequity with a focus on the social determinants of health since 2000. This systematic review included an evidence search within the PubMed/Medline, Google Scholar, and Scopus medical research databases. Out of 1,559 published articles between 2000 and 2014, 29 who met the inclusion and exclusion criteria were chosen. Most countries studied considered financial intervention, such as increasing governmental health expenditure and insurance coverage, to establish universal health coverage. Primary care has been neglected in many reform plans as most countries focused on inpatient or outpatient care. None of the reforms have been entirely successful and health inequity remains among different socioeconomic groups. The articles highlighted the significance of socioeconomic and political determinants on the success rate of reforms within the study context. Moreover, strengthening primary health care, implementing stepwise reform, establishing a robust monitoring system and considering quality along with quantitative coverage is necessary to reduce health inequity.