Paper short abstract:

Our paper analyses existing individual case studies that focus on the politics of health financing reforms in LMICs. The analysis uses the 3-Is framework, enabling us to provide a more nuanced and fine-grained explanation of why health financing reform succeeds in some countries and fails in others.

Paper long abstract:

There is growing interest in the politics and political economy of health financing reform, as universal health coverage (UHC) has risen to the top of the global development agenda. While there is vast research discussing common political economy factors that impact health systems reforms across high-income countries, less research is available on the interplay of political factors affecting national health systems reform processes across low- and middle-income countries. Research that seeks to unpack political economy dynamics in health system reform processes tends to focus on the concept of 'political will'. This broad conclusion offers a limited explanation of why certain countries like Thailand, Mexico, Ghana, and Rwanda have successfully adopted health financing reforms to advance UHC, while other countries' reform processes have not yielded tangible improvements in healthcare access.

This paper presents the findings of a systematic review investigating political factors and dynamics impacting national governments' success or failure in implementing UHC financing reforms. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed data from six databases, then extracted and applied the '3-i' framework to understand how ideas/ideologies, interests, and institutions have influenced UHC reforms. Preliminary analysis shows that, rather than being the outcome of a generalised lack of political will, various actors within national healthcare systems hold different views and interests in adopting health financing mechanisms. Often, their views are influenced both by domestic and outside pressures, such as expectations from donors and international organisations and funding constraints as a consequence of globalised neoliberalism.