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The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting.

The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society.

At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation.

The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization.

This study aims to shed some light on the subject matter of the exploration of public medical coverage and elderly done as such far across the world. To achieve this objective, a comprehensive bibliometric examination was used to investigate papers published between the years 1960 and 2020. An aggregate of 366 papers was selected and analysed for the same. The investigation endeavours to recognise the journals with outstanding performance in this field, distribution of papers concerning the year of their publication, most referred to papers. Then various maps depicting bibliometric networks are provided, namely, the joint-authorship network map, inter-country joint-authorship network map and keyword co-occurrence network map.

To achieve the objective of this study, the Scopus database was used for comprehending the vast magnitude of information about numerous papers included in this paper. VOSviewer has been used to create a joint-authorship network map, inter-country joint-authorship network map and keywords concurrences network map.

The result of this investigation demonstrates that the highest number of publications came out in the year 2019, the most notable journal is Journal of Aging and Social Policy, and the most referred to research paper is about long-term care insurance (LTCI) in Japan. The USA is the most productive nation with the most elevated number of papers published under its name. Tamiya N. has teamed up with the highest number of authors, which is 29. Again the USA is the nation that participated with the highest number of authors of different countries in the research paper.

This paper accord with the current writing on public health insurance and elderly. A much far-reaching and solid image of this sector is given using the bibliometric analysis technique. The authors keen on directing future exploration on this topic can take guidance from the results of this study.

The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries.

The present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process.

According to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes.

Based on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population.

It might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation.

The linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions.

Health care is an essential need of the society and it is an integral part thereof. In this sense, everybody is entitled to medical services to provide health and well‐being that improves lifestyle. Policymakers and researchers focus substantial attention on hospitals and public spending of financial resources, because they recognise the political power and the general collective obligation of preserving a health care for the present and future generations. The empirical analysis used a sample based in the 31 corporate hospitals that belong to the Portuguese health care system as a National Health Service in the period 2002–2003. The disclosure of information allows comparability and identifies similarities between the hospitals in the sample. Relevant organizational variables were managed statistically through the multivariate analysis. The geographical analysis shows inequalities of the distribution of hospitals facilities in Portugal, with marked concentration in the urban coastal areas, affected by the number of persons that live there. The financial analysis is supported in the Portuguese Official Accounting Plan that follows the same accounting trend of corporations. So, the disclosure and the accountability system are not opened up to a new field for accounting in health care based in the Health Official Accounting Plan. The research shows implications at the operational level, the efficiency and the effectiveness of the health care strategy with differences between hospitals. The authors believe that, as complex organizations, hospitals must based their disclosure police in transparency to allow patients to identify their own orientations that should be driven mainly by corporate social responsibility as a public service and not by the economic perspective of a business. This research confirms that as a global strategy for the health care system, corporate social responsibility is urgently needed. As a finite resource, the health should demand a permanent attention from society, as well as the Government in accomplishment prevention and monitoring systems, with a view to the defence of a sustainable health care system. More than merely investing efforts in fighting for political changes, without any advantage for society it is crucial to invest in prevention of the quality of life as a basic requirement to honour the corporate social responsibility in hospitals. Especially needed are health care improvements and infrastructures. In summary, the health care system exists as a fundamental element that assures life and high standards of living, so it should be available to everybody and for everybody…

This study aims to analyze the challenges in financing the healthcare system of Pakistan and develop a comprehensive health financing strategy aimed at achieving universal health coverage (UHC).

The paper utilizes World Health Organization (WHO) framework on health financing to build the argument. It uses qualitative research design involving focus group discussions and in-depth interviews with key stakeholders, including Federal Board of Revenue, Ministry of Finance, Planning Commission, development partners, academia and health ministries at federal and provincial levels, as well as social health insurance entities.

The research findings highlight several critical issues within Pakistan’s healthcare system: Firstly, health spending is inadequate to provide financial protection to 24 million people. Secondly, the available health funding is allocated in clusters and caters primarily to specific groups, which exacerbates inequities in healthcare provision. Thirdly, the existence of multiple purchasing agents who operate concurrently to buy health services results in duplication and wastage of resources. Fourthly, the public financial management system, intended to support the swift distribution of public funds to health facilities, is not aligned with the requirements of the health system. Lastly, the devolved health setup has led to governance issues in managing the health sector.

This study fills a significant gap in the literature on health financing within Pakistan and proposes a unique empirical approach using WHO’s framework in a decentralized healthcare context. It also provides actionable recommendations for policymakers to develop strategies that improve the effectiveness of public financial management and health service delivery.

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health.

Methodology – The standard methods proposed by O’Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys.

Findings – General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes.

Policy implications – The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

Amidst the backlash against gay rights in the U.S., a rapidly expanding number of companies are instituting inclusive policies. While in 1990 no major corporations provided health insurance for the partners of lesbian and gay employees, by early 2004, over 200 companies on the Fortune 500 list (approximately 40%) had adopted domestic partner benefits. This study of Fortune 1000 corporations reveals that the majority of adopters instituted the policy change only after facing pressure from groups of lesbian, gay, and bisexual employees. Despite such remarkable success, scholars have yet to study the workplace movement, as it is typically called by activists. Combining social movement theory and new institutional approaches to organizational analysis, I provide an “institutional opportunity” framework to explain the rise and trajectory of the movement over the past 25 years. I discuss the patterned emergence and diffusion of gay employee networks among Fortune 1000 companies in relation to shifting opportunities and constraints in four main areas: the wider sociopolitical context, the broader gay and lesbian movement, the media, and the workplace. Next, using the same wide-angle lens, I explain the apparent decline in corporate organizing since 1995. My multimethod approach utilizes surveys of 94 companies with and without gay networks, intensive interviews with 69 networks and 10 corporate executives, 3 case studies, field data, and print and virtual media on gay-related workplace topics. By focusing on not simply political but also broader institutional opportunities, I provide a framework for understanding the emergence and development of movements that target institutions beyond the state.

The purpose of this paper is to investigate the extent to which the Thai Universal Healthcare Insurance Coverage Scheme (UC) has contributed to villagers’ well-being in the northeast of Thailand. Public opinion polls specifically advocate the schemes are used to justify its ongoing political support. However, the question still remains as to whether it has made a difference in the lives of poorer rural people.

A multi-methods approach and a well-being focused evaluation (WFE) approach are used to understand villagers’ experiences of having and using the scheme and investigate the villagers’ satisfaction with the scheme and how this satisfaction has contributed to their life as a whole.

It is found that the scheme had made a valuable contribution to improving perceived well-being amongst villagers. Apart from the direct benefits of having that healthcare when needed, there is also the indirect benefit of increasing villagers’ sense of security that healthcare will be accessible if required.

There are still pertinent issues for policy consideration; for example, almost 31 per cent of the villagers with the card have never used it. Approximately 22 per cent of people using the card reported dissatisfactions. Although healthcare direct-costs were now more affordable, a range of opportunity costs, geographic, social, cultural and other factors still need to be factored into further policy and service development to make the scheme more equitable and effective.

The study proposes “WFE”, a new evaluation approach. WFE may also be applied to other forms of social policy particularly concerning the impact of its policy on people's well-being.