“Top-Three” health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview

High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from considering reform experiences abroad, exchange is limited. This paper provides an overview of health reform trends in 31 high-income countries in 2018 and 2019, i.e., before Covid-19. In 2018, 81 reforms were reported in 28 countries. Out of that, 44 went to four clusters: ‘insurance coverage & resource generation’, ‘governance’, ‘healthcare purchasing & payment’, and ‘organisation of hospital care’. In 2019, 86 reforms in 30 countries were reported, and 48 fell under ‘organisation of primary & ambulatory care’, ‘governance’, ‘care coordination & specialised care’, and ‘organisation of hospital care’. Most 2018 reforms were reported ongoing in 2019; 27 implemented; seven abandoned. Health agency-led reforms were implemented most frequently, followed by central government-legislated reforms. The main conclusion is that policymakers can leverage international experience of distinct reform approaches addressing similar challenges and similar approaches to address distinct problems. Such knowledge may help inspire or support future successful health reform processes.