“Examining the roles, relationships and power dynamics shaping universal health system policy processes in high- and upper-middle-income countries: a scoping review.”
This scoping review examines the literature on policy processes, stakeholder influences, and contextual factors shaping policies for universal health system reforms.
Key highlights:
• Important evidence gaps persist: many eligible countries are underrepresented in the literature, and research is heavily skewed towards agenda-setting and policy formulation, with far less attention paid to implementation, evaluation and long-term sustainability.
• Universal health policies are a continuously negotiated political project, not a fixed policy outcome. It functions as a powerful organising idea that brings diverse actors together. Policy entrepreneurs mobilise shared ideas and ideologies to build coalitions, shaping both the direction and limits of reform; however, their ambiguity also allows reform goals to be diluted or reinterpreted over time.
• Crises open windows for reform, not guarantees of durability. Economic shocks and public health emergencies can accelerate policy change, but without strong institutional embedding, reforms are often partial, temporary, or reversible.
• The dominance of UHC as a global policy objective has narrowed ambition. An emphasis on coverage expansion and financialisation runs the risk of sidelining broader goals of equity, quality, and effective access.
This paper forms the first part of my PhD, completed as a Health Research Board (HRB) SPHeRE PhD Programme Scholar at the Centre for Health Policy and Management, School of Medicine, Trinity College Dublin and reflects a broader interest in understanding universal healthcare as a political and institutional process, not just a technical policy goal. The next phase of my research builds on these findings through an in-depth examination of the Irish case.
I’m very grateful to my supervisors and co-authors Sarah Parker, PhD, Anne Matthews and Sara Burke for their guidance, support, and collaborative contribution to this research.
🔗 Open-access article: https://lnkd.in/dW7DpMzX