Welcome to the fourth edition of The Healthcare Law Review. It is impossible to start a global healthcare text in 2020 without reference to the covid-19 pandemic and first and foremost to pay tribute to the commitment shown by all working in the sector: the healthcare professionals, the organisational leaders, all staff working in health and social care environments, and the scientists and public health officials seeking to navigate nations through this crisis. This review provides an introduction to healthcare economies and their legal frameworks in 15 jurisdictions, with new contributions from Cambodia, Malta and Vietnam in this edition. Every country will have been touched by the pandemic and, of course, each has responded in a different way. Some leading healthcare systems have been overwhelmed, many have been revealed as vulnerable and limited, and internationally governments and the private sector have shown their ability to innovate, expand capacity and ask more of their systems and professionals than ever thought possible.

Our expert authors have reviewed and updated their chapters to reflect the ever-evolving situation in the jurisdictions covered in earlier editions. At the time of writing, many countries will still be subject to emergency legislation and altered priorities. The legal position is subject to constant review as countries move through positions in relation to the scale and spread of the coronavirus. This review does not seek to navigate the rapidly changing pandemic-based positions but this year's chapters reveal how underlying systems have been changed and may be expected to adapt as a result of this past year's events. As previously, the book reveals both diverse areas of practice and the common challenges and similar approaches in very different countries.

Previous editions considered the rapid expansion of telehealth and telemedicine but few could have foreseen the 3,000 per cent increase in online consultations reported in a number of jurisdictions as we went into lockdown. Regulations, laws and reimbursement had to be revised or rewritten overnight. We will undoubtedly emerge with a newfound confidence about what care can and should be delivered remotely, where the risks that need to be regulated are, and where to prioritise face-to-face interactions between patients and healthcare professionals.

Scopes of practice have been revisited with professionals fulfilling roles outside their usual scope and the recently retired being brought back into practice, often in non-frontline roles, allowing current practitioners to step forward.

Every country wants a health system that cares for the sick and promotes the well-being of its people. Every nation wants to raise the bar to keep up with improving living standards and expectations. However, every economy requires this to be done at an affordable price. Managing the costs of healthcare and workforce shortages, and ensuring a sustainable model of delivery, have been seen as key drivers in each of the countries covered in this publication. Countries around the world realise that excess deaths and heightened morbidity during the pandemic are not just from coronavirus. Many patients have not attended healthcare facilities for other illnesses or ongoing treatment, and getting care back on track at a time of economic recession or even a depression will be tough. The virus has asked huge questions of our healthcare systems and populations will be re-evaluating expectations in the months and years ahead.

Integration between health and wider social care continues to be a key topic, and in countries where care home mortality has been devastating, further questions are being raised about how social care is expected to operate in conjunction with existing hospital and hospice settings.

This publication identifies the broad characteristics of healthcare to be found in each jurisdiction. It considers: the role of insurance or public payers; models of commissioning; the interplay (or lack of it) between primary, secondary and social care; and the regulatory and licensing arrangements for healthcare providers and professionals.

This has been a unique year for the delivery of healthcare and one that has laid down challenges and opened opportunities. Each chapter describes a country's healthcare ecosystems. I would like to thank the many leading experts for the time and attention they have given to this project, and also the wider team at Law Business Research for their support and organisation.

Sarah Ellson
Fieldfisher LLP
(working from home)
August 2020