Health policy and planning最新文献

{"title":"Can Medical Consortiums Bridge the Gap in Health Inequity in China? A Propensity Score Matching Analysis.","authors":"Chong Feng, Yusheng Chen, WeiWei Wang, Shuzhen Chen","doi":"10.1093/heapol/czaf031","DOIUrl":"https://doi.org/10.1093/heapol/czaf031","url":null,"abstract":"<p><p>While health is a fundamental right, health inequities between urban and rural residents remain significant in China. Medical consortia aim to bridge this gap by providing equitable and affordable healthcare. However, their effectiveness in enhancing health equity remains underexplored. This study aims to explore whether medical consortia have mitigated health inequity between urban and rural residents. We employed propensity score matching to mitigate selection bias among 9,918 electronic medical records. We focused on two key areas: the effectiveness of medical consortia in reducing healthcare burdens and their influence on health equity, as indicated by the disparities in medical expenses between urban and rural residents. To obtain more detailed insights, we segmented medical expenses into low, medium, and high categories for both urban and rural residents and examined how medical consortia differentially affect health equity across these segments. Moreover, we evaluated whether the differences in referral effects on medical expenses between urban and rural residents can be explained by their varying disease structures and age distributions. We found that medical consortia can significantly reduce the medical burden on populations, but have limitations in improving health equity. The findings highlight a substantial reduction in medical expenses for urban populations. However, no significant reduction was observed in rural populations, with the low-medical-expense group experiencing an increased healthcare burden following the implementation of medical consortia. These findings are robust across various matching methods. Despite reducing healthcare burdens, medical consortia have not equalised health outcomes between urban and rural residents. Significant differences in the disease and age structures exist between urban and rural residents, which may account for the differing causal effects observed between them. Policymakers must prioritise health equity in healthcare reform and consider targeted interventions to address the distinct healthcare challenges of different socioeconomic groups.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention co-design to Reduce the Impact of Heat Exposure on Pregnant and Postpartum Women and Newborns in Burkina Faso.","authors":"Kadidiatou Kadio, Mariam Congo, Adama Sana, Véronique Filippi, Nathalie Roos, Fiona Scorgie, Sari Kovats, Britt Nakstad, Giorgia Gon, Matthew Chersich, Jeremy J Hess, Seni Kouanda","doi":"10.1093/heapol/czaf030","DOIUrl":"https://doi.org/10.1093/heapol/czaf030","url":null,"abstract":"<p><p>Interventions are needed to reduce the impact of heat on the health and wellbeing of women and newborns in Burkina Faso where seasonal temperatures can be extremely high. In this article, we share our experience and lessons learned from co-designing an intervention to improve maternal and neonatal health, about heat in a rural and an urban district of Burkina Faso. We performed community engagement and a series of workshops with 49 community members (health workers, women group representatives, youth leaders, religious leaders, traditional leader, and mothers-in-law) and 36 implementers, stakeholders and professionals (officials from the Ministry of Health, midwives and related health workers, meteorologists, and environmental health practitioners). Following the discussions and group reflections, emerging intervention priorities were ranked based on their perceived likelihood of success, cost effectiveness, implementation feasibility, and sustainability. The co-design workshops identified behaviour change interventions encompassing raising awareness of the effects of heat through targeted messages on adaptative behaviour to adopt. The effective operationalisation of these interventions was further achieved through co-planning involving health system actors in contact with women and local stakeholders with relevant expertise. We aimed to engage health professionals and community health workers to integrate heat and dehydration messages into their routine work with pregnant and postpartum women with the aim of changing behaviour through communication: educational group talks, interpersonal exchanges in the consultation room, and broadcasts of information to the public who attend the clinic (video played on a television set in the waiting room). The codesign workshops were an opportunity to build capacity among facilitators and participants as well as to prioritize and develop interventions to address the impact of heat exposure -amplified by climate change- on pregnant and postpartum women, and on newborns.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Extreme Heat Impacts on Health in Pregnant Women and Infants: a community based intervention in Kilifi, Kenya.","authors":"Adelaide Lusambili, Fiona Scorgie, Martha Oguna, Matthew Chersich, Stanley Luchters, Giorgia Gon, Veronique Filippi, Sari Kovats, Kevin McCawley, Jeremy Hess, Britt Nakstad","doi":"10.1093/heapol/czaf028","DOIUrl":"https://doi.org/10.1093/heapol/czaf028","url":null,"abstract":"<p><p>High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behavior-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and postpartum women (n=10), mothers-in-law (n=10), male spouses (n=10), and community influencers (n=40). Researchers and local community health volunteers supported pregnant and postpartum women and their household networks weekly for four months. At month five, a structured interview, originally administered at baseline, was repeated to evaluate understandings of heat risks and changes in behaviour (reducing exposure to heat by changing daily schedules, reducing heavy workload, and increasing spousal support). Pregnant and postpartum women reported a better understanding of the effects of heat on their health and the newborn, including the importance of staying hydrated, breastfeeding frequently, and avoiding heavy clothing for newborns. They also reported an increase in mothers-in-law and male spouses assisting with household chores and disseminating heat-health messaging to families. However, women noted that male spouses who supported them with chores sometimes reported being stigmatised by their peers. Community approaches to support pregnant and postpartum women during heat periods are feasible and key community influencers can be trained to include heat-health messaging in their daily routines. Additional research is needed to examine whether repeated training is required to ensure sustainability. Future heat interventions focusing on maternal and neonatal health should consider factors such as employment, age, and depth of support networks.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking complexities surrounding tobacco control policy formulation and tobacco industry interference in South Africa: a qualitative study.","authors":"Mateusz Zatoński, Adam Bertscher, Allen W A Gallagher, Britta K Matthes","doi":"10.1093/heapol/czaf013","DOIUrl":"https://doi.org/10.1093/heapol/czaf013","url":null,"abstract":"<p><p>South Africa (SA) used to be recognized as a committed leader in tobacco control (TC) having passed effective TC policies in the 1990s, but in recent years, it has been overtaken by other countries. While research suggests that the tobacco industry (TI) predominantly uses economic arguments to shape TC policy discussions in SA, TI tactics to influence policy formulation have not been examined in the peer-reviewed literature. In this study, we draw on three frameworks (health policy triangle, 'bit in the middle', and Policy Dystopia Model) and 20 interviews, supplemented with academic and 'grey' literature, to explore TC policy formulation in SA. We focus on SA's 2018 draft TC Bill, which as of January 2025 has not been adopted. We found that despite SA's commitment to protect TC policies from the TI's vested interests, as set out in Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, TI actors interfered throughout the policy formulation process. Participants reported efforts to shape policy alternatives by influencing the impact assessment and generating favourable evidence. To influence deliberation, they lobbied policymakers. To advocate for their preferred outcome, they sought to shape public opinion through campaigns and built alliances, for example, with the non-tobacco business community. The identified strategies were consistent with those observed elsewhere. Some were tailored to the SA context characterised by political corruption, and sensitivity around race and the legacy of Apartheid, as well as rivalry between transnational corporations and local producers. Industry actors also sought to redirect attention to TC areas (illicit trade and taxation) not led by the health sector, likely more susceptible to TI influence. The study demonstrates to policymakers, advocates, and researchers, the importance of not looking at a TC policy in isolation and of being mindful of industry efforts to exploit inherent policy-making complexities.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"40 5","pages":"531-547"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compensation preferences of home-based disabled beneficiaries in the long-term care insurance system in Guangzhou, China.","authors":"Yi Qian, Yusupujiang Tuersun, Duqiao Li, Lan Luo, Yingdan Kou, Wenhao Yuan, Lehuan Li, Liancheng Zheng, Mengping Wu, Wenyu Wang, Jiangyun Chen","doi":"10.1093/heapol/czaf015","DOIUrl":"https://doi.org/10.1093/heapol/czaf015","url":null,"abstract":"<p><p>This study explores the preferences and willingness-to-pay of home-based disabled elderly individuals for long-term care insurance (LTCI) compensation mechanisms in Guangzhou, China, using a discrete choice experiment. The research aims to identify preferred compensation strategies, analyze heterogeneity in preferences, and provide recommendations for policy optimization. Using purposive and cluster sampling, 156 eligible participants were identified, with 96 completing the survey (response rate: 61.5.%). Disabled elderly individuals were defined based on activities of daily living assessments. A conditional Logit model was applied to analyze preferences, and subgroup analyses examined differences by education, gender, activities of daily living status, and caregiving arrangements. Key findings include preferences for medical care over life care, family caregivers over professional ones, and cash subsidies over mixed or proportional reimbursement. Respondents were willing to pay an additional $21.60 for medical care and $25.26 for cash subsidies (1 USD = 7.3 CNY). The average out-of-pocket cost for LTCI services was $27.39 per session, with a sub-average cost of $16.44 for basic care services. Subgroup analyses revealed higher-educated individuals favored medical care, while lower-educated groups prioritized affordability. Severely disabled individuals preferred professional caregivers, such as registered nurses. This study highlights the need to expand medical care services, integrate flexible compensation models, and tailor policies to demographic differences. The findings provide evidence for optimizing China's LTCI system and offer insights for aging populations in low- and middle-income countries.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"40 5","pages":"556-565"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political commitment and implementation: the health system response to violence against women in Mexico.","authors":"Sophie M Morse, Manuela Colombini, Erin C Lentz, Carolina Dotoreo Soriano, Ana Jocelyn Mejía Morales, Claudia Diaz Olavarrieta, Daniela C Rodríguez","doi":"10.1093/heapol/czaf012","DOIUrl":"10.1093/heapol/czaf012","url":null,"abstract":"<p><p>Violence against women (VAW) is a widespread concern globally and in Mexico, where in 2021, 44% of women aged ≥15 years have experienced some form of intimate partner violence during their relationship and a quarter have experienced sexual violence in the past 12 months. To respond, Mexico passed comprehensive legislation addressing VAW, which outlines the role of the health system in identifying, treating, and referring women experiencing violence; however, implementation of such regulations has been slow and far from successful. Using a conceptual framework of political commitment, we conducted a health policy analysis to evaluate how health policies addressing VAW in Mexico have been implemented. The political commitment framework includes the dimensions of expressed, institutional, and budgetary commitment. We adopted a multi-methods qualitative case study approach combining document analysis with 25 stakeholder interviews with policymakers and health facility directors in Mexico City. The results show that Mexico exhibits limited expressed political commitment from the president, but some commitment exists among Ministry of Health officials. We document that the mixed findings on expressed commitment are mediated, in part, by internalized social and gender norms that normalize and tolerate violence, which are present in society writ large. We find that institutional commitment exists through policies and institutions. However, monitoring systems for policy implementation were not working as designed, and there was limited effort and capacity to implement these policies, reflecting structural barriers and norms within the health system that shape the treatment of violence survivors. Finally, we found a budgetary allocation for VAW; however, it was unclear if the budget was utilized correctly. While progress has been made in addressing VAW in the health system in Mexico, implementation is lagging due to a lack of sustained political commitment, and thus, policies are likely not reaching their intended beneficiaries: survivors of violence.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"519-530"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivering integrated and standardized services to eliminate mother-to-child transmission of sexually transmitted infections: experience of the E-Clinic model in a Chinese pilot district.","authors":"Yali Luo, Shuang Gao, Jiahong Chen, Dingyan Lv, Weizhen Mai, Wei Wang, Yuanfang Zhu","doi":"10.1093/heapol/czaf006","DOIUrl":"10.1093/heapol/czaf006","url":null,"abstract":"<p><p>The elimination of mother-to-child transmission (EMTCT) of syphilis and hepatitis B virus (HBV) is a crucial strategy for preventing and reducing new pediatric infections. Timely and standardized EMTCT interventions for maternal infections have been demonstrated to be highly cost-effective and efficient. Regrettably, healthcare providers have encountered challenges in delivering these interventions due to the complexity of multidepartment referrals. Baoan district in Shenzhen, Guangdong Province, which serves as one of the six national pilot districts tasked with exploring effective EMTCT strategies, has pioneered the integration of infection management into antenatal care by establishing the E-Clinic (short for the Elimination of mother-to-child transmission Clinic) within the Obstetrics Department. The E-Clinic, through its provision of integrated services, has witnessed increased coverage of syphilis treatment for pregnant women living with syphilis, as well as increased coverage of antiviral treatment for high-risk pregnant women living with HBV. The E-Clinic has been recognized as a best practice for EMTCT by the World Health Organization and has been widely adopted and adapted in over 100 maternal and child healthcare institutions across Guangdong Province. The success of the E-Clinic underscores the importance of government leadership, innovation, and multilevel engagement in promoting standardized EMTCT services, providing insights for implementing EMTCT strategies in other regions worldwide.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"578-584"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter 'Impact of the free health care policies in Burkina Faso: Underscoring important nuances'.","authors":"Thit Thit Aye, Hoa Thi Nguyen, Laurène Petitfour, Valéry Ridde, Felix Amberg, Emmanuel Bonnet, Mariam Seynou, Joël Arthur Kiendrébéogo, Manuela De Allegri","doi":"10.1093/heapol/czaf018","DOIUrl":"10.1093/heapol/czaf018","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"588-589"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.","authors":"Robert J Montgomery, Elaine Scudder, Caitlin Tulloch, Muna Jama, Naoko Kozuki, Baris Ata","doi":"10.1093/heapol/czaf014","DOIUrl":"10.1093/heapol/czaf014","url":null,"abstract":"<p><p>Investment in community health worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia. After establishing the resource requirements for delivering 25 evidence-based maternal and neonatal interventions, we used the Lives Saved Tool and optimization techniques to determine the package of care that leads to the most projected lives saved. With a cadre of 1450 female health workers and a budget of $435 000 for maternal and neonatal health commodities and programming over 1 year, we calculated that the optimized set of interventions for Galmudug could avert 15% of the 4132 projected maternal and neonatal deaths in 2024. We also conducted sensitivity analyses to show how the optimal combination of interventions and the number of lives saved change as the resource levels change. The model provides practitioners with a new tool and accompanying approach to evaluate possible packages of community health interventions with competing resource requirements.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"566-577"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritization of methods for assessing alcohol use in emergency room settings: findings from a qualitative study.","authors":"Petal Petersen Williams, Megan Prinsloo, Jodilee Erasmus, Charles Dh Parry, Richard Matzopoulos, Margaret M Peden","doi":"10.1093/heapol/czaf016","DOIUrl":"10.1093/heapol/czaf016","url":null,"abstract":"<p><p>Limited alcohol-related injury data in hospital settings globally underscore the need for routine monitoring to inform policy formulation for injury prevention, especially in addressing violence and road traffic injuries. COVID-19 and the related alcohol sales bans in South Africa in 2020-21 brought the impact of alcohol on trauma presenting to health facilities into sharp focus and highlighted the absence of practical, cost-effective, and accurate alcohol diagnostic tools in emergency rooms This qualitative study aims to identify valuable alcohol-related information for stakeholders to inform a validation study of alcohol diagnostics for injury-related trauma. We conducted five virtual focus group discussions (FGDs) with four groups of stakeholders: clinicians (n = 9), academics (n = 4), hospital and other operational staff (n = 6), and policymakers (n = 4). FGDs were audio recorded and transcribed verbatim. Coding and thematic analyses were conducted using NVivo version 12. Results highlighted the belief that alcohol places a burden on the healthcare system and plays a significant role in injury causation and mortality. Currently, robust alcohol assessment in emergency rooms is lacking. Despite acknowledging that quantified blood alcohol levels would not change acute clinical management, there was consensus regarding the need-to-know patients' alcohol usage to inform long-term management and broader public health objectives. Findings support plans to validate the efficacy of selected alcohol diagnostic tools in public hospital settings and to further test their feasibility and utility at a national level.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"548-555"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}