Health policy and planning最新文献

{"title":"First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision.","authors":"Tamara Mulenga Willows, Rosanna Mazhar, Suraj Bhattarai, Chit-Su Tinn, Nadine Misago, Jean Jacque Roger Ikuzwe, Mike English","doi":"10.1093/heapol/czaf021","DOIUrl":"10.1093/heapol/czaf021","url":null,"abstract":"<p><p>First referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further, we undertook a narrative review to examine the clinical service expectations of FRHs outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision-making needed at the national level on the role of FRHs as a service delivery platform within integrated health systems helping countries achieve universal health coverage.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"652-660"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752393","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":"Assessing the role of long-term care insurance in shaping living arrangements of older adults: evidence from China.","authors":"Zhenyu Zhu, Chen Bai","doi":"10.1093/heapol/czaf027","DOIUrl":"10.1093/heapol/czaf027","url":null,"abstract":"<p><p>The establishment of long-term care insurance (LTCI) has become one of the key measures adopted by countries worldwide to address growing care needs associated with population aging. While existing studies focus on LTCI's impact on medical expenditure and healthcare utilization, its effects on living arrangements of older adults, a core component of long-term care, remain underexplored in China. Living arrangements reflect both the well-being of older adults and their approaches to aging. This study examines the effects of China's LTCI pilots on living arrangements of older adults. Using three-wave panel data from the Chinese Longitudinal Healthy Longevity Survey, we analyzed the rollout of LTCI pilots across different cities from 2014 to 2021, employing a time-varying difference-in-differences approach. Our findings indicate that LTCI significantly increases the likelihood of older adults living alone or only with their spouse and decreases their preference for living with adult children. We provide two explanations for the observed effects: LTCI facilitates aging in place through the provision of home- and community-based services and enhances older adults' health by reducing the incidence of severe illnesses. The effects of LTCI are shaped by policy design, specifically reimbursement structures. These findings offer valuable insights for developing a universal LTCI system in China and other developing countries.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"641-651"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011758","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":"Community detection and management of mild cognitive impairment in Shanghai: a mixed-methods study.","authors":"Yuan Lu, Dehua Yu, Yvonne Wells, Chaojie Liu","doi":"10.1093/heapol/czaf025","DOIUrl":"10.1093/heapol/czaf025","url":null,"abstract":"<p><p>Dementia has been regarded as a priority in public health for healthy ageing. Mild cognitive impairment (MCI) detection and management is one of the strategies to confront the challenge of increasing burden of dementia. However, MCI is not well recognized or managed in primary care. This study aimed to assess system barriers relating to MCI detection and management in the community. A mixed-methods study was undertaken over the period from October 2020 to October 2022. First, a focus group study (n = 124) in Shanghai explored the experiences of general practitioners (GPs), people with MCI and their informal caregivers, and community health managers using thematic analysis. This was followed by 2 rounds of national Delphi surveys among 22 eligible experts to solicit their consensus on the system conditions needed for community detection and management of MCI. A questionnaire survey based on the Delphi consultations was conducted with GPs (n = 1253) recruited from 56 community health centres (CHCs) in Shanghai to quantify their knowledge, attitudes, and practice (KAP) toward community detection and management of MCI and perceived system barriers. The results were mapped and triangulated in line with the chronic care model (CCM) and the health system building blocks articulated by the World Health Organization. Potential system barriers were identified from eight themes: (i) lack of self-management skills and enablement; (ii) lack of family support; (iii) lack of community support; (iv) unprepared healthcare system; (v) health service delivery deterrence; (vi) inadequate clinical decision support; (vii) lack of case management; and (viii) misaligned clinical information systems. The primary care system in Shanghai is not adequately equipped to handle the task of detecting and managing MCI. Both intrinsic and extrinsic obstacles impede the successful conversion of MCI knowledge into desired actions. A systems approach is needed to confront the challenge of MCI detection and management in China.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"613-624"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003145","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":"Implementing the Chinese mandatory antimicrobial stewardship program: barriers to continuous improvement.","authors":"Xiaomin Wang, Leesa Lin, Xin Xu, Stephan Harbarth, Laith Yakob, Ran Zhang, Xudong Zhou","doi":"10.1093/heapol/czaf019","DOIUrl":"10.1093/heapol/czaf019","url":null,"abstract":"<p><p>This study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted. A common implementation strategy was found among the surveyed hospitals in response to the AMS programs mandated by healthcare authorities. The hospital leadership empowered an AMS team to set AMS-related indicators for each clinical department and each doctor, and adopted core elements of AMS to optimize antimicrobial prescribing. However, the mandatory AMS approach also caused unintended consequences including regulatory circumvention, shift of risk to doctors and patients, and demotivation of healthcare workers. Two key barriers to AMS implementation were identified: (i) poor communication and cooperation between the AMS team and doctors, characterized by a high-power-low-power dynamic within hospital disciplines; and (ii) the profit-driven compensation system, which discourages collaboration and resource distribution for AMS implementation. Mandatory AMS programs should intensify AMS training, promote communication and cooperation between the AMS team and doctors, adjust the compensation system to facilitate better AMS implementation, and offer supportive measures that enable the adoption of strict regulations.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"591-599"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668964","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":"Trends and determinants of healthcare-induced poverty in China 2013-2019.","authors":"Linwei Li, Bingqing Guo, Chaojie Liu, Qiang Yao","doi":"10.1093/heapol/czaf026","DOIUrl":"10.1093/heapol/czaf026","url":null,"abstract":"<p><p>Healthcare costs are a major driver of poverty, accounting for 44.1% of poverty cases in China. By 2015, nearly 20 million people fell into or returned to poverty due to health issues. In response, the Chinese government launched the national health poverty alleviation project in 2016. This study aims to evaluate the distribution and trends of healthcare-induced poverty from 2013 to 2019. Using data from the China Household Finance Survey (CHFS), we estimated the incidence of household catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and analyzed their determinants through multi-level logistic regression models. Subgroup analyses were conducted based on rural/urban location, geographic region, and province. In 2013, 31.83% of households experienced CHE, while 9.56% faced IHE. CHE incidence declined significantly after 2016 [adjusted odds ratio (AOR)  = 0.493-0.766, P < 0.001]. IHE incidence initially increased in 2015 (AOR = 1.580, P < 0.001) before declining from 2017 onward (AOR = 0.465-0.607, P < 0.001). The most significant reduction (9.99%-10.95%) occurred among the highest income quartile. CHE and IHE shared similar determinants. Higher odds of CHE and IHE were associated with older age of the household head (AOR = 1.225-2.175, P < 0.001), rural residency (AOR = 1.093-1.199, P < 0.05), the presence of an elderly household member (AOR = 1.237-1.336, P < 0.001), and having more household members in poor self-rated health (AOR = 2.455-4.137, P < 0.001). Conversely, lower odds of CHE and IHE were associated with higher educational attainment (AOR = 0.681-0.879, P < 0.001) and employment (AOR = 0.610-0.708, P < 0.001) of the household head, higher household income per capita (AOR = 0.017-0.860, P < 0.001), and larger household size (AOR = 0.335-0.684, P < 0.001). Households in urban areas and the eastern developed region had lower incidences of CHE and IHE compared to others. In conclusion, China has seen a significant decline in CHE and IHE, particularly after implementing the national poverty alleviation project. However, regional, urban-rural, and income-related disparities persist, underscoring the need for equity-focused interventions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"625-640"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013761","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":"How, why, and under what circumstances can supportive supervision programs improve malaria case management? A realist program theory.","authors":"Fatuma Manzi, Jessie K Hamon, Mena K Agbodjavou, Jenna Hoyt, August Kuwawenaruwa, Yusufu Kionga, Christian Agossou, Abdunoor M Kabanywanyi, Christelle Boyi-Hounsou, Abdallah Lusasi, Samwel Lazaro, Ramani Saliou, Augustin Kpemasse, Erik Reaves, Chonge Kitojo, Ahmed Saadani Hassani, Virgile Gnanguenon, Jean-Paul Dossou, Jayne Webster","doi":"10.1093/heapol/czaf020","DOIUrl":"10.1093/heapol/czaf020","url":null,"abstract":"<p><p>Supportive supervision (SS) programs aim to enhance the quality of care by strengthening the performance of health providers. Commonly part of broader quality improvement efforts, SS programs are increasingly used in low-and middle-income countries to improve malaria case management. Despite substantial investments and some positive outcomes, little is known about what drives their effectiveness. A realist evaluation was conducted in Tanzania and Benin to explain how, why, and under what circumstances SS programs can improve the facility-based management of uncomplicated malaria in children <5 years. A program theory was developed through a team-based analysis of empirical data collected in both countries at two time points. Data included 218 in-depth and 12 structured interviews with stakeholders, 154 audits of febrile case management decisions, and 4 health facility audits. Stakeholder perspectives identified three acceptability mechanisms driving SS program outcomes in the studied contexts: the affective attitude, self-efficacy, and burden of the program as perceived by key actors. The pathway through which these mechanisms were perceived to shape malaria case management (diagnosis and treatment) practices was defined by the (i) extent to which the program was integrated into the public health system; (ii) frequency with which SS visits were conducted by appropriate supervisors; (iii) degree to which supervisors coached, rather than policed, supervisees; and (iv) level of collaboration achieved between supervisees and supervisors. The program actors' perception of the program's effectiveness was also found to be crucial to its sustainability. This study explains the dynamics driving SS program outcomes and underscores the role played by the cognitive and emotional responses of program actors. These insights are likely to be transferable to other settings with similar contexts and can help inform the design, implementation, monitoring, and evaluation of new and ongoing SS programs.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"600-612"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718795","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":"Power dynamics and intersectoral collaboration for health in low- and middle-income countries: a realist review.","authors":"Praveenkumar Aivalli, Sara Dada, Brynne Gilmore, Prashanth Nuggehalli Srinivas, Aoife De Brún","doi":"10.1093/heapol/czaf022","DOIUrl":"10.1093/heapol/czaf022","url":null,"abstract":"<p><p>Intersectoral collaboration (ISC) is a critical strategy in global health for addressing complex challenges requiring multi-sectoral engagement. Although studies examined ISC in low- and middle-income countries (LMICs), gaps remain in understanding how power dynamics between stakeholders influence the effectiveness of ISC in these settings. This realist synthesis examines how, why, for whom, under what context, and to what extent power dynamics shape ISC in LMIC health programmes and policies, offering insights crucial for improving health policy implementation. Five initial programme theories were developed through a scoping review, document analysis, and qualitative study. A systematic search of Medline, Embase, CINAHL, Web of Science, and grey literature (2012-23) yielded 2850 records, with 23 included after screening. This period was chosen to capture contemporary shifts in ISC, following the 2012 UN Political Declaration on NCDs and the WHO's 2013 Health in All Policies (HiAP) framework, which strengthened multi-sectoral governance in LMICs. It also builds on prior reviews, ensuring an up-to-date synthesis of power dynamics in ISC. Data were synthesized using the context-mechanism-outcome framework, generating demi-regularities to refine programme theories (PTs). Findings reveal that power imbalances frequently manifest through hierarchical governance structures, resource disparities, and historical inequities, shaping ISC outcomes. Six refined PTs highlight: (i) inclusive policy development processes mitigate power asymmetries but require intentional facilitation to prevent marginalization of less dominant sectors. (ii) Leadership commitment and shared goal alignment enhance collaboration, yet competing institutional priorities often reinforce power struggles. (iii) Equitable resource allocation acts as both a catalyst for trust and a source of conflict, with donor influence exacerbating dependency dynamics. (iv) Hierarchical communication norms in LMICs undermine transparency, though informal interpersonal networks can circumvent bureaucratic barriers. (v) Ambiguity in roles and mandates amplifies power vacuums, enabling dominant actors to disproportionately influence agendas. Additionally, a sixth PT emerged: (vi) sustained interpersonal relationships counterbalance structural power imbalances, fostering accountability and adaptive problem-solving. These findings demonstrate that power dynamics in ISC within LMICs are mediated by both structural factors (e.g. funding models and institutional hierarchies) and relational mechanisms (e.g. trust and negotiation). Successful collaboration hinges on recognizing and addressing these dual dimensions of power. This synthesis advances the theoretical and practical understanding of ISC, offering policymakers actionable insights to navigate power-related challenges in intersectoral health initiatives.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"661-683"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788202","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":"Protecting unaccompanied migrant youth in transit through Mexico: frontline perspectives on appropriate policy implementation.","authors":"Susanna Corona Maioli, Rochelle A Burgess","doi":"10.1093/heapol/czaf037","DOIUrl":"https://doi.org/10.1093/heapol/czaf037","url":null,"abstract":"<p><p>Mexico is the world's largest global migration corridor and in the last decade there has been an increase in forced migration of families, women and unaccompanied children and adolescents. The latter population requires specific policy and implementation frameworks due to increased vulnerability related to their age, gender and unaccompanied status, which can seriously impact their long-term health and wellbeing. However, globally and in Mexico there are reports of lack of appropriate implementation of protection measures. Thus, this article aims to explore the perspectives of frontline workers who conduct daily work with unaccompanied migrant youth. Through 29 semi-structured interviews conducted with different migration workers, mostly based in Mexico, in summer 2021, we found that possibilities for advancing child rights exist even with scarcity of resources. In fact, although workers highlighted a context of lack of resources, partly determined by a political vision which does not recognize humanity as a priority, specific skills and knowledge were identified for fostering migrant youth resilience. Knowledge such as clear best interests of the child guidelines and skills such as empathy, adaptation and recognition of agency of young people enabled some workers to provide appropriate safeguarding. However, we highlight how the contextual scarcity of services overruns individual worker capacities, leading to a lack of appropriate safeguarding overall. Based on worker perspectives, we provide recommendations for appropriate policy implementation. Results are reported according to COREQ guidelines.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225315","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":"Crises and complexity: how can we make health interventions succeed?","authors":"Zaruhi Mkrtchyan, Yolanda Moyo, Fiammetta Bozzani, Heather Ingold, Graham Medley, Sergio Torres-Rueda, Fern Terris-Prestholt, Lorna Guinness, Anna M Foss, Francis Ruiz","doi":"10.1093/heapol/czaf032","DOIUrl":"https://doi.org/10.1093/heapol/czaf032","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215672","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":"Determinants of distress financing for healthcare service utilization: a convergent mixed-method study at a tertiary hospital in Malaysia.","authors":"Siti Mariam Binti Abd Gani, Nithiah Thangiah, Hirotsugu Aiga","doi":"10.1093/heapol/czaf034","DOIUrl":"https://doi.org/10.1093/heapol/czaf034","url":null,"abstract":"<p><p>Households with ill members often face financial hardship during healthcare seeking. Households mobilize their resources from various sources to pay for treatment costs. Financially, some households resort to borrowing money and selling their assets. This type of financial coping strategies is called distress financing (DF). This study aims to estimate the prevalence and determinants of DF among households with hospitalized members at University Malaya Medical Centre, Malaysia. It further explores the dynamics of DF and its impact on households' welfare by employing convergent mixed method approach. Quantitative data were collected using structured interview. Households having reported to either borrow money, sell their assets and/or withdraw employee provident fund were categorized as those suffering DF. To explore how households coped with high medical expenses and the consequences of DF, seven households adopting more than one DF strategy were purposively selected for in-depth interview. Of 199 households, 22 (11.1%) reported to underwent DF. Psychological distress, medical indebtedness and poverty were typical consequences of DF. During hardship, social network played a principal role in alleviating financial burden, further emphasizing the importance of kinship. Households undergoing catastrophic health expenditure, headed by Chinese ethnicity, living in other states, and living in rental house, were 8.2, 4.6, 4.4, and 3.5 times more likely to undergo DF respectively. Targeted assistance in removing financial barriers would assure the continuum of care among the households possibly suffering DF, thereby improve their health outcomes.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186949","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}