Health policy and planning最新文献

{"title":"Informal employment and high burden of out-of-pocket healthcare payments among older workers: evidence from the Longitudinal Ageing Study in India.","authors":"Poulomi Chowdhury, Srinivas Goli","doi":"10.1093/heapol/czae074","DOIUrl":"10.1093/heapol/czae074","url":null,"abstract":"<p><p>India's economy is among the fastest growing in the world. However, a large share of informal workforce is a common characteristic of country's economy, comprises a significant portion of most of its labour markets. This workforce often receives low wages and lacks benefits such as strong social security and health coverage for all. The majority of healthcare spending in India is private. As India's population ages and the informal sector expands, it is expected that many of these workers will continue to work beyond the retirement age to bear their own healthcare costs due to lack of savings, pensions, and the precarious nature of their employment. In this context, this study estimates the burden of out-of-pocket (OOP) payments on India's informal older workers compared to their formal counterparts, using data from the first wave of the nationally representative Longitudinal Ageing Study in India. According to estimates from the two-part regression model, informal older workers pay, on average, INR 1113 (P < 0.01) and INR 55 (P < 0.05) less than their formal counterparts for inpatient and outpatient care, respectively. Further, probit regression models revealed that the burden of combined (both inpatient and outpatient) OOP payments exceeding (by 40, 20 and 10%) of their income is significantly higher among informal older workers compared to formal older workers. The study underscores the need for strengthening of universal health insurance schemes to ensure everyone has access to medical services without experiencing financial hardship. It also advocates for policies specifically tailored towards informal workers, considering their unique challenges with regard to livelihoods and healthcare security. In particular, this encompasses bolstering the existing social security and healthcare system, and related policies for ensuring financial security against OOP payments, especially for informal workers and all the population in general.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"123-139"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889023","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":"Impact of family mutual aid system for personal medical insurance accounts on paediatric patients' outpatient utilization patterns and costs: a difference-in-differences analysis.","authors":"Xinyi Liu, Chunhui Gao, Mingyue Wei, Guohong Li, Xianqun Fan","doi":"10.1093/heapol/czae100","DOIUrl":"10.1093/heapol/czae100","url":null,"abstract":"<p><p>This study explores the effect of the transformation of paediatric healthcare through the implementation of the Family Mutual Aid System (FMAS) for personal medical insurance accounts among paediatric patients at a children's hospital (Hospital A in Shanghai, China). We conducted a cohort study in the endocrinology department of Hospital A from August 2021 to July 2023 to assess the impact of FMAS enrolment on patients' annual outpatient visits, annual outpatient expenditures, and the allocation of these costs among the basic medical insurance pooling fund and patients' out-of-pocket expenses, with a further subdivision into online and offline consultations. Analysis employed a weighted difference-in-differences approach within a fixed-effects model following propensity score matching. The study encompassed 10 975 paediatric patients, divided into those enrolled in FMAS (observation group) and those not (control group). Enrolment in FMAS was associated with a statistically significant increase in annual outpatient visits by an average of 1.107, predominantly attributed to an uptick in offline consultations. Additionally, there was a substantial 38.9% rise in annual outpatient costs. Detailed analysis revealed a 52.5% increase in costs covered by the medical insurance pooling fund, while patients' out-of-pocket expenses decreased by an average of 69.2%. These findings highlight the beneficial effects of FMAS enrolment on healthcare service utilization and the risk-sharing mechanisms of medical insurance.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"176-182"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619056","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":"Becoming eligible for long-term care insurance in China brought more ageing at home: evidence from a pilot city.","authors":"Zeyuan Chen, Hui Zhou, Xiang Ma","doi":"10.1093/heapol/czae109","DOIUrl":"10.1093/heapol/czae109","url":null,"abstract":"<p><p>Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of place of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of place of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by ∼16%, and this positive impact was larger for those insured, of higher education level, or of higher disability grade. By bringing more ageing in place, LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program, such as who could receive subsidies, family values, and family members' engagement in the labor market, could all work together to shape the substitution pattern between home and institutional care.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"165-175"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619054","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":"A Political Economy Analysis of Health Policymaking in Nigeria: The Genesis of the 2014 National Health Act.","authors":"Julia Ngozi Chukwuma, Felix Abrahams Obi","doi":"10.1093/heapol/czaf007","DOIUrl":"https://doi.org/10.1093/heapol/czaf007","url":null,"abstract":"<p><p>This article explores the ideologies, interests, and institutions affecting health policymaking in Nigeria, and the role of the private sector therein. It covers the period from the late-1950s, the years leading up to independence, to 2014, when the country enacted its first-ever law to govern its healthcare system. The National Health Act (NHAct) was adopted after a decade of preparation and civil society-driven advocacy, making the objective of Universal Health Coverage (UHC) explicit. However, in its final version, the NHAct earmarked only a small share of public funds for UHC, solidifying the country's reliance on private healthcare and out-of-pocket payments. To examine the specific set of ideologies, interests, and institutions defining Nigeria's pathway toward UHC and the contribution of the private sector, we adopted Rizvi and colleagues' political economy framework, situating the genesis of the 2014 NHAct within the broader political and economic context of Nigeria's health system reform process since the 1950s. Drawing on qualitative data collected during interviews and focus groups, we found that the deep entrenchment of private-sector healthcare in Nigeria is the result of a path-dependent process. This implies that Nigeria's current reliance on the private sector is influenced by historical patterns, competing interests, and institutional practices that have reinforced the role of private actors over time. We identified three major explanatory factors that have shaped health policymaking in Nigeria. First, since the 1980s, the ideology that private healthcare is the solution to an underfunded and underperforming public healthcare system has been reinforced by leading international organisations. Second, private actors in Nigeria have been in a strong position to influence health policymaking since independence. Third, Nigeria's challenging socioeconomic context and the limitations of its federal governance structure have fostered a general level of public distrust in the capacity of the public sector to provide quality healthcare.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065278","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":"Correction to: Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India.","authors":"","doi":"10.1093/heapol/czaf003","DOIUrl":"10.1093/heapol/czaf003","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033095","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":"Can public education campaigns equitably counter the use of substandard and falsified (SF) medical products in African countries?","authors":"Janelle M Wagnild, Samuel Asiedu Owusu, Simon Mariwah, Victor I Kolo, Ahmed Vandi, Didacus Bambaiha Namanya, Rutendo Kuwana, Babatunde Jayeola, Vigil Prah-Ashun, Moji Christianah Adeyeye, James Komeh, David Nahamya, Kate Hampshire","doi":"10.1093/heapol/czaf004","DOIUrl":"https://doi.org/10.1093/heapol/czaf004","url":null,"abstract":"<p><p>Substandard and falsified (SF) medical products are a serious health and economic concern that disproportionately impact low- and middle-income countries and marginalized groups. Public education campaigns are demand-side interventions that may reduce risk of SF exposure, but the effectiveness of such campaigns, and their likelihood of benefitting everybody, is unclear. Nationwide pilot risk communication campaigns, involving multiple media, were deployed in Ghana, Nigeria, Sierra Leone, Uganda in 2020-2021. Focus group discussions (n=73 FGDs with n=611 total participants) and key informant interviews (n=80 individual interviews and n=4 group interviews with n=111 total informants) were conducted within each of the four countries to ascertain the reach and effectiveness of the campaign. Small proportions of focus group discussants (8.0%-13.9%) and key informants (12.5%-31.4%) had previously encountered the campaign materials. Understandability was varied: the use of English and select local languages, combined with high rates of illiteracy, meant that some were not able to understand the campaign. The capacity for people to act on the messages was extremely limited: inaccessibility, unavailability, and unaffordability of quality-assured medicines from official sources, as well as illiteracy, constrained what people could realistically do in response to the campaign. Importantly, reach, understandability, and capacity to respond were especially limited amongst marginalized groups, who are already at greatest risk of exposure to SF products. These findings suggest that there may be potential for public education campaigns to help combat the issue of SF medicines through prevention, but that the impact of public education is likely to be limited and may even inadvertently widen health inequities. This indicates that public education campaigns are not a single solution; they can only be properly effective if accompanied by health system strengthening and supply-side interventions that aim to increase the effectiveness of regulation.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004483","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":"How has the concept of health system software been used in health policy and systems research? A scoping review.","authors":"Nicola Burger, Lucy Gilson","doi":"10.1093/heapol/czaf001","DOIUrl":"https://doi.org/10.1093/heapol/czaf001","url":null,"abstract":"<p><p>Understanding health systems as comprising interacting elements of hardware and software acknowledges health systems as complex adaptive systems (CAS). Hardware represents the concrete components of systems, whereas software represents the elements which influence actions and underpin relationships, such as processes, values and norms As a specific call for research on health system software was made in 2011, we conducted a qualitative scoping review considering how and for what purpose the concept has been used since then. Our overall purpose was to synthesise current knowledge and generate lessons about how to deepen research on, and understanding of, health system software. The review consisted of two phases: first, for the period 2011-2023, all papers which explicitly used the concept of health system software were identified and mapped; second, drawing on a sub-set of papers from phase 1, we explored how the concept was purposively used within research. The databases Pubmed, Scopus, EBSCOhost, Web of Science and Google Scholar were systematically searched using a strategy developed by a skilled librarian. In Phase 1, data were extracted from 98 papers. Our analysis revealed that a third of the papers used the software concept rather superficially; a third used it to conceptualise the importance of selected software elements; and a third used it in examining a specific health system experience, such as preparedness or resilience. In Phase 2, our analysis confirmed that researchers have found value in pro-actively using the software concept within studies, demonstrating two patterns of use. However, limited understanding of how to investigate interactions amongst hard- and software elements was also revealed. Future health policy and systems research should purposively investigate hardware-software interactions, in order to gain greater understanding of the complex, adaptive nature of health systems, understand their operations, and to institutionalise thinking that considers health systems as CASs.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004484","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":"Strengthening local health systems and governance for Universal Health Coverage: experiences and lessons from the COVID-19 pandemic response in Quezon City, Philippines.","authors":"Esperanza Anita Escano-Arias, Ramona Asuncion D G Abarquez, Rolando V Cruz, Rosalie Espeleta, Madeline Mae Ong, Arianna Maever Loreche, Veincent Christian F Pepito, Vida Gomez, Manuel M Dayrit","doi":"10.1093/heapol/czaf002","DOIUrl":"https://doi.org/10.1093/heapol/czaf002","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970565","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":"Who pays to treat malaria and how much? Analysis of the cost of illness, equity and economic burden of malaria in Uganda.","authors":"Katherine Snyman, Catherine Pitt, Angelo Aturia, Joyce Aber, Samuel Gonahasa, Jane Frances Namuganga, Joaniter Nankabirwa, Emmanuel Arinaitwe, Catherine Maiteki-Sebuguzi, Henry Katamba, Jimmy Opigo, Fred Matovu, Grant Dorsey, Moses R Kamya, Walter Ochieng, Sarah G Staedke","doi":"10.1093/heapol/czae093","DOIUrl":"10.1093/heapol/czae093","url":null,"abstract":"<p><p>Case management of malaria in Africa has evolved markedly over the past 20 years and updated cost estimates are needed to guide malaria control policies. We estimated the cost of malaria illness to households and the public health service and assessed the equity of these costs in Uganda. From December 2021 to May 2022, we conducted a costing exercise in eight government-run health centres covering seven sub-regions, collecting health service costs from patient observations, records review and a time-and-motion study. From November 2021 to January 2022, we gathered data on households' cost of illness from randomly selected households for 614 residents with suspected malaria. Societal costs of illness were estimated and combined with secondary data sources to estimate the total economic burden of malaria in Uganda. We used regression analyses and concentration curves to assess the equity of household costs across age, geographic location and socio-economic status. The mean societal economic cost of treating suspected malaria was $15.12 [95% confidence interval (CI): 12.83-17.14] per outpatient and $27.21 (95% CI: 20.43-33.99) per inpatient case. Households incurred 81% of outpatient and 72% of inpatient costs. Households bore nearly equal costs of illness, regardless of socio-economic status. A case of malaria cost households in the lowest quintile 26% of per capita monthly consumption, while a malaria case only cost households in the highest quintile 8%. We estimated the societal cost of malaria treatment in Uganda was $577 million (range: $302 million-1.09 billion) in 2021. The cost of malaria remains high in Uganda. Households bear the major burden of these costs. Poorer and richer households incur the same costs per case; this distribution is equal, but not equitable. These results can be applied to parameterize future economic evaluations of malaria control interventions and to evaluate the impact of malaria on Ugandan society, informing resource allocations in malaria prevention.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"52-65"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463914","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":"Correction to: Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries.","authors":"","doi":"10.1093/heapol/czae107","DOIUrl":"10.1093/heapol/czae107","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"121-122"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686819","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}