Health policy and planning最新文献

{"title":"Indonesian medical interns' intention to practice in rural areas.","authors":"Ardi Findyartini, Fona Qorina, Azis Muhammad Putera, Eghar Anugrapaksi, Aulia Nafi Syifa Putri Khumaini, Ikhwanuliman Putera, Ikrar Syahmar, Dujeepa D Samarasekera","doi":"10.1093/heapol/czae111","DOIUrl":"10.1093/heapol/czae111","url":null,"abstract":"<p><p>The maldistribution of physicians, especially in rural areas, remains a global public health challenge. The internship programme for medical doctors is one of the efforts undertaken to address this issue. However, evidence aiming to disentangle this persistent challenge in the Indonesian context has been scant. This study aims to identify factors influencing medical doctors' intentions to practise in rural areas and how these factors affect their decisions. We adopted a sequential explanatory mixed-method design using a validated questionnaire. Then, focus group discussions were conducted with medical doctors from three different regions (West, Central, and East) to gain in-depth understanding of motivations, intentions, and barriers to practicing in rural areas. Participants were intern doctors who had been practising for at least 6 months in their internship locations. Quantitative analysis was based on a questionnaire addressing each factor, rated using five-point Likert scales, with bivariate and multivariate logistic regression analyses. The qualitative results were analysed using thematic analysis. In total, 498 respondents completed the questionnaire where 9.6%, 49%, and 40.9% intend to practise in rural, suburban, and urban areas, respectively. Three factors were positively associated with a preference for rural practice: prior living experience in rural areas, accessibility to cultural centres and events, and personal savings as funding resources during medical school. However, the importance of 'internet accessibility' was negatively associated with a preference for rural practice. Furthermore, the qualitative study involving 18 participants resulted in four main themes: the role of the internship programme in enhancing motivation as medical doctors, factors generally influencing the intention to practise, factors influencing the intention to practise in rural areas, and policy recommendations to increase the intention to practise in rural areas. Addressing the challenge of attracting and retaining medical doctors in rural areas requires multisectoral approaches involving both personal and professional factors.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"318-330"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675382","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":"Managing medicines in decentralization: discrepancies between national policies and local practices in primary healthcare settings in Indonesia.","authors":"Relmbuss Biljers Fanda, Ari Probandari, Maarten Olivier Kok, Roland A Bal","doi":"10.1093/heapol/czae114","DOIUrl":"10.1093/heapol/czae114","url":null,"abstract":"<p><p>In Indonesia, primary health centres (PHCs) are mandated to provide essential medicines to ensure equal access to medication for all Indonesians, as stated in the national medicine policy. However, limited information is available regarding the actual practices of health workers within the context of decentralized governance. This paper investigates the discrepancies between national policies and local practices in two Indonesian districts, shedding light on coping mechanisms employed in each phase of medicine management within PHCs. The mixed-method study began by identifying pertinent policies addressing medicine management in PHCs. Subsequently, panel data on patient visits to tuberculosis, maternal and neonatal health (MNH), and noncommunicable disease (NCD) services were collected from 2019 to 2022. After analysing the panel data, interviews were conducted with 56 health workers including physicians, nurses, pharmacists, midwives, and public health programme managers regarding their views on fluctuations in medicine stocks and the patient visit data. These participants included pharmacists and programme managers specializing in tuberculosis, MNH, and NCD care and were affiliated with PHCs and district health offices. Our findings highlight the occasional unavailability of essential medicines in PHCs, with stockouts being attributed to supplier shortages at provincial and national levels and to variations in the capacity of the local health system. Low-skilled pharmaceutical staff are a contributing factor in each phase of medicine management. Additionally, health workers employ coping mechanisms, such as deviating from policy on the use of capitation funds to purchase medicines, to manage temporary stockouts. To tackle systemic stockouts, central government should prioritize capacity-building among health workers, by establishing a continuous and easily accessible local learning system.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"346-357"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686835","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":"The discrepancy between objective and subjective assessments of catastrophic health expenditure: evidence from China.","authors":"Bingqing Guo, Chaojie Liu, Qiang Yao","doi":"10.1093/heapol/czae115","DOIUrl":"10.1093/heapol/czae115","url":null,"abstract":"<p><p>The pro-rich nature of catastrophic health expenditure (CHE) indicators has garnered criticism, inspiring the exploration of the subjective approach as a complementary method. However, no studies have examined the discrepancy between subjective and objective approaches. Employing data from the Chinese Social Survey (CSS) 2013-2021 waves, we analysed the discrepancy between objective and subjective CHE and its associated socioeconomic factors using logit regression modelling. Overall, self-rating generated higher CHE incidence (28.35% to 33.72%) compared to objective indicators (9.92% to 21.97%). Objective indicators did not support 17.57% to 23.90% of self-rated cases of household CHE, while 2.73% to 8.42% of households classified with CHE by objective indicators did not self-rate with CHE. The normative subsistence spending indicator showed the least consistency with self-rating (70.66% to 74.28%), while the budget share method produced the most consistent estimation (72.73% to 76.10%). Living with elderly and young children [adjusted odds ratios (AOR): 1.069 to 1.169, P < 0.1], lower educational attainment (AOR: 1.106 to 1.225, P < 0.1), lower income (AOR: 1.394 to 2.062, P < 0.01), and lower perceived social class (AOR: 1.537 to 2.801, P < 0.05) were associated with higher odds of self-rated CHE without support from objective indicators. Conversely, low socioeconomic status (AOR: 0.324 to 0.819, P < 0.1) was associated with lower odds of missing CHE cases classified by objective indicators in self-rating. The commonly used objective indicators for assessing CHE may attract doubts about their fairness from socioeconomically disadvantaged people. The CHE subjective approach can be adopted as a complementary measure to monitor financial risk protection.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"331-345"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824170","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":"Implementation science research priorities for Universal Health Coverage: methodological lessons from the design and implementation of a multicountry modified Delphi study.","authors":"Breanna K Wodnik, Prossy Kiddu Namyalo, Ophelia Michaelides, Beverley M Essue, Sumit Kane, Erica Di Ruggiero","doi":"10.1093/heapol/czae119","DOIUrl":"10.1093/heapol/czae119","url":null,"abstract":"<p><p>Delphi studies are rapidly gaining prominence in global health research. However, researchers' modifications to the Delphi method are often not well-described or justified, limiting opportunities to systematically learn from these studies when the methods are applied to other topics and settings. This paper aims to describe an approach to implementing a modified Delphi study and reflect on the research process in the context of a multicountry study of implementation science research priorities to advance Universal Health Coverage (UHC). We review trends in the use of the modified Delphi method in global health research, outline our three-phased modified Delphi approach, and share reflections on five decision points for implementing the study: (I) identifying and recruiting participants for the expert panel, (II) addressing participant attrition between rounds, (III) justifying the most appropriate cutoff points, (IV) incorporating new items raised by participants in open-ended survey sections, and (V) ensuring maximum variation in perspective in the panel of experts. Insights from this work foster greater understanding of the underlying assumptions for, and interpretation of, 'modified' in modified Delphi studies. This study will encourage critical dialogue about points of methodological contention in Delphi methodology and thus are relevant for scaling the use of modified Delphi studies in public health, including global health research.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"422-427"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806744","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":"A Chinese conundrum: does higher insurance coverage for hospitalization reduce financial protection for the patients who most need it?","authors":"Xiaoying Zhu, Ajay Mahal, Shenglan Tang, Barbara McPake","doi":"10.1093/heapol/czae108","DOIUrl":"10.1093/heapol/czae108","url":null,"abstract":"<p><p>This paper evaluates the relationship between the degree of cost-sharing and the utilization of outpatient and inpatient health services in China. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated the association between outpatient and inpatient service utilization and cost-sharing levels associated with outpatient and inpatient services, as well as a comparative metric that quantifies the relative cost-sharing burden between the two. We found that patients in areas with higher levels of cost-sharing for outpatient services exhibit a lower propensity to use outpatient care and a higher inclination to utilize costly hospitalization services. Conversely, as the ratio of cost-sharing for outpatient services to that for inpatient services increases, the likelihood of patients forgoing doctor-initiated hospitalization correspondingly increases. This suggests that when cost-sharing for outpatient care rises relative to inpatient care, observed increases in inpatient care utilization reflect an escalation in moral hazard rather than a correction for the underutilization of inpatient services. We conclude that both substitution and complementary roles exist between outpatient and inpatient services. Our findings suggest that a more effective design of cost-sharing is needed to enhance the equity and efficiency of China's health system.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"287-299"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619053","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":"What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence.","authors":"Charlotte Ward, Elias Rejoice Maynard Phiri, Catherine Goodman, Alinane Linda Nyondo-Mipando, Monica Malata, Wanangwa Chimwaza Manda, Victor Mwapasa, Timothy Powell-Jackson","doi":"10.1093/heapol/czae112","DOIUrl":"10.1093/heapol/czae112","url":null,"abstract":"<p><p>There is a widely held view that good management improves organizational performance. However, hospitals are complex organizations, and the relationship between management practices and health service delivery is not straightforward. We conducted a global, systematic literature review of the quantitative evidence on the link between the adoption of management practices and quality of care in hospitals. We searched in PubMed, EMBASE, EconLit, Global Health, and Web of Science on 16 October 2024, without language or country restrictions. We included empirical studies from 1 January 2000 onwards, examining the quantitative association between hospital management practices and quality of care. Outcomes included structural quality (availability of resources such as drugs and equipment), clinical quality (adherence to guidelines), health outcomes, and patient satisfaction or experience with care. In every study, each tested association was categorized as significantly positive (at the 5% level), null, or significantly negative. The study was registered with PROSPERO (CRD42022301462). Of 11 731 articles, 25 studies met the inclusion criteria and had an acceptable risk of bias. Studies were equally distributed between high-income and low- and middle-income countries, with 22 cross-sectional and three intervention studies. Of 111 associations, 55 (49.5%) were significantly positive, one (1%) was significantly negative, and 55 (49.5%) were null. Among the associations tested, the majority were significantly positive for structural quality (79%), clinical quality (60%), and health outcomes (57%), while most associations between hospital management and patient satisfaction (80%) were null. The findings are mixed, with a similar proportion of positive and null associations between management practices and quality of care across studies. The evidence is limited by the risk of bias introduced by nonrandomized study designs. Evidence of positive associations in some settings warrants further investigation of the association through intervention studies or natural experiments. This could leverage methodological developments in quantitatively measuring management, highlighted by this review.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"409-421"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686840","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 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":"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 (CASs). Hardware represents the concrete components of systems, whereas software represents the elements that 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 synthesize 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 2011-23, all papers that explicitly used the concept of health system software were identified and mapped; second, drawing on a subset 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 conceptualize 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 proactively using the software concept within studies, demonstrating two patterns of use. However, a limited understanding of how to investigate interactions among hardware and software elements was also revealed. Future health policy and systems research should purposively investigate hardware-software interactions in order to gain a greater understanding of the complex, adaptive nature of health systems, understand their operations, and institutionalize thinking that considers health systems as CASs.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"391-408"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886817/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development partner influence on domestic health financing contributions in Senegal: a mixed-methods case study.","authors":"Frederik Federspiel, Josephine Borghi, Elhadji Mamadou Mbaye, Henning Tarp Jensen, Melisa Martinez Alvarez","doi":"10.1093/heapol/czae110","DOIUrl":"10.1093/heapol/czae110","url":null,"abstract":"<p><p>Sustainable and equitably contributed domestic health financing is essential for improving health and making progress towards Universal Health Coverage (UHC) in low- and middle-income countries. In this study, we explore the pathways through which development partners influence the combination of domestic health financing sources in Senegal. We performed a qualitative case study that comprised 32 key stakeholder interviews and a purposive document review, supplemented by descriptive statistical analysis of World Health Organization and Organization for Economic Cooperation and Development data on health financing sources in Senegal. We developed a novel framework to analyse the different mechanisms and directions of development partner influence on domestic health financing contributions. We identified development partner influence via four mechanisms: setting aims and standards, lobbying/negotiation, providing policy/technical advice, and providing external financing. Overall, development partners worked to increase tax-based government contributions and expand Community-Based Health Insurance (CBHI), which is seemingly equity enhancing. Fungibility and intrinsic equity issues related to CBHI may, however, limit equity gains. We encourage stakeholders in the health financing sphere to use our framework and analysis to unpack how development partners affect domestic health financing in other settings. This could help identify dynamics that do not optimally enhance equity and support progress towards UHC to help achieve more coherent policy-making across all domains of development partner activities in support of UHC. Future research should investigate the role of international creditors, lending, and loan conditionalities on domestic health financing in recipient countries, including equity implications.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"300-317"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681545","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":"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":"10.1093/heapol/czaf002","url":null,"abstract":"<p><p>The COVID-19 pandemic has disrupted the Philippines's transition toward universal health coverage. However, some local government units in the country made use of the pandemic as a catalyst to strengthen their local health system, scale-up the provision of preventive and primary care services, and improve health governance to make it more prepared to face future pandemics and realize the aims of the country's new Universal Healthcare Act. This paper describes the response of the local government of Quezon City, Philippines, to COVID-19 and how it strengthened local health systems. We also discuss enablers such as partnerships, collaborations, and foresight to ensure that investments during the pandemic will continue to be of use. We also identify some constraints and propose recommendations to consolidate local health system gains during the COVID-19 pandemic response in the transition toward universal health coverage.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"436-442"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886787/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Hospital response to a new case-based payment system in China: the patient selection effect.","authors":"","doi":"10.1093/heapol/czae123","DOIUrl":"10.1093/heapol/czae123","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"443"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894080","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}