Health policy and planning最新文献

{"title":"The long-term effects of cash transfer programmes on young adults' mental health: a quasi-experimental study of Colombia, Mexico, and South Africa.","authors":"Annie Zimmerman, Mauricio Avendano, Crick Lund, Ricardo Araya, Yadira Diaz, Juliana Sanchez-Ariza, Philipp Hessel, Emily Garman, Sara Evans-Lacko","doi":"10.1093/heapol/czae102","DOIUrl":"10.1093/heapol/czae102","url":null,"abstract":"<p><p>Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico, and South Africa (N = 14 431), we applied logistic regression models with country and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment, and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood [odds ratio (OR) = 0.96, 95% confidence intervals (CIs): 0.93, 0.98]. We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03) and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population-level depressive symptoms during early adulthood.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"206-217"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557700","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":"Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India.","authors":"Veena Sriram, Girija Vaidyanathan, G S Adithyan, Shambo Basu Thakur, Simran Kaur, Hari Narayanan Gl, Sabah Haque, V R Muraleedharan","doi":"10.1093/heapol/czae096","DOIUrl":"10.1093/heapol/czae096","url":null,"abstract":"<p><p>The capacity of government agencies to develop effective policy responses to external shocks is an important area of focus for health policy processes, as illustrated by the coronavirus (COVID-19) pandemic. However, few empirical studies exploring the subnational capacity of governments and the influence of institutional, organizational and political factors in shaping the policy response to complex emergencies have been conducted. The purpose of this study is to examine the governance capacity to develop and implement a policy response to a major health emergency-COVID-19-in Tamil Nadu, India, and to understand the factors shaping governance capacity during the first and second waves (2020-21). Tamil Nadu offers a useful case for exploring governance capacity due to its long-standing public health institutions and previous experiences with disaster and outbreak response. We utilized three sources of data: (1) a review of key policy documents (n = 164); (2) a review of English-language media articles in the Indian press (n = 336); and (3) in-depth interviews with senior decision makers, technical experts and other stakeholders (n = 10). We present four key findings from this analysis. Firstly, Tamil Nadu's institutional framework enabled state-level governance capacity during an emergency of massive complexity, allowing for flexibility and nimbleness to adapt to evolving dynamics of centralization and decentralization over the course of the pandemic. Secondly, the ability to integrate public health expertise was circumscribed at important phases. Thirdly, while coordination with external experts was utilized extensively, engagement with civil society groups was perceived as limited. Fourthly, the electoral cycle was perceived by some to have constrained governance capacity at a critical point in the pandemic. By analysing the dynamics of state-level capacity in Tamil Nadu during a complex emergency, this study provides important learnings for other contexts globally regarding the drivers shaping capacity to develop and implement policy responses to crises.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"153-164"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463911","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884802/pdf/","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":"OA","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}

{"title":"The political economy of national health insurance schemes: evidence from Zambia.","authors":"Doris Osei Afriyie, Regina Titi-Ofei, Felix Masiye, Collins Chansa, Günther Fink","doi":"10.1093/heapol/czae094","DOIUrl":"10.1093/heapol/czae094","url":null,"abstract":"<p><p>Governments in low and middle-income countries (LMICs) are increasingly considering the introduction of national health insurance scheme (NHIS) as a strategy to achieve universal health coverage (UHC) targets. The literature has widely documented the technical challenges associated with implementing UHC policies in LMICs but much less is known about the political process necessary to pass UHC legislation. In this article, we document the political economy issues surrounding the establishment of the Zambia NHIS in 2018. We adapted a political economy framework incorporating, semi-structured interviews with diverse stakeholders and document analysis of policies, operational reports and legislatures from 1991 and 2018. Our findings show the 26-year journey towards the establishment of the NHIS in Zambia involved a long sequence of policy dialogue, technical review and stakeholder engagement. Our interviews with key stakeholders suggest that the act was eventually passed due to strong political will and dominant leadership of the Ministry of Health. Passing the law required trade-offs between choices influenced by stakeholder pressures and recommendations from research and actuarial studies. Another equally critical factor was the high public support and legacies of past policies, such as the removal of user fees that had created quality gaps and inequities in the health system. Furthermore, global ideas about UHC and initiatives implemented by other countries also generated support for Zambia's NHIS. Overall, this study highlights the complex set of political economy factors that need to align in order for governments to be able to adopt health insurance in low-income settings. We show that political leadership and commitment to getting reforms passed is crucial. We also highlight how certain narratives about countries in the global health sphere can shape policies in other countries.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"66-74"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463913","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":"Digitalizing disease surveillance: experience from Sierra Leone.","authors":"Magoba Bridget, Gebrekrstos Negash Gebru, George S Odongo, Calle Hedberg, Adel Hussein Elduma, Joseph Sam Kanu, James Bangura, James Sylvester Squire, Monique A Foster","doi":"10.1093/heapol/czae039","DOIUrl":"10.1093/heapol/czae039","url":null,"abstract":"<p><p>The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aims to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data were collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy and DHIS2 documentation. Content and thematic data analyses were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In the early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform are analysed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio and Anthrax have been tracked in real-time through the eCBDS.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"85-96"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174855","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":"Finding the missing men with tuberculosis: a participatory approach to identify priority interventions in Uganda.","authors":"Jasper Nidoi, Justin Pulford, Tom Wingfield, Thomson Rachael, Beate Ringwald, Winceslaus Katagira, Winters Muttamba, Milly Nattimba, Zahra Namuli, Bruce Kirenga","doi":"10.1093/heapol/czae087","DOIUrl":"10.1093/heapol/czae087","url":null,"abstract":"<p><p>Gender impacts exposure and vulnerability to tuberculosis (TB) evidenced by a higher prevalence of both TB disease and missed TB diagnoses among men, who significantly contribute to new TB infections. We present the formative research phase of a study, which used participatory methods to identify gender-specific interventions for systematic screening of TB among men in Uganda. Health facility-level data were collected at four Ugandan general hospitals (Kawolo, Gombe, Mityana and Nakaseke) among 70 TB stakeholders, including healthcare workers, TB survivors, policymakers and researchers. Using health-seeking pathways, they delineated and compared men's ideal and actual step-by-step TB health-seeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a 'river' and each 'steppingstone' as a solution, was employed to identify interventions which would help link men with TB symptoms to care. These insights were then synthesized in a co-analysis meeting with 17 participants, including representatives from each health facility to develop a consensus on proposed interventions. Data across locations revealed the actual TB care pathway diverted from the ideal pathway due to health system, community, health worker and individual-level barriers such as delayed health seeking, unfavourable facility operating hours and long waiting times that conflicted with men's work schedules. Stakeholders proposed to address these barriers through the introduction of male-specific services; integrated TB services that prioritize X-ray screening for men with cough; healthcare worker training modules on integrated male-friendly services; training and supporting TB champions to deliver health education to people seeking care; and engagement of private practitioners to screen for TB. In conclusion, our participatory co-design approach facilitated dialogue, learning and consensus between different health actors on context-specific, person-centred TB interventions for men in Uganda. The acceptability, effectiveness and cost effectiveness of the package will now be evaluated in a pilot study.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106870","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}