Health policy and planning最新文献

{"title":"An unintended complementarity: how the outpatient pooling policy increases inpatient services in China.","authors":"Jianhui Wang, Mengyao Zhang, Miao Yu","doi":"10.1093/heapol/czag073","DOIUrl":"10.1093/heapol/czag073","url":null,"abstract":"<p><p>This study investigates the relationship between outpatient and inpatient services within China's tiered healthcare system following the implementation of outpatient pooling reform. Data were sourced from official administrative healthcare service records across counties in Sichuan Province (2010-20) and individual survey data from the China Health and Retirement Longitudinal Study (2011-18). Using a staggered difference-in-differences design with an imputation model, we identified an unexpected increase in hospital admissions post-reform, which was contrary to the policy's intent to optimize healthcare resource allocation. We found that increased use of outpatient services was positively associated with demand for inpatient care, demonstrating a complementary effect. Mechanism analysis revealed that the rising hospital admissions were partly attributable to two factors: (i) expansion of outpatient services in primary care institutions generating an induced hospitalization effect that contributed to the rise in inpatient volume and (ii) hospitals improving inpatient service efficiency by shifting selected diagnostic and treatment tests to the outpatient account. These findings confirm the complex interaction between outpatient and inpatient services and underscore the need for a more effective design of the medical insurance payment system to enhance the efficiency of China's healthcare services.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1212-1225"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015207","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":"Balancing policy ambition and systems reality in expanding access to non-communicable diseases medicines: lessons from Ghana and Georgia.","authors":"Augustina Koduah, Akaki Zoidze, Maia Uchaneishvili, Jacob Novignon, Adrianna Murphy, Benjamin Palafox, Tolib Mirzoev, George Gotsadze","doi":"10.1093/heapol/czag082","DOIUrl":"10.1093/heapol/czag082","url":null,"abstract":"<p><p>Ensuring sustained access to affordable, high-quality medicines is central to achieving universal health coverage (UHC) in low- and middle-income countries (LMICs). This is particularly true for chronic non-communicable diseases (NCDs), which require long-term, uninterrupted treatment. Although global guidance recommends expanding pharmaceutical benefits, regulating prices, promoting generics, and strengthening procurement and supply chains, many LMICs continue to face inequities in medicine availability and high out-of-pocket costs. The experiences of Ghana and Georgia, two countries that have invested heavily in UHC reforms, pharmaceutical benefits, centralized procurement, and pricing policies, illustrate gaps between policy ambitions and implementation realities in expanding access to NCD medicines. This paper examines four health-system factors influencing access to NCD medicines: system capacity, provider behaviour, digital enablers, and public trust. In both countries, centralized procurement faces forecasting inaccuracies, procurement delays, supply chain weaknesses, and distribution challenges, leading to stockouts and inconsistent availability. Provider behaviours further influenced access, with reimbursement delays, low payment rates, and administrative burdens contributing to informal fees, off-list prescribing, and suboptimal use of generics. Investments in digital systems such as logistics management information systems and electronic prescribing showed promise but were limited by uneven adoption, data quality issues, and insufficient integration into decision-making processes. Public awareness and trust emerged as critical yet neglected determinants. Limited communication and perceptions of low quality of state-purchased medicines reduced uptake of benefits in Georgia, while gaps between National Health Insurance Scheme (NHIS) intentions and patient experiences constrained equitable access in Ghana. Strengthening access to NCD medicines requires system-wide readiness, aligned provider-patient incentives, effective digital integration, and sustained community engagement to build trust and support uptake.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1349-1352"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328843","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":"Participation of civil society organizations and academia in COVID-19 governance: insights from a six country study.","authors":"Sumegha Asthana, Roujia Lin, Sanjana Mukherjee, Alexandra L Phelan, Ibrahim B Gobir, J J Woo, Clare Wenham, Mohammad Mushtuq Husain, Tahmina Shirin, Nevashan Govender, Mohannad Al Nsour, Winifred Ukponu, Adachioma C Ihueze, Sumit Asthana, Renee Vongai Mutare, Claire J Standley","doi":"10.1093/heapol/czag063","DOIUrl":"10.1093/heapol/czag063","url":null,"abstract":"<p><p>This paper focuses on the engagement of persons and groups with diverse interests in the governance of the COVID-19 pandemic. During emergencies, involving diverse perspectives in governance mechanisms can contribute to more equitable and evidence-based policies that address societal needs. Previous literature shows that, even with the intent to include diverse perspectives, there can be gaps in engaging non-governmental entities in epidemic governance. This study sought to analyze participation of two important interest groups: academia and civil society organizations (CSOs) during the COVID-19 response, to identify best practices and strategies for enhancing their roles in future health crisis governance. We adopted a comparative case study design to collect data from six countries: Nigeria, Singapore, South Africa, Bangladesh, Jordan, and the United Kingdom, representing varied political and economic contexts, geographic locations, and response strategies during the pandemic. Data sources included key informant interviews and focus group discussions with a total of 64 stakeholders, including government officials, academic experts, and personnel from CSOs. During the COVID-19 pandemic, CSOs actively participated in response efforts, but in the six countries we analyzed, they largely did so independently of the government, particularly during the initial response phase. In some countries, governments involved CSOs only after reports of clusters of new transmission, primarily for risk communication and service delivery like vaccine distribution, without involving them in governance mechanisms like making pandemic preparedness and response policies. Other governments worked with public universities to gather evidence for decision-making and policy formulation starting from the pre-pandemic phase to the initial phase of the pandemic. Across disciplines, experts in epidemiology, mathematical modelling, and infectious diseases were more likely to be consulted, whereas economists, sociologists, ethicists, and anthropologists were less involved.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1154-1164"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947606","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":"Survive and Thrive in Brazil: estimating the impact of the Boa Vista early childhood program.","authors":"Alexandra Brentani, Georg Loss, Luana Bessa, Susan Chang-Lopez, Susan P Walker, Ana Paula Ferrer, Sandra Grisi, Florencia Lopez Boo, Günther Fink","doi":"10.1093/heapol/czag057","DOIUrl":"10.1093/heapol/czag057","url":null,"abstract":"<p><p>This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as well as mothers of children under age 3 was rolled out in three phases. Neighborhoods were selected either for home visits or for group meetings held at Social Assistance Reference Centers. To allow for an evaluation of the program, the timing of the rollout was randomized at the neighborhood level. To assess the impact of the program on neonatal mortality, we used complete vital registration data from the period 2010 to 2010, and estimated differences in child mortality before and after the program were launched. Impact on child development was assessed through a detailed assessment of 744 children born in 2019 using the Caregiver Reported Early Child Development Index and Regional Project on Child Development Indicators instruments. Home visits resulted in a significant improvement in child development [d = 0.28, 95% Confidence Interval (CI) (-0.013, 0.57), P-value of .06] and reduction of neonatal mortality [Risk Ratio (RR) 0.58, 95% CI (0.36, 0.93), P-value of .02]. No impacts were found for the group meetings. The findings indicate that a home visiting program beginning in pregnancy can significantly reduce neonatal mortality and improve child development in poor urban neighborhoods of Brazil.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1115-1125"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769876","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":"Tailoring implementation strategies for acute coronary syndrome quality improvement program at primary care level in east, west, and central China.","authors":"Can Liu, Yixuan Wu, Zongbin Wang, Siwei Xie, Zhi-Jie Zheng, Shuduo Zhou","doi":"10.1093/heapol/czag064","DOIUrl":"10.1093/heapol/czag064","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and timely treatment of STEMI patients, the chest pain unit (CPU) program was established to strengthen referral pathways to qualified facilities. This study explores key barriers and facilitators to the CPU implementation and proposes context-specific strategies to optimize its delivery and scale-up. We conducted a qualitative study using semi-structured interviews in three purposively selected, representative counties across eastern, central, and western China. A total of 61 key informants from 36 township hospitals participated in the study. All interviews were audio-recorded, transcribed verbatim, and thematically coded guided by the Consolidated Framework for Implementation Research (CFIR) 2.0 using Atlas.ti 9. Implementation strategies were mapped and refined using Expert Recommendations for Implementing Change. We identified 46 barriers and 50 facilitators, spanning all five domains of CFIR. Technical deficiencies, residents' lack of health-seeking awareness, financial difficulties, inefficient awareness campaign, and limited professional knowledge are respectively the most significant barriers for the five domains. We developed a three-pronged strategy framework, including innovation optimization, external empowerment, and internal improvement, to inform future practice. Accordingly, the most urgent strategies encompass enhancing technical capacity, expanding financing mechanisms, empowering communities, implementing mass media campaigns, strengthening patient adherence through structured follow-up, and providing continuous practical training. We recommend that the proposed strategies should be taken into full consideration to facilitate timely detection and intervention of ACS in the primary healthcare context.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1255-1268"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856211","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":"Hospital twinning partnership for health system strengthening in rural China: a mixed-methods implementation study using WHO building blocks and CFIR framework.","authors":"Wenjuan Tao, Wenwu Shen, Hao Guo, Xiru Yu, Meirong Tian, Xin Di, Jian Li, Jun Guo, Jin Wen","doi":"10.1093/heapol/czag067","DOIUrl":"10.1093/heapol/czag067","url":null,"abstract":"<p><p>Hospital twinning partnerships have emerged as a strategy for health system strengthening, yet evidence on their implementation in domestic settings within low- and middle-income countries remains limited. This study examined a hospital twinning partnership between West China Hospital and Dafang County People's Hospital in western China to identify partnership components and implementation determinants, complemented by an assessment of implementation outcomes. A mixed-methods implementation study was conducted using the World Health Organization health system building blocks and the Consolidated Framework for Implementation Research (CFIR). Data were collected through semi-structured interviews (n = 10), structured surveys (n = 63), and administrative records. Partnership elements were mapped to the building blocks, while CFIR constructs were rated to identify facilitators and barriers. Qualitative and quantitative findings were integrated to provide a comprehensive understanding of implementation determinants. Partnership elements spanned all six building blocks, with particular emphasis on leadership and governance, service delivery, and health workforce development. Key facilitators included source credibility and reputation of the supporting hospital, government support, and a two-way partnership philosophy. Barriers included IT infrastructure limitations, inadequate external funding, intervention complexity, sustainability pressure, and cultural inertia toward change. Implementation outcomes showed improvements in service capacity, workforce development, and organizational culture, with observable changes extending to township health centers within the County Medical Consortium. The findings from this study suggest that structured domestic hospital twinning partnerships may serve as a promising approach to rural health systems. The comprehensive approach addressing multiple health system building blocks, combined with mechanisms for extending support to primary care facilities, offers a replicable model for health system strengthening in resource-limited settings.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1140-1153"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941295","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":"Financial protection in flux: longitudinal evidence on out-of-pocket spending among middle-aged and older Mexicans during the 'Seguro Popular'-INSABI transition.","authors":"Jose Eduardo Cabrero-Castro, Marissa Gonzalez, Emma Aguila, Héctor Arreola-Ornelas, Michael Touchton, Felicia Marie Knaul, Alfonso Rojas-Alvarez","doi":"10.1093/heapol/czag059","DOIUrl":"10.1093/heapol/czag059","url":null,"abstract":"<p><p>Mexico is ageing rapidly, placing growing strain on health financing and long-term care systems. Older adults face a double burden: higher healthcare needs due to chronic conditions and multimorbidity, and limited or informal income in later life, leaving them highly exposed to out-of-pocket (OOP) spending. In 2020, the government replaced 'Seguro Popular' (SP) with the 'Instituto de Salud para el Bienestar' (INSABI) to strengthen financial protection, but its implications on older adults remain unclear. We analysed OOP among 13 616 individuals aged ≥50 years in the Mexican Health and Aging Study, interviewed in 2018 and 2021. Expenditures for hospitalizations, outpatient procedures, medical visits and medications in the previous 12 months were indexed to inflation and converted to 2021 US dollars. Tobit models estimated total and component OOP, including an interaction between insurance category (Uninsured; Social Security-IMSS/ISSSTE/PEMEX/Defence; SP 2018/INSABI 2021; Other) and survey year, adjusting for sociodemographic and health covariates. Between 2018 and 2021 the proportion of older adults reporting no health insurance tripled from 9.5% to 27.2%, while SP affiliation fell from 30.1% to 10.9%. Social Security beneficiaries spent substantially less than the uninsured on total OOP (about US$1 033 less in 2018 and US$539 less in 2021). SP in 2018 and INSABI in 2021 were also associated with lower OOP (-US$291 and -US$298 versus the uninsured, respectively). Only Social Security was associated with a statistically significant reduction in medication-related OOP. Overall, the transition from SP to INSABI coincided with a marked rise in reported uninsurance and persistently high OOP, particularly for medicines, the principal driver of financial burden among older adults. These findings highlight the fragility of recent health financing reforms and the need to ensure sustained, employment-independent financial protection for Mexico's ageing population.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1067-1079"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837209","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":"Health facilities as a lever for birth registration in low- and middle-income countries: a realist review.","authors":"Lisanne Wolsink, Zakaria Belrhiti, Wiedaad Slemming, Matty Crone, Marsha Orgill","doi":"10.1093/heapol/czag078","DOIUrl":"10.1093/heapol/czag078","url":null,"abstract":"<p><p>The health system has been identified as a key lever for increasing access to birth registration (BR) directly after birth. BR is critical for upholding human rights and accessing essential services, yet many low- and middle-income countries struggle with low BR rates. In this realist synthesis, we reviewed literature on two separate interventions that are designed to increase access to BR services. This included (i) embedding or appointing an official to register births in health facilities and (ii) incorporating education on BR in routine perinatal care programmes. This study aimed to support the knowledge base on how these interventions work, why, and for whom, within health facility contexts. We followed the RAMESES I publication guidelines for realist syntheses. Iterative searches were carried out in PubMed, Scopus, and Web of Science. The search also included grey literature, policy documents, and insights from a key informant in South Africa. We adopted an iterative cycle of searches guided by review team exchanges, stakeholders' insights, and sequential snowballing searches for theory and background information. We developed two initial programme theories, presented as ICAMO configurations, that were then refined against empirical evidence from 17 included studies, with publication dates ranging from 1992 to 2021. Our review findings highlight that the interventions improved BR rates by lowering logistical barriers, raising awareness, and supporting BR staff, (i.e. personnel responsible for conducting BR within health facilities). Literature from low- and middle-income countries suggests that the effectiveness of facility-level BR interventions is often affected by access to care, travel distances, and transportation costs, as well as by the availability of resources, BR infrastructure, and staff motivation within healthcare facilities. These factors may, in turn, affect BR demand, parents' self-efficacy, and the extent to which BR initiatives align with parents' real-life contexts.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1280-1306"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271157","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":"Approximating vaccine delivery costs to reach zero-dose children: a Bayesian meta-regression analysis.","authors":"Allison Portnoy, Emma Clarke-Deelder, Taylor A Holroyd, Daniel R Hogan, Tewodaj Mengistu","doi":"10.1093/heapol/czag085","DOIUrl":"10.1093/heapol/czag085","url":null,"abstract":"<p><p>The Immunization Agenda 2030 calls for reaching all people with immunization services, including \"zero-dose\" children-children who have not received any routine vaccines. To plan and finance efforts to fully vaccinate these children and improve coverage and equity, decision-makers need reliable cost estimates. However, primary data on the costs of reaching zero-dose children, typically part of disadvantaged and hard-to-reach populations, are scarce. This study approximates these costs using standardized, country-level estimates of vaccine delivery unit costs for outreach delivery in low- and middle-income countries (LMICs). We extracted outreach delivery cost per dose estimates for childhood immunization services from the 2024 update of the Immunization Delivery Cost Catalogue. Using these data, we developed a meta-regression model to estimate standardized outreach vaccine delivery unit costs. The generalized linear model assumed a Gamma-distributed outcome with a log link and included both country-level and study-level predictors: study year, economic or financial cost basis, routine or campaign delivery, and full or incremental costing approach. The fitted model was used to estimate 2024 outreach delivery costs per dose for 129 LMICs. The model was estimated using 48 observations from 19 countries focused on outreach or mobile vaccine delivery. The best-fitting specification included diphtheria-tetanus-pertussis coverage, per capita gross domestic product, and under-five population size as predictors. For 2024, the predicted mean economic cost per dose was $8.65 (95% credible interval $2.33-23.71), averaged across all 129 LMICs. To fully immunize a zero-dose child with 13 recommended vaccinations, the equivalent cost estimate was $112.45 ($30.29-308.23). Reaching zero-dose children is crucial for improving equity in global health, and estimates of the costs of doing so are needed to inform budgeting for immunization programs. These meta-regression-based cost estimates can help countries to improve budgeting, planning, and resource allocation for efforts to reach zero-dose children.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1269-1279"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368256","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 Indian Medical Association's role in federal and state policy processes in India: a scoping review.","authors":"Alessia Montecalvo, Veena Sriram, Kiran Kumbhar, Vikash Ranjan Keshri","doi":"10.1093/heapol/czag062","DOIUrl":"10.1093/heapol/czag062","url":null,"abstract":"<p><p>Physician associations play a significant role in shaping health policy at national and subnational levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess-for the first time-the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies, and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programmes. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1334-1348"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856306","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}