International Journal of Health Policy and Management最新文献

{"title":"Trends in Avoidable Mortality in Kazakhstan From 2015 to 2021.","authors":"Lyazzat Kosherbayeva, Nazgul Akhtayeva, Kamshat Tolganbayeva, Aizhan Samambayeva","doi":"10.34172/ijhpm.2024.7919","DOIUrl":"https://doi.org/10.34172/ijhpm.2024.7919","url":null,"abstract":"<p><strong>Background: </strong>The health system performance assessment is a challenging process for decision-makers. In case of Kazakhstan's healthcare system, the calculation of avoidable mortality, which has been underutilized to date, could serve as an additional tool to prioritize areas for improvement. Therefore, the aim of the study is to analyse avoidable mortality in Kazakhstan.</p><p><strong>Methods: </strong>The data was retrieved from the Bureau of National Statistics, Kazakhstan. It covers population data by age, mortality rates from disease groups based on the Joint OECD/Eurostat classification of preventable and treatable causes of mortality. The data spans from 2015 to 2021, categorized by gender and 5-year age groups (0, 1-4, 5-9, ..., 70-74). Standardization was performed using the 2015 OECD standard population. We used joinpoint regression analysis to calculate the average annual percentage change.</p><p><strong>Results: </strong>From 2015 to 2019, the annual percentage change in avoidable mortality per 100000 population was -3.8 (-5.7 to -1.8), and from 2019 to 2021 it increased by 17.6 (11.3 to 24.3). Males exhibited higher avoidable mortality rates compared to females. The preventable mortality rate was consistently higher than the treatable mortality. Both preventable and treatable mortality decreased from 2015 to 2019, with preventable mortality reaching 272.17 before rising to 379.23 per 100000 population in 2021. Between 2015 and 2021, treatable mortality rates increased from 179.3 (176.93- 181.67) to 205.45 (203.08-207.81) per 100000 population.</p><p><strong>Conclusion: </strong>In Kazakhstan, the leading causes of avoidable mortality were circulatory diseases, respiratory diseases, and cancer. To achieve the goals of Universal Health Coverage and improve the overall population health, there is an urgent need to amend the healthcare system and reduce avoidable mortality. While it is important to acknowledge the influence of COVID-19 on these trends, our study's focus on avoidable mortality provides valuable insights that complement the understanding of pandemic-related effects.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893380","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":"\"Caught in Each Other's Traps\": Factors Perpetuating Incentive-Linked Prescribing Deals Between Physicians and the Pharmaceutical Industry.","authors":"Mishal Sameer Khan, Afifah Rahman-Shepherd, Muhammad Naveed Noor, Amna Rehana Siddiqui, Catherine Goodman, Virginia Wiseman, Afshan Khurshid Isani, Wafa Aftab, Sabeen Sharif, Sadia Shakoor, Sameen Siddiqi, Rumina Hasan","doi":"10.34172/ijhpm.2024.8213","DOIUrl":"10.34172/ijhpm.2024.8213","url":null,"abstract":"<p><strong>Background: </strong>Despite known adverse impacts on patients and health systems, \"incentive-linked prescribing,\" which describes the prescribing of medicines that result in personal benefits for the prescriber, remains a widespread and hidden impediment to quality of healthcare. We investigated factors perpetuating incentive-linked prescribing among primary care physicians in for-profit practices (referred to as private doctors - PDs), using Pakistan as a case study.</p><p><strong>Methods: </strong>Our mixed-methods study synthesised insights from a survey of 419 systematically sampled PDs and 68 semi-structured interviews with PDs (n=28), pharmaceutical sales representatives (SRs) (n=12), and provincial and national policy actors (n=28). For the survey, we built a verified database of all registered PDs within Karachi, Pakistan's most populous city, administered an electronic questionnaire in-person and descriptively analysed the data. Semi-structured interviews incorporated a vignette-based exercise and data was analysed using an interpretive approach.</p><p><strong>Results: </strong>Our survey showed that 90% of PDs met pharmaceutical SRs weekly. Three interlinked factors perpetuating incentive-linked prescribing we identified were: gaps in understanding of conflicts of interest and loss of values among doctors; financial pressures on doctors operating in a (largely) privately financed health-system, exacerbated by competition with unqualified healthcare providers; and aggressive incentivisation by pharmaceutical companies, linked to low political will to regulate an over-saturated pharmaceutical market.</p><p><strong>Conclusion: </strong>Regular interactions between pharmaceutical companies and PDs are normalised in our study setting. Progress on regulating these is hindered by the substantial role of incentive-linked prescribing in the financial success of physicians and pharmaceutical industry employees. A first step towards addressing the entrenchment of incentive-linked prescribing may be to reduce opposition to restrictions on incentivisation of physicians from stakeholders within the pharmaceutical industry, physicians themselves, and policy-makers concerned about curtailing growth of the pharmaceutical industry.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":"8213"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857070","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":"Phase IV Drug Trials With a Canadian Site: A Comparison of Industry-Funded and Non-Industry-Funded Trials.","authors":"Joel Lexchin, Blue Miaoran Dong, Aravind Ramanathan, Marc-André Gagnon","doi":"10.34172/ijhpm.2024.8239","DOIUrl":"10.34172/ijhpm.2024.8239","url":null,"abstract":"<p><p>Recent regulatory reforms have favored expedited drug marketing and increased reliance on Phase IV clinical trials for safety and efficacy assurance. This study, utilizing ClinicalTrials.gov, assesses the characteristics of Phase IV trials, with at least one site in Canada, examining those funded by industry sponsors and those lacking industry funding. Additionally, it compares the publication status of industry-funded and non-industry-funded trials through a manual review of the medical literature. Between 2000 and 2022, 864 Phase IV trials were completed, with 480 (55.6%) receiving industry funding and 384 (44.4%) funded solely by non-industry sources. Industry-funded clinical trials were larger (mean 204 enrollees versus 70), more likely to be international (57.7% versus 9.6%) and reported results more promptly (1.21 years after completion versus 1.85 years), yet both types shared similar designs, outcomes, and completion times. Publication rates were 81.8% for industry-funded and 65.8% for non-industry-funded trials. The ClinicalTrials. gov registry displayed 48 inaccuracies in publication associations, raising concerns about its accuracy. Our findings underscore the existing institutional limitations in ensuring comprehensive reporting and publication of Phase IV trial results funded by both industry and non-industry sources.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8239"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889170","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":"Public Heterogeneous Preferences for Low-Dose Computed Tomography Lung Cancer Screening Service Delivery in Western China: A Discrete Choice Experiment.","authors":"Wenjuan Tao, Ting Bao, Tao Gu, Jay Pan, Weimin Li, Ruicen Li","doi":"10.34172/ijhpm.8259","DOIUrl":"10.34172/ijhpm.8259","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is an efficient method that can reduce lung cancer mortality in high-risk individuals. However, few studies have attempted to measure the preferences for LDCT LCS service delivery. This study aimed to generate quantitative information on the Chinese population's preferences for LDCT LCS service delivery.</p><p><strong>Methods: </strong>The general population aged 40 to 74 in the Sichuan province of China was invited to complete an online discrete choice experiment (DCE). The DCE required participants to answer 14 discrete choice questions comprising five attributes: facility levels, facility ownership, travel mode, travel time, and out-of-pocket cost. Choice data were analyzed using mixed logit and latent class logit (LCL) models.</p><p><strong>Results: </strong>The study included 2529 respondents, with 746 (29.5%) identified as being at risk for lung cancer. Mixed logit model (MLM) analysis revealed that all five attributes significantly influenced respondents' choices. Facility levels had the highest relative importance (44.4%), followed by facility ownership (28.1%), while out-of-pocket cost had the lowest importance (6.4%). The at-risk group placed relatively more importance on price and facility ownership compared to the non-risk group. LCL model identified five distinct classes with varying preferences.</p><p><strong>Conclusion: </strong>This study revealed significant heterogeneity in preferences for LCS service attributes among the Chinese population, with facility level and facility ownership being the most important factors. The findings underscore the need for tailored strategies targeting different subgroup preferences to increase screening participation rates and improve early detection outcomes.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8259"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889173","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":"Unravelling Low-Value Care Decision-Making: Residents' Perspectives on the Influence of Contextual Factors.","authors":"Lotte A Bock, Cindy Y G Noben, Roel H L Haeren, Florine A Hiemstra, Walther N K A van Mook, Brigitte A B Essers","doi":"10.34172/ijhpm.2024.7907","DOIUrl":"10.34172/ijhpm.2024.7907","url":null,"abstract":"<p><strong>Background: </strong>Several initiatives have been developed to target low-value care (ie, waste) in decision-making with varying success. As such, decision-making is a complex process and context's influence on decisions concerning low-value care is limitedly explored. Hence, a more detailed understanding of residents' decision-making is needed to reduce future low-value care. This study explores which contextual factors residents experience to influence their decision-making concerning low-value care.</p><p><strong>Methods: </strong>We employed nominal group technique (NGT) to select four low-value care vignettes. Prompted by these vignettes, we conducted individual interviews with residents. We analyzed the qualitative data thematically using an inductive-deductive approach, guided by Bronfenbrenner's social-ecological framework. This framework provided guidance to \"context\" in terms of sociopolitical, environmental, organizational, interpersonal, and individual levels.</p><p><strong>Results: </strong>In 2022, we interviewed 19 residents from a Dutch university medical center. We identified 33 contextual factors influencing residents' decision-making, either encouraging or discouraging low-value care. The contextual factors resided in the following levels with corresponding <i>categories</i>: (1) environmental and sociopolitical: <i>society, professional medical association,</i> and <i>governance</i>; (2) organizational: <i>facility characteristics, social infrastructure,</i> and <i>work infrastructure</i>; (3) interpersonal: <i>resident-patient, resident-supervising physician,</i> and <i>resident-others</i>; and (4) individual: <i>personal attributes</i> and <i>work structure</i>.</p><p><strong>Conclusion: </strong>This paper describes 33 contextual factors influencing residents' decision-making concerning low-value care. Residents are particularly influenced by factors related to interactions with patients and supervisors. Furthermore, organizational factors and the broader environment set margins within which residents make decisions. While acknowledging that a multi(faceted)-intervention approach targeting all contextual factors to discourage low-value care delivery may be warranted, improving communication skills in the resident-patient dynamics to recognize and explain low-value care seems a particular point of interest over which residents can exercise an influence themselves.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"7907"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889181","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":"Discrepancies Among Hospitals and Regions in the Provision of Low-Value Care.","authors":"Yu-Chen Kuo, Kuan-Chia Lin, Elise Chia-Hui Tan","doi":"10.34172/ijhpm.2024.7876","DOIUrl":"10.34172/ijhpm.2024.7876","url":null,"abstract":"<p><strong>Background: </strong>Low-value care (LVC) is a critical issue in terms of patient safety and fiscal policy; however, little has been known in Asia. For the purpose of better understanding the extent of LVC on a national level, the utilization, costs, and associated characteristics of selected international recommendations were assessed in this study.</p><p><strong>Methods: </strong>This retrospective cohort study used the National Health Insurance (NHI) claims data during 2013-2017 to evaluate the LVC utilization. Adult beneficiaries who enrolled in the NHI program and received at least one of the low-value services in hospitals were included. We measured seven procedures derived from the international recommendations at the hospital level, and a composite measure was created by summing the total utilization of selected services to determine the overall prevalence and corresponding cost. The generalized estimating equation (GEE) model was adopted to estimate the association.</p><p><strong>Results: </strong>A total of 1 970 496 episodes of LVC was identified among 1 218 146 beneficiary-year observations and 2054 hospital-year observations. Overall, the utilization rate of the composite measure increased from 150.70 to 186.23 episodes per 10 000 beneficiaries with the growth in cost from US$ 5.40 to US$ 6.90 million. LVC utilization was proportional to the volume of outpatient visits and length of stay. Also, hospitals with a large volume of outpatient visits (adjusted odds ratio [aOR]: 95% CI, 2.10: 1.26 to 3.49 for Q2-Q3, 2.88: 1.45 to 5.75 for ≥Q3) and a higher proportion of older patients (aOR: 95% CI, 1.06: 1.02 to 1.11) were more likely to have high costs.</p><p><strong>Conclusion: </strong>The utilization and corresponding cost of LVC appeared to increase annually despite the relatively lower prevalence compared to other countries. Multicomponent interventions such as recommendations, de-implementation policies and payment reforms are considered effective ways to reduce LVC. Repeated measurements would be needed to evaluate the effectiveness of interventions.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":"7876"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862172","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":"Examining the Contextual Factors Influencing Intersectoral Action for the SDGs: Insights From Canadian Federal Policy Leaders.","authors":"Joslyn Trowbridge, Julia Y Tan, Sameera Hussain, Erica Di Ruggiero","doi":"10.34172/ijhpm.8108","DOIUrl":"10.34172/ijhpm.8108","url":null,"abstract":"<p><strong>Background: </strong>The interdependent and intersecting nature of the Sustainable Development Goals (SDGs) require collaboration across government sectors, and it is likely that departments with few past interactions will find themselves engaged in joint missions on SDG projects. Intersectoral action (IA) is becoming a common framework for different sectors to work together. Understanding the factors in the environment external to policy teams enacting IA is crucial for making progress on the SDGs.</p><p><strong>Methods: </strong>Interviews [n=17] with senior public servants leading SDG work in nine departments in the federal government of Canada were conducted to elicit information about issues affecting how departments engage in IA for the SDGs. Transcripts were coded based on a set of factors identified in a background review of 20 documents related to Canada's progress on SDGs. Iterative group thematic analysis by the authors illuminated a set of domestic and global contextual factors affecting IA processes for the SDGs.</p><p><strong>Results: </strong>The mechanisms for successful IA were identified as facilitative governance, leadership by a central coordinating office, supportive staff, flexible and clear reporting structures, adequate resources, and targeted skills development focused on collaboration and cross-sector learning. Factors that affect IA positively include alignment of the SDG agenda with domestic and global political priorities, and the co-occurrence of social issues such as Indigenous rights and gender equity that raise awareness of and support for related SDGs. Factors that affect IA negatively include competing conceptual frameworks for approaching shared priorities, lack of capacity for \"big picture\" thinking among bureaucratic staff, and global disruptions that shift national priorities away from the SDGs.</p><p><strong>Conclusion: </strong>IA is becoming a normal way of working on problems that cross otherwise separate government accountabilities. The success of these collaborations can be impacted by contextual factors beyond any one department's control.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8108"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889141","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 Systems Innovation Perspective on Implementation and Sustainment Barriers for Healthy Food Store Interventions: A Reflexive Monitoring in Action Study in Dutch Supermarkets.","authors":"Cédric N H Middel, Tjerk Jan Schuitmaker-Warnaar, Joreintje D Mackenbach, Jacqueline E W Broerse","doi":"10.34172/ijhpm.2024.8036","DOIUrl":"10.34172/ijhpm.2024.8036","url":null,"abstract":"<p><strong>Background: </strong>Healthy food store interventions (HFIs) are an important health-promotion tool, but face implementation and sustainment barriers. This paper aims to explore the underlying factors that produce these barriers using an innovative systems innovation perspective, through the case study of a multi-component HFI. The HFI was implemented in a minor, national, cooperative supermarket chain, in the Netherlands, a competitive market where price-based competition is the norm.</p><p><strong>Methods: </strong>The HFI was implemented for 6-12 months, in six stores. It was implemented by the researchers, and maintained by store employees. The study applied a Reflexive Monitoring in Action (RMA) approach, meaning that the researchers monitored stores' adherence to the HFI, via store visits, to identify potential issues. Subsequently, the researchers interviewed the store managers responsible for the intervention, to have them reflect upon the barriers leading to these adherence issues, underlying systemic factors, and potential solutions. The stores implemented these solutions, and during the next monitoring visit the researchers evaluated whether the barrier had been resolved.</p><p><strong>Results: </strong>We found that the HFI often clashed with regular activities of the stores (eg, competing over the same spaces) and that store managers generally prioritized these regular activities. This prioritization was based on the greater commercial value of those regular activities (eg, selling unhealthy products) according to store managers, based on their beliefs and assumptions about commerce, health, and consumer preferences. Due to the limited resources of supermarkets (eg, people, time, space), and the HFI often not fitting within the existing structures of the stores as easily as traditional practices, store managers often neglected the HFI components in favor of regular store activities.</p><p><strong>Conclusion: </strong>Our findings illustrate the systemic factors that produce implementation barriers for HFIs, and the dynamics by which this production occurs. These insights help future researchers to anticipate and respond to such barriers.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8036"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889162","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":"Grappling With the Inclusion of Patients and the Public in Consensus Building: A Commentary on Inclusion, Safety, and Accessibility Comment on \"Evaluating Public Participation in a Deliberative Dialogue: A Single Case Study\".","authors":"Davina Banner, Katrina Plamondon, Nelly D Oelke","doi":"10.34172/ijhpm.2024.7715","DOIUrl":"10.34172/ijhpm.2024.7715","url":null,"abstract":"<p><p>Deliberative dialogue (DD) may be relatively new in health research but has a rich history in fostering public engagement in political issues. Dialogic approaches are future-facing, comprising structured discussions and consensus building activities geared to the collective identification of actionable and contextualized solutions. Relying heavily on a need for co-production and shared leadership, these approaches seek to garner meaningful collaborations between researchers and knowledge users, such as healthcare providers, decision-makers, patients, and the public. In this commentary, we explore some of the challenges, successes, and opportunities arising from public engagement in DD, drawing also upon insights gleaned from our own research, along with the case study presented by Scurr and colleagues. Specifically, we seek to expand discussions related to inclusion, power, and accessibility in DD, highlight the need for scholarship that addresses the epistemic, methodological, and practical aspects of patient and public engagement within dialogic methods, and identify promising practices.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"7715"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889165","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":"The Economic Rationale for Healthcare Reform.","authors":"Naoki Ikegami","doi":"10.34172/ijhpm.8441","DOIUrl":"10.34172/ijhpm.8441","url":null,"abstract":"<p><p>Healthcare reform is analyzed from an economic perspective. First, the economic rationale for providing access to healthcare lies in the benefit from knowing that those without means would be able to access health services. However, this does not explain why they should be entitled to the same quality of service. In practice, even in high-income countries, patients who are willing and able to pay tend to have better access to specialist services. Secondly, the division of labor has not increased efficiency in healthcare because health services are provided by professionals who have autonomy. However, efficiency can be increased by standardizing the process with clinical pathways and shifting service delivery from physicians to nurses and technicians. Thirdly, cost-effectiveness analysis is being used to making decisions on listing pharmaceutical products in the national formulary, but pricing and prescribing have continued to be made idiosyncratically. Lastly, Japan's healthcare system is analyzed based on this framework.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8441"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889177","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}