International Journal of Health Policy and Management最新文献

{"title":"Longitudinal Trends in Medicine Supply, Price and Utilisation in Primary Care Facilities in Rural Southwestern China Under National Essential Medicines Policy (2012-2017): Disparities Across Facilities and Medicines.","authors":"Zhaohua Huo, Xuechen Xiong, Ge Bai, Jianchao Quan, Allen Tc Lee, Linda Cw Lam, Li Luo","doi":"10.34172/ijhpm.8991","DOIUrl":"10.34172/ijhpm.8991","url":null,"abstract":"<p><strong>Background: </strong>The long-term impacts of the National Essential Medicines Policy (NEMP) in remote and rural areas of China remain underexplored. This study investigates the longitudinal trends in medicine supply, affordability, and utilisation in a rural county in Southwestern China from 2012 to 2017.</p><p><strong>Methods: </strong>A quasi-experimental design was employed to analyse 108 111 purchase records covering 650 medicines from seven township health centres (THCs) and 73 village clinics. Drug supply was assessed by the available number of medicine types, utilisation by sales volume, and affordability using a Drug Price Index (DPI) based on a fixed basket of 344 medicines. Interrupted time-series analysis was then conducted to evaluate trends during the first-stage NEMP and to identify changes following the implementation of second stage in November 2015.</p><p><strong>Results: </strong>Medicine number in rural primary care facilities increased steadily (+5.1 quarterly) during the first stage of NEMP, but exhibited abrupt and sustained drops (-2.1 quarterly) following the second-stage NEMP. DPIs exhibited gradual increases throughout both policy stages (+0.2% quarterly), while overall drug sales remained stable. Disaggregated by medicines, traditional Chinese medicines (TCMs) exhibited a faster increase in the available number than Western (chemical or biological) medicines and were associated with slower growth in DPI. By facility levels, village clinics experienced continuous declines in the number of Western medicines, accompanied by sharp increases in DPI. THCs also revealed a rising DPI in Western medicines, which consistently dominated overall drug sales.</p><p><strong>Conclusions: </strong>Primary care facilities in rural Southwestern China experienced relatively stable medicine supply and utilisation, alongside rising medicine prices, over the long-term implementation of NEMP. Significant disparities and structural changes across facility tiers and medicine categories underscore the urgent need to address the pressing challenges of the declining availability and increasing costs of Western medicines in rural village clinics.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8991"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662678","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":"Orphan Drug Approval in Canada, 1999-2022: A Cross-sectional Study.","authors":"Joel Lexchin","doi":"10.34172/ijhpm.8916","DOIUrl":"10.34172/ijhpm.8916","url":null,"abstract":"<p><p>The number of drugs for orphan indications has been increasing significantly in Canada and the federal government recently announced an investment of $1.5 billion dollars over 3 years primarily directed at helping to fund the cost of these drugs. There are claims and counterclaims about what percent of Food and Drug Administration (FDA) orphan drugs are available in Canada and how delayed these drugs are in being approved by Health Canada. This study uses FDA and Health Canada databases and data from three health technology assessment agencies and one drug bulletin to provide objective data about the percent of FDA approved drugs that were also approved by Health Canada, any delays in Canadian approval and the additional therapeutic value of new orphan drugs. Decisions about what drugs should be publicly covered and how long it took to make those decisions were not investigated. From 1999 to 2022, the FDA approved 326 new drugs for an orphan indication and Health Canada approved 231 (70.9%) for the same indication. The median time between FDA and Health Canada approval was 346 days (interquartile range [IQR] 181, 785). The percent rated as major improvements declined from 50% of the total in 2004-2008 to 13.6% in 2019-2022. These findings need to be taken into account as Canada develops an orphan drug policy and decides on criteria for funding this group of drugs. Specifically, when high quality evidence about the additional therapeutic value of orphan drugs is not available at the time of approval, risk sharing funding agreements with manufacturers should be put in place. Manufacturers should understand that if the results of post-market trials do not provide convincing evidence of value, funding will be withdrawn. Finally, the quality of any research plan should be used to prioritize candidates for federal funding.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8916"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12595579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662701","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":"Why Substantial Budget Reallocations Are Not and Should Not Be a Major Factor in Active Purchasing in Dutch Healthcare Comment on \"Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands\".","authors":"Fredo Schotanus","doi":"10.34172/ijhpm.9115","DOIUrl":"10.34172/ijhpm.9115","url":null,"abstract":"<p><p>This commentary discusses the study by Stadhouders et al, which analyzes budget reallocations among Dutch healthcare providers as a result of one form of active purchasing. The study assumes that healthcare purchasers aim to shift substantial funds from inefficient to efficient providers, yet finds little evidence of such shifts. This commentary explains more explicitly why substantial volume shifts are not and should not be a major factor in the Dutch context, citing factors such as the scarcity of underperforming providers, strong regional dependencies, data quality limitations, and patient reluctance to change provider. More promising avenues for active purchasing include fostering active collaboration and improving contractual arrangements.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"9115"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12595580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662749","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 Right Balance: Challenges in Optimising the Promise of Complexity Research for NCD Best-Buys Implementation and Adoption Comment on \"Barriers and Opportunities for WHO 'Best Buys' Non-communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review\".","authors":"Pragati B Hebbar, Upendra M Bhojani, Prashanth Nuggehalli Srinivas","doi":"10.34172/ijhpm.9040","DOIUrl":"10.34172/ijhpm.9040","url":null,"abstract":"<p><p>There is a growing interest in complexity research. A recent systematic review by Loffreda et al attempted to study the barriers and opportunities for the adoption and implementation of the \"best buys\" for non-communicable diseases (NCDs) from a political economy perspective. In this commentary we take forward the discussion on the NCD best-buys by comparing the findings of the article with one of the risk factors of tobacco use and its control in India. We reflect on the challenges in actualizing the promise of research methods and approaches while studying such complex interventions like the NCD best buys. The balance of studying complexity while still keeping the findings translatable at country levels. Future research could potentially use a comparative lens focusing on either industry/government or actor behaviour across the different risk factors to facilitate cross learning, anticipate and pre-empt adverse policy decisions and implementation outcomes.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":"9040"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690164","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":"First They Came for Science.","authors":"Mohammad Karamouzian","doi":"10.34172/ijhpm.9035","DOIUrl":"10.34172/ijhpm.9035","url":null,"abstract":"","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"9035"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789018","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":"Commercial Determinants Drive Political Determinants of Health in a Neoliberal Society Comment on \"Energy as a Social and Commercial Determinant of Health: A Qualitative Study of Australian Policy\".","authors":"Linda A Selvey","doi":"10.34172/ijhpm.8711","DOIUrl":"10.34172/ijhpm.8711","url":null,"abstract":"<p><p>Energy policies have a major impact on the health and well-being of the population. However, Australia's energy policies rarely consider health and well-being in their policies. In Australia and in many other countries, energy policies, while developed by governments, are heavily influenced by commercial entities within the fossil fuel industry. This means that Australia's energy policy does not reflect what climate science tells us is necessary for a safe climate. Australia's environmental laws are insufficient to protect both nature and the environment. Environment and climate advocates have been urging the Australian government to strengthen these laws while industry, particularly the mining industry have been pushing to weaken them. This clearly demonstrates the strong intersection between commercial and political determinants of health.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8711"},"PeriodicalIF":5.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788998","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":"No Time Like the Present: Centring Politics in the Global NCD Policy Agenda Comment on \"Barriers and Opportunities for WHO 'Best Buys' Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review\".","authors":"Lana M Elliott, Stephanie M Topp","doi":"10.34172/ijhpm.9145","DOIUrl":"10.34172/ijhpm.9145","url":null,"abstract":"<p><p>The World Health Organization's (WHO's) non-communicable disease (NCD) Best Buys provides a comprehensive package of technically sound policy advice in response to the growing global burden of NCDs. However, despite these policy mechanisms being touted as beneficial to countries' health and economic bottom lines, uptake has remained slow and globally disparate. Loffreda and colleagues' analysis draws attention to the importance of political economy forces in shaping governments' responses to NCDs and, in particular, their uptake of the NCD Best Buys. In building on this work, we examine the history and instances of contemporary application of the NCD Best Buys to consider the limitations of these technocratically framed policy recommendations. In doing so, we highlight the risks present in focusing on the technical - while negating the contextually nuanced political - dimension of policy adoption. We thus advocate for greater political engagement in policy design and implementation as well as a revitalised \"double-loop\" approach to NCD policy learning, where policy and system feedback is not solely used to reify policy advice but rather interrogate the assumptions underpinning such.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"9145"},"PeriodicalIF":5.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789044","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":"Principles and Pragmatics for Building Trust in Authority Comment on \"Placing Trust at the Heart of Health Policy and Systems\".","authors":"Stephen David Reicher","doi":"10.34172/ijhpm.8964","DOIUrl":"10.34172/ijhpm.8964","url":null,"abstract":"<p><p>McKee et al make a powerful plea for placing trust-building at the core of public health initiatives. I endorse that call and propose one general principle along with four practical guidelines for building trust between the public and the authorities. The general principle is that trust is rooted in shared identity and that, therefore, the task of building trust is rooted in building a sense of shared identity both amongst the public and between the public and authorities. The four guidelines are (1) trust the people!; (2) recognise and respect difference; (3) engage with the public; and (4) understanding and support trump blame and punishment. Details and justifications for each of these guidelines is provided in Supplementary file 1.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8964"},"PeriodicalIF":5.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789047","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 Conditions for a Path Beyond Capitalism Comment on \"Can a Well-Being Economy Save Us?\"","authors":"Lina Brand-Correa","doi":"10.34172/ijhpm.8912","DOIUrl":"10.34172/ijhpm.8912","url":null,"abstract":"<p><p>In this commentary I aim to contribute to Ronald Labonté's recent editorial \"Can a Well-Being Economy Save Us?\" on the role of well-being economies in providing for everyone's needs within the limits of our planet. In particular, I add a couple of lessons from the COVID-19 pandemic that can provide the required inspiration to plot a path beyond capitalism - one that is based on hope that change is possible, one where our understanding of well-being is detached from economic growth, one where demand and excess are challenged and one where we go beyond the market to meet our needs.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8912"},"PeriodicalIF":5.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789058","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":"Smart Governance: A Foundation for Good Governance for Health.","authors":"Omid Parvizi, Azam Raoofi, Amirhossein Takian","doi":"10.34172/ijhpm.8924","DOIUrl":"10.34172/ijhpm.8924","url":null,"abstract":"","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"14 ","pages":"8924"},"PeriodicalIF":5.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789057","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}