Health Policy Open最新文献

{"title":"Adjusting hospital reimbursements to the onset of a new disease: Lesson from Covid-19","authors":"Francesco Copello ,&nbsp;Michela Dattaro ,&nbsp;Lucia Leporatti ,&nbsp;Marcello Montefiori","doi":"10.1016/j.hpopen.2025.100148","DOIUrl":"10.1016/j.hpopen.2025.100148","url":null,"abstract":"<div><div>The COVID-19 pandemic represented a significant shock to healthcare systems, which faced substantial challenges on multiple fronts. In addition to organizational and clinical issues, one important challenge that required attention was adapting hospital service reimbursement systems to address a new disease with initially unknown costs and consequences. In this paper, we quantify the gap between DRG tariffs and the actual hospitalization costs of COVID-19 cases, through a comparison with pre-COVID-19 cases of respiratory tract infections, at San Martino Polyclinic Hospital, Genoa, Italy. We collected and analyzed a unique administrative dataset comprising Hospital Discharge Records (HDRs). We used propensity score matching to compare health outcomes and hospitalization costs of patients with confirmed SARS-CoV-2 pneumonia and patients in a control group of pre-COVID-19 patients with similar characteristics. We found that COVID-19 infection leads to a higher probability of being admitted to the Intensive Care Unit (ICU) and death, fewer days of hospitalization, increased hospital services, and increased costs of these services. Factors that increased hospitalization costs included female gender, age group 65–74 years, being admitted to ICU, death, increased length of stay (LOS), and the association between mechanical respiration DRGs and COVID-19 infection. In the period examined, DRG reimbursements were underestimated in severe COVID-19 cases requiring mechanical respiration. Knowledge of the factors that influence COVID-19 hospitalization costs may lead to a more comprehensive DRG tariff and, overall, to more effective management of financial resources in the event of future similar outbreaks.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100148"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary health care policy investments in the Latin America context: Health systems experiences from Brazil, Chile, and Colombia","authors":"Adriano Massuda ,&nbsp;Michelle Fernandez ,&nbsp;Marco Antonio Catussi Paschoalotto ,&nbsp;Elisandréa Sguario Kemper","doi":"10.1016/j.hpopen.2025.100147","DOIUrl":"10.1016/j.hpopen.2025.100147","url":null,"abstract":"<div><div>This study examines the policy investments in Primary Health Care (PHC) within the health systems of Brazil, Chile, and Colombia, highlighting their contributions toward achieving Universal Health Coverage (UHC). Employing a qualitative methodology, the research includes an institutional historical review and interviews with key stakeholders to analyze the development of PHC financing policies and practices in these countries. Brazil, with its Unified Health System (SUS), demonstrates federal leadership through initiatives like Requalifica UBS and the new PAC, albeit facing challenges in regional equity and monitoring. Chile emphasizes central governance but struggles with municipal funding capacity and infrastructure renewal. Colombia lacks targeted PHC investment policies but shows promise through emerging frameworks such as the Planes Maestros. The findings underline the critical role of integrated governance, sustainable funding, and advanced technological investment in strengthening PHC systems. Recommendations include enhancing territorial diagnostics, fostering public–private partnerships, and aligning investments with demographic and regional needs. Therefore, this research contributes to understanding PHC financing structures, offering actionable insights for improving equity and access. Limitations include the study’s focus on three countries and qualitative scope, suggesting future research should adopt broader comparative frameworks and mixed methodologies to evaluate the long-term impacts of PHC investments globally.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100147"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"They don’t want to close Roxy: a qualitative account on the perceived efforts by Ivory Coast to end the informal market for medicines","authors":"Victor Chimhutu ,&nbsp;Armel Dagrou ,&nbsp;Archlove Takunda Tanyanyiwa","doi":"10.1016/j.hpopen.2025.100145","DOIUrl":"10.1016/j.hpopen.2025.100145","url":null,"abstract":"<div><div>The informal market for medicines poses great danger to public health as they expose populations to counterfeit and expired medicines, among many vices. Ivory Coast is one of the countries where this market is growing. The country has been trying to end this market unsuccessfully. This study aims to investigate the perceived role of the state in the regulation and efforts to end this market. A qualitative case study design was used, with in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods for data collection. 20 IDIs and 3 FGDs with 13 participants in total were conducted with sellers, buyers, and pharmaceutical experts. We found that: the informal market plays an integral role in the health system and that it provides employment to many. Additionally, this informal market is complex and requires a lot of cooperation and coordination at many levels to successfully end it, which is resource demanding. Based on some of these reasons, there is an ambivalence in the regulation and the quest to end this market. The study concludes that the government of Ivory Coast needs to be decisive in its roles of regulation and that of ensuring that medicines are available and accessible.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100145"},"PeriodicalIF":1.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of public health organization on response to the COVID-19 pandemic in four Canadian provinces: A comparative qualitative analysis","authors":"Susan Usher ,&nbsp;Sara Allin ,&nbsp;Lara Gautier ,&nbsp;Katherine Fierlbeck ,&nbsp;Veena Sriram ,&nbsp;Aidan Bodner ,&nbsp;Camille Trapé ,&nbsp;Leah Shipton ,&nbsp;Alessia Montecalvo ,&nbsp;Peter Berman","doi":"10.1016/j.hpopen.2025.100146","DOIUrl":"10.1016/j.hpopen.2025.100146","url":null,"abstract":"<div><h3>Background</h3><div>Studies of COVID-19 pandemic responses reveal shortcomings that may relate to the organization of public health systems.</div></div><div><h3>Objective</h3><div>This study uncovers the organizational factors that may strengthen pandemic responses in high-income countries through a comparative analysis of four Canadian provinces.</div></div><div><h3>Methods</h3><div>We undertook a qualitative multiple case study, collecting data through document review and 103 interviews with government and non-governmental actors involved in pandemic response. Analysis explored how differences in the organization of provincial public health systems influenced decision-making, advisory, coordination and adaptation processes.</div></div><div><h3>Results</h3><div>The scale of the pandemic positioned the Premier as legitimate decision-maker in all provinces regardless of the distribution of authority in their public health systems. Capacity for generating public health advice was increased through existing or new organizations and highlighted the advantage of links to university expertise. All public health systems relied on healthcare resources for testing programs despite differences in the integration of public health under healthcare governance structures; centralization of healthcare governance was a facilitator. Adapting pandemic control measures to population needs was supported by linkages between organizations capable of apprehending needs and organizations that made decisions.</div></div><div><h3>Conclusions</h3><div>This study builds on the literature of pandemic responses across high-income countries and uncovers organizational factors that may enhance agility to rapidly expand capacities, connect actors for emergency responses, and strengthen public health systems.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100146"},"PeriodicalIF":1.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national multisectoral commission: Contours and Contributions to the Population Health Development","authors":"Pavitra Paul","doi":"10.1016/j.hpopen.2025.100144","DOIUrl":"10.1016/j.hpopen.2025.100144","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization (WHO) Global Action Plan for the Prevention and Control of Non-communicable diseases (NCDs) 2013–2030 emphasises that effective NCD prevention and control requires leadership, coordinated multisectoral and multistakeholder engagement across a broad range of sectors, and partnerships with relevant civil-society organisations and private-sector entities. This study identifies country specific policy instruments and levers, and thus<em>,</em> unfolds the context specific contributions of a national multisectoral commission to tackle the problems of NCDs.</div></div><div><h3>Methods</h3><div>The data from twenty-six countries (low-income countries: 2, lower-middle-income countries: 9, upper-middle-income countries: 11 and high-income countries: 4) spread over all six WHO regions are analysed at two levels – the first level of analysis examines the correlation between having a national multisectoral commission and the select risk factors for NCDs. In the second level of analysis, a series of regression-based models is applied for understanding the effect of having a national multisectoral commission on the probability of dying from any of four NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases), and also on the health adjusted life expectancy (HALE) at birth and at age 60 years.</div></div><div><h3>Results</h3><div>Our results comprehend that (a) a national multisectoral commission is acting through a varied combinations of different instruments and levers, and such combinations do not follow any definite pattern, and (b) a consistent improvement of HALE is better sustained with having a national multisectoral commission for NCDs.</div></div><div><h3>Conclusion</h3><div>To conclude, this study establishes the need for further research on the performance of a national multisectoral commission, agency or mechanism for NCDs with a three-dimensional approach that is with an approach that includes (1) the national multisectoral commission, agency or mechanism for NCDs with its attributes, (2) the distribution of risk factors across different population groups, and (3) the demography and its determinants of health for the population.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100144"},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic and impoverishing out-of-pocket payments for health care in Poland in 2013–2021","authors":"Marzena Tambor ,&nbsp;Jorge Alejandro García-Ramírez ,&nbsp;Milena Pavlova","doi":"10.1016/j.hpopen.2025.100143","DOIUrl":"10.1016/j.hpopen.2025.100143","url":null,"abstract":"<div><div>Protecting households from financial hardship when accessing health care is a universal policy objective across European countries. Previous analyses have shown that households in Poland relatively often experience financial strain due to out-of-pocket payments for health. This study aims to provide new evidence on financial protection in Poland, using indicators of catastrophic and impoverishing health spending. We used data from annual household budget surveys between 2013 and 2021. Catastrophic spending is defined as payments for health greater than 40% of the household’s capacity to pay, while impoverishing spending occurs when out-of-pocket payments are higher than the capacity to pay. We employed logistic regression to identify factors associated with catastrophic payments. The incidence of catastrophic spending was 9% in 2021 and remained relatively constant over the years analyzed, nearing 10% only in 2020. Further, 3.3% of households in 2021 were impoverished or further impoverished, down from 4.1% in 2013. Payments for medicines contribute the most to catastrophic spending, but the role of other services has been increasing. We found a significant association between catastrophic payments and gender, age, education, disability, residence place, number of children, main source of income, and consumption level. It is necessary to address existing coverage gaps and to evaluate implemented policies in order to develop more effective measures to reduce the burden of out-of-pocket payments in Poland.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100143"},"PeriodicalIF":1.7,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What gets measured in palliative care? A review and synthesis of routine data collection in 16 countries","authors":"Eimir Hurley ,&nbsp;Peter May ,&nbsp;Soraya Matthews ,&nbsp;Charles Normand ,&nbsp;Bridget M. Johnston","doi":"10.1016/j.hpopen.2025.100141","DOIUrl":"10.1016/j.hpopen.2025.100141","url":null,"abstract":"<div><h3>Background</h3><div>There is an increasing focus on strengthening palliative care data infrastructure to evaluate and improve the quality of care. We conducted an extensive review of policy documents to identify international best practice in the use of routine data in palliative care.</div></div><div><h3>Methods</h3><div>We identified 16 countries with well-established palliative care services before undertaking the review. We searched systematically for relevant documentation on each country in the academic, grey and governmental literature. For each country we then compiled a narrative synthesis utilising a standardised extraction template. Local experts verified country-level synopses. We combined the 16 country documents using thematic synthesis.</div></div><div><h3>Results</h3><div>There was significant heterogeneity in the data infrastructure of the countries examined. The majority of the databases and data sources focused on specialist palliative care services with a notable lack of data on palliative care delivered in primary and community care. Several countries have established bespoke palliative care databases; others harness existing data sources, and capitalise on the existence of unique patient identifiers. The gaps and limitations identified were commonly shared across all types of palliative and end of life care data infrastructure. Similarly, many of the factors deemed highly influential in implementing and sustaining existing databases are relevant across all data infrastructure.</div></div><div><h3>Conclusions</h3><div>This first-of-its-kind analysis details the characteristics of databases/data sources and highlights the significant heterogeneity which exists. The strengths and limitations of existing databases/data sources and the factors that influence how well these systems are sustained are examined, providing key learnings for those eager to improve the data infrastructure in their own jurisdictions.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100141"},"PeriodicalIF":1.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global landscape of country-level health technology assessment processes: A survey among 104 countries","authors":"Andrew J. Mirelman,&nbsp;Kratu Goel,&nbsp;Tessa Tan-Torres Edejer","doi":"10.1016/j.hpopen.2025.100138","DOIUrl":"10.1016/j.hpopen.2025.100138","url":null,"abstract":"<div><div>To make progress towards universal health coverage (UHC), countries need to be able to develop and implement evidence-informed<!--> <!-->and inclusive processes for decision-making to inform what services are provided and purchased.<!--> <!-->Health Technology Assessment (HTA) processes are an established mechanism to support evidence-informed decision-making in the health sector. To assess the practice of HTA in countries, WHO conducted a global survey that explores the status of HTA. The survey is the largest source of information in terms of number of countries<!--> <!-->for describing global<!--> <!-->HTA status. The final sample analysed in this paper is the 104 countries (82% or 104/127) that responded “yes” to the question of having a systematic, formal health decision-making process at the national level. The results show that while many countries have HTA bodies in place, these serve different functions. While there are more established processes in higher income country groups, even those show room for improvement in areas such as social participation and appeals. Lack of awareness of the importance of HTA and institutionalization were the top two barriers to HTA utilization. There is further progress that needs to be made in HTA globally. Countries need to build on available guidance to ensure the appropriate elements are in place for sustainable country decision-making processes and develop more understanding of how they vary across settings.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100138"},"PeriodicalIF":1.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of the states’ crisis response policies: Survival analysis on the COVID-19 transmission suppression in the United States","authors":"Hanvit Kim,&nbsp;Kyungmin Lee,&nbsp;Jungwon Yeo","doi":"10.1016/j.hpopen.2025.100140","DOIUrl":"10.1016/j.hpopen.2025.100140","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the effectiveness of various COVID-19 response policies in the United Sates that facilitated rapid virus transmission suppression and promoted quick return to normalcy during the first three years of the pandemic.</div></div><div><h3>Method</h3><div>We constructed comprehensive and unique time-to-event panel data that tracks the timeline of all policy implementations, and transmission waves, specifically measuring the duration from peak transmission to the desired suppression level, over 157 weeks. We then conducted a survival analysis to estimate the effectiveness of COVID-19 response policies in relation to the virus transmission dynamics. Our analysis focuses on the ten most populous U.S. states, representing diverse geographic, cultural, and political landscapes across the country. The survival analysis leverages the extensive time-to-event panel data collected from multiple sources.</div></div><div><h3>Results</h3><div>Our findings indicate that not all policies were equally effective in facilitating rapid transmission and promoting swift suppression return to normalcy. Containment or closure policies, such as school closures and stay-at-home orders, are associated with a shorter duration for returning to normalcy, highlighting their effectiveness in curbing COVID-19 transmission. In contrast, health system policies and vaccine policies showed mixed results.</div></div><div><h3>Conclusion</h3><div>The findings from our survival analysis of the novel data set provide practical insights for prioritizing policy measures among various options to effectively and timely suppress the transmission of highly contagious diseases. These insights can also enhance resource utilization and allocation within and across public health systems, while minimizing restrictions on people’s daily lives.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100140"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-Private partnership (PPP) and health service delivery in Malawi: The case of Christian Health Association of Malawi (CHAM) facilities in Mzimba district","authors":"Chisomo Salangwa ,&nbsp;Reston Munthali ,&nbsp;Lusungu Mfune ,&nbsp;Vegha Kaunga Nyirenda","doi":"10.1016/j.hpopen.2025.100139","DOIUrl":"10.1016/j.hpopen.2025.100139","url":null,"abstract":"<div><h3>Background</h3><div>PPPs are crucial in addressing healthcare challenges in Malawi, a low-income country. These partnerships, including those with CHAM, help improve access to health services by complementing the public sector, especially in areas with inadequate infrastructure and limited healthcare resources.</div></div><div><h3>Method</h3><div>This study employed qualitative methods, including interviews, focus groups, and document analysis, to investigate the impact of PPP on healthcare infrastructure and access. Purposive and snowball sampling selected 30 interviewees and 20 focus groups. Thematic analysis revealed insights into PPP dynamics, resource allocation, stakeholder interactions, and socio-economic factors in healthcare.</div></div><div><h3>Results</h3><div>Government officials recognise PPPs’ positive impact on healthcare access, especially in rural areas, but raise concerns about sustainability due to policy inconsistencies, financial instability, and service duplication. CHAM and district health professionals highlight delayed payments, cost management, and infrastructure issues. While PPPs increase healthcare utilisation, challenges like drug shortages, staff shortages, and financial strain threaten long-term sustainability without better coordination.</div></div><div><h3>Conclusion</h3><div>This study explores PPPs in Malawi’s health sector, focusing on healthcare quality, efficiency, equity, and access. It identifies challenges like mistrust, misaligned incentives, data inflation, contract renegotiations, staffing shortages, and infrastructure issues. The study emphasises improving transparency, aligning incentives, and addressing sustainability through better resource management and financing.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100139"},"PeriodicalIF":1.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}