Health Policy Open最新文献

{"title":"Cross-sectional analysis of accuracy versus interpretability in Medicare Advantage risk adjustment","authors":"Maya Lozinski","doi":"10.1016/j.hpopen.2025.100160","DOIUrl":"10.1016/j.hpopen.2025.100160","url":null,"abstract":"<div><h3>Background</h3><div>Risk adjustment models in Medicare Advantage determine annual payments of over $300 billion in public funds to private companies. Policymakers want risk adjustment models that are both accurate and interpretable to ensure appropriate use of public funds.</div></div><div><h3>Methods</h3><div>The trade-off between accuracy and interpretability from using standard machine learning (ML) models for risk adjustment was evaluated. A cross-sectional analysis was conducted using 2018–2019 Medicare claims with 3,602,618 beneficiaries. Multiple risk adjustment models were estimated, including traditional and ML-based approaches. Performance was assessed using out-of-sample mean absolute and squared error (MAE and MSE). Interpretability was measured using coefficient count and log-transformed coefficient count of models.</div></div><div><h3>Results</h3><div>ML models, especially gradient-boosted trees, significantly improved prediction accuracy relative to recent Medicare models, with MAE reductions of − 1,352 (95 % CI: −1,392, −1,316) and MSE reductions of − 5 (95 % CI: −9, −1). However, these improvements increased model complexity by more than 1000x and provided less than 0.1 % of the accuracy improvement per additional coefficient of a previous major model change. Notably, the predictions from gradient-boosted trees responded less to strategic diagnosis coding, reducing incentives to upcode.</div></div><div><h3>Conclusions</h3><div>Standard ML models can modestly improve predictive accuracy but substantially worsen model interpretability in risk adjustment. Future research is needed to improve accuracy in these models while maintaining the interpretability essential for oversight of public spending.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100160"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924348","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":"Oral health care’s contribution to catastrophic spending in Canada: a descriptive study","authors":"Diego Proaño ,&nbsp;Sara Allin ,&nbsp;Beverley M. Essue ,&nbsp;Sonica Singhal ,&nbsp;Carlos Quiñonez","doi":"10.1016/j.hpopen.2025.100155","DOIUrl":"10.1016/j.hpopen.2025.100155","url":null,"abstract":"<div><h3>Background</h3><div>Oral health care (OHC) in Canada is largely financed through employer-sponsored insurance and out-of-pocket (OOP) payments and is generally excluded from its system of universal health coverage, although public financing will increase substantially with the introduction of the Canadian Dental Care Plan (CDCP). We generate estimates of catastrophic health expenditure (CHE) in Canada and assess the contribution of OOP spending in OHC on CHE between 2010 and 2019.</div></div><div><h3>Methods</h3><div>We examined the Survey of Household Spending from 2010 to 2019 by year and in pooled cross-sections and followed the WHO/Europe methodology to determine CHE. Spending OOP in OHC was compared to medicines, medical products, outpatient care, diagnostic tests, and inpatient care. We assessed CHE and the share of OOP spending annually, nationally, provincially, across income quintiles and presence of private insurance including oral health coverage.</div></div><div><h3>Results</h3><div>Estimates in CHE dropped from 5<!--> <!-->% (2010) to 3.4<!--> <!-->% (2019) and was more common among lower income groups, those without private insurance and Québec residents. Oral health care was the second highest contributor to CHE (after medicines) especially among the lowest income groups. Having private insurance yielded a higher share of OOP spending among lower than higher income groups.</div></div><div><h3>Conclusions</h3><div>From 2010 to 2019, OOP spending in OHC was the second-highest contributor to CHE in Canada. Further monitoring is warranted to ensure financial protection is achieved for OHC after the full implementation of the CDCP.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100155"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615614","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":"Virginia’s inpatient mental healthcare geography post SB260","authors":"Mary Schwoerer,&nbsp;Timothy F. Leslie","doi":"10.1016/j.hpopen.2025.100152","DOIUrl":"10.1016/j.hpopen.2025.100152","url":null,"abstract":"<div><div>This study explores the impact of mental health policy reforms on geographic variations in inpatient psychiatric facility utilization and mental health outcomes in Virginia. Following the enactment of Senate Bill 260 (SB260), we observed significant changes in utilization patterns, particularly in regions with higher proportions of Medicaid-eligible populations. We identify nuanced factors influencing facility usage, including proximity to facilities and demographic characteristics, shedding light on the complex dynamics of mental health care access. Notably, our analysis indicates a notable increase in overall utilization of Virginia’s state-operated mental hospitals post-SB260, suggesting a greater fulfillment of unmet needs for inpatient care. Moreover, our research underscores the necessity to reconsider IMD exclusion laws, emphasizing the potential benefits of policy changes for underserved populations. This research contributes to mental health policy discussions by offering evidence-based considerations for future reforms aimed at improving access and equity in mental health care delivery in Virginia.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100152"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924347","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":"Association of hospitalization costs with demographic, socioeconomic, and lifestyle characteristics: Population-based study in Sao Paulo city, Brazil, 2003–2015","authors":"Lucas Akio Iza Trindade ,&nbsp;Jaqueline Lopes Pereira ,&nbsp;Marcelo Macedo Rogero ,&nbsp;Regina Mara Fisberg ,&nbsp;Flavia Mori Sarti","doi":"10.1016/j.hpopen.2026.100162","DOIUrl":"10.1016/j.hpopen.2026.100162","url":null,"abstract":"<div><div>Evidence from studies conducted in high-income countries suggests that lifestyle factors, such as leisure-time physical activity, sedentary habits, and obesity, are associated with a significant socioeconomic burden of disease and the attribution of direct costs to healthcare systems. In Brazil, the occurrence of primary care-sensitive hospitalizations is responsible for a relevant socioeconomic burden. However, there is a scarcity of evidence regarding the association of lifestyle factors on the direct costs of the Brazilian healthcare system. In this context, the present study aims to analyze the association between leisure-time physical activity, sedentary habits, and obesity with hospitalization costs in São Paulo city, Brazil. A quantitative analysis of microdata from the São Paulo Health Survey (ISA-Capital), which is representative for the urban population of São Paulo City, and was conducted in 2003, 2008, and 2015, was employed. Multiple two-part regression models (logit and GLM) and marginal effects (ME) were estimated. The study’s findings suggest that meeting the weekly frequency of leisure-time physical activity recommended by the World Health Organization is associated with lower hospitalization costs in the public (logit β = −0.475, p &lt; 0.05; ME = −31.03, p &lt; 0.05) and private sector (logit β = −0.494, p &lt; 0.01; ME = −37.89, p &lt; 0.01). Sedentary habits (logit β = 0.442, p &lt; 0.05; ME = 40.92, p &lt; 0.01), and obesity (GLM β = 0.385, p &lt; 0.05) were associated with higher costs in the private sector. No associations were observed between sedentary habits and obesity for hospitalization costs in the public sector. The evidence from the present study suggests that policies encouraging the adoption of healthy active lifestyles, such as practicing leisure-time physical activity and reducing sedentary habits, as well as policies for obesity prevention, may be important strategies for minimizing hospitalization costs in urban population contexts in the two-tier of the Brazilian healthcare system. Yet, associations identified in the study should be interpreted with caution due to the impossibility of establishment of causal links between lifestyle factors and healthcare expenditures.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100162"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022872","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":"Structural drivers of health inequality in sub-Saharan Africa: Evidence and policy implications","authors":"Mercedes Tejería-Martínez,&nbsp;Vanesa Jordá,&nbsp;José María Sarabia","doi":"10.1016/j.hpopen.2025.100151","DOIUrl":"10.1016/j.hpopen.2025.100151","url":null,"abstract":"<div><div>Health inequalities remain a major challenge in global development, particularly in sub-Saharan Africa (SSA), where disparities are exacerbated by limited access to healthcare and widespread socioeconomic inequities. This study examines health inequality in 10 SSA countries using Body Mass Index as a health outcome. Drawing on data from the Demographic and Health Surveys, we employ conditional inference trees to assess the extent of health disparities by classifying populations into groups based on shared socioeconomic status, demographic characteristics, and lifestyle choices. Our analysis reveals significant health inequality, particularly in Mauritania, Eswatini, and Kenya, while Egypt emerges as the most equal country in terms of health outcomes. Furthermore, our findings show that disparities are largely driven by illegitimate sources of inequality, such as wealth and education, while legitimate factors linked to personal decisions have a minimal impact. Demographic factors, particularly age, are the largest contributors to health disparities in most countries, with gender also standing as a major determinant in many countries. These findings underscore the need for targeted health policies that address the root causes of inequality, such as expanding access to healthcare, implementing social protection programs, and promoting gender equality in health.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100151"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521265","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":"Price transparency & out-of-pocket payments for medications: Implications of associated delivery fees in the United States","authors":"Deborah R. Kaye ,&nbsp;Hui-Jie Lee ,&nbsp;Daniel J. George ,&nbsp;Charles D. Scales ,&nbsp;M.Kate Bundorf","doi":"10.1016/j.hpopen.2026.100163","DOIUrl":"10.1016/j.hpopen.2026.100163","url":null,"abstract":"<div><h3>Background</h3><div>Price transparency has been cited as a tool to reduce out-of-pocket (OOP) payments to patients. These tools for prescription drugs often focus on the price to patients for the drug alone. However, costs associated with drug delivery (i.e. infusion center fees, labs, etc) are often unknown and could impact the effectiveness of price transparency tools. Objective: To examine total OOP payments on day of drug receipt (“full day”, i.e. drug + drug administration fees) out-of-pocket (OOP) payments associated with six first-line treatments for metastatic castrate resistant prostate cancer and compare these with payments for drug alone and by insurance type.</div></div><div><h3>Methods</h3><div>Using the IBM Marketscan databases, we identify male patients who initiated treatment with one of six focus drugs (docetaxel, abiraterone, enzalutamide, sipuleucel-T, cabazitaxel, and radium-223) used to treat mCRPC from 07/01/2013–06/30/2019. We calculated total OOP payments on day of drug receipt (full day OOP payments) by drug type for six first line treatments. We then used a two-part model to assess the association of first-line therapy with OOP payments for the four most frequently prescribed during the study time period.</div></div><div><h3>Results</h3><div>We find that there is variation in the proportion of payments for drug alone relative to full day payments across first-line treatments. However, regression-adjusted mean full day OOP payments are not statistically different across first-line treatments for mCRPC for the four most frequently prescribed drugs. There are differences in the likelihood that an individual will incur any OOP payment by first-line treatment type and by health plan type.</div></div><div><h3>Conclusion</h3><div>These analyses suggest that when accounting for additional services required on the day of drug receipt, the amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for the drug alone; these payments also vary by drug and health plan type. Therefore, price transparency for drug alone may not lead to reduced OOP payments for patients.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100163"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077234","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":"Strengthening global health cooperation-insights from worldwide WHO collaborating centres","authors":"Sophia Achab ,&nbsp;Benedetto Saraceno","doi":"10.1016/j.hpopen.2025.100158","DOIUrl":"10.1016/j.hpopen.2025.100158","url":null,"abstract":"<div><h3>Background</h3><div>WHO Collaborating Centres (WHO CCs) are entities designated to provide scientific or technical support to the World Health Organization (WHO) in specific areas. They play a crucial role in global public health efforts; however, their leadership and sustainability present multiple complex challenges.</div></div><div><h3>Objectives</h3><div>The aim of this analysis is to identify the strategic and management challenges faced by WHO CCs and to provide expert recommendations to enhance their sustainability. This study focuses on leadership capabilities as a key driver of successful global health cooperation.</div></div><div><h3>Methods</h3><div>The study employed a three-phase approach: (1) a conceptual framework for strategic management of WHO CCs, (2) empirical testing through qualitative interviews with WHO CCs directors worldwide, and (3) development of actionable recommendations. A flexible sampling strategy was used, including convenience, purposeful, and database-based sampling to ensure diversity across regions, institution types, and health topics.</div></div><div><h3>Results</h3><div>WHO CCs are manageable organizations but face unique strategic (mission alignment, core values, vision), and management challenges (project management, financial constraints, communication barriers).</div><div>Long-lasting WHO CCs were led by directors whose leadership practices aligned with established models of effective leadership (e.g., self-awareness, strategic positioning, clear, and engaging vision). Key threats included a lack of resources, recognition, or project management skills, misaligned strategic vision, and communication gaps with WHO or the host institution.</div></div><div><h3>Conclusion</h3><div>WHO CCs are vital to global health but require structured strategic management and leadership development. Their strategic management must take into account both the similarities and differences with other organizations. Expert recommendations include securing financial resources, improving WHO- WHO CCs communication, and fostering leadership skills to ensure sustainability and impact.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100158"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924349","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":"Structural determinants of HIV inequities in South Africa: Policy analysis of the national strategic plan for HIV 2023–2028","authors":"Aqilah Julaihi","doi":"10.1016/j.hpopen.2025.100154","DOIUrl":"10.1016/j.hpopen.2025.100154","url":null,"abstract":"<div><h3>Background</h3><div>South Africa continues to experience the world’s highest HIV burden despite major progress in antiretroviral therapy (ART) scale-up. Persistent disparities across gender, geography, and socioeconomic status reveal that structural and political inequities shape vulnerability, access, and outcomes. This paper examines inequalities in HIV outcomes and evaluates how social, economic, and political structures influence policy effectiveness despite expanded ART coverage.</div></div><div><h3>Methods</h3><div>A document-based policy analysis was conducted using Walt and Gilson’s Policy Triangle framework. National strategic plans, government policy documents, and peer-reviewed literature published between 2015 and 2025 were identified through targeted database and grey literature searches. Documents addressing HIV policy, health system reform, or structural determinants were thematically analysed across four domains: policy content, context, actors, and processes.</div></div><div><h3>Results</h3><div>Structural inequities in HIV incidence, access, and treatment outcomes remain despite expanded services. The 2023–2028 National Strategic Plan adopts a more equity-oriented and multisectoral approach, aligning with Universal Health Coverage and WHO behavioural insights. It includes differentiated service delivery, community-led monitoring, legal reform, and social protection integration. However, implementation is constrained by health system fragmentation, workforce shortages, donor dependency, and weak accountability. The suspension of PEPFAR funding disrupted community-based services, demonstrating the fragility of external financing. International experiences (eg, Thailand, Kenya) show that integrating HIV services within UHC and decentralising delivery can improve retention and equity when supported by domestic investment.</div></div><div><h3>Conclusions</h3><div>Policy commitments increasingly recognise that equity requires structural transformation rather than solely biomedical solutions. Without stronger domestic investment, clearer implementation mechanisms, and alignment with broader reforms such as National Health Insurance, equity goals risk remaining aspirational. Embedding HIV services within a decentralised, accountable, and people-centred UHC framework offers a credible pathway to sustainability and health equity.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100154"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570578","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 RELIANT checklist: a novel approach to revealing implicit factors in HTA deliberations","authors":"Clara Monleón ,&nbsp;Hans-Martin Späth ,&nbsp;Carlos Crespo ,&nbsp;Mondher Toumi","doi":"10.1016/j.hpopen.2025.100149","DOIUrl":"10.1016/j.hpopen.2025.100149","url":null,"abstract":"","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100149"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521264","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 NICE experience of designing and utilising severity weights","authors":"Allan Wailoo ,&nbsp;Helen Bell Gorrod ,&nbsp;Lorna Dunning ,&nbsp;Juliet Kenny ,&nbsp;Emily Leckenby ,&nbsp;Koonal Shah","doi":"10.1016/j.hpopen.2025.100156","DOIUrl":"10.1016/j.hpopen.2025.100156","url":null,"abstract":"<div><h3>Background</h3><div>In January 2022, NICE changed from “End of Life” (EoL) to “severity” weights, whereby additional value is applied within cost effectiveness analysis to health benefits arising from health technologies deemed to qualify This study examines the relationship between these concepts, how they relate to patient age, and whether the new system is cost-neutral as intended.</div></div><div><h3>Methods</h3><div>Data was extracted from 555 NICE Technology Appraisal decisions from 2009 to 2024. Absolute (AS) and proportional shortfall (PS) severity indicators were estimated for pre 2022 decisions. Post 2022 decisions were judged against EoL criteria.</div><div>We describe the relationship between severity weights, including the constituent AS and PS elements, age and EoL. Comparisons are made between the distribution of AS, PS and overall severity categories using descriptive statistics and significance tests.</div></div><div><h3>Results</h3><div>AS and PS have different relationships with patient age. In NICE appraisals, AS reduces with age but the relationship is flat between 40 and 60 years. All decisions in the highest AS category (AS &gt; 18 QALYs) have a starting age below 20 years. PS peaks around 60 years. EoL applies almost exclusively where age exceeds 40 years. 91 % of appraisal decisions meeting EoL would receive a severity weight above 1.</div><div>There is no difference in the mean severity weight between pre and post 2022 appraisal decisions (1.116 vs 1.125). Mean AS is lower in post 2022 appraisals.</div></div><div><h3>Conclusions</h3><div>Severity weights do not correlate precisely with EoL. They have been applied as often as expected. The change from EoL to severity weights has been approximately cost-neutral.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100156"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681577","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}