Health Policy Open最新文献

{"title":"Private health insurance in Gulf Cooperation Council countries: A scoping review","authors":"Husein Reka ,&nbsp;Robin van Kessel ,&nbsp;Elias Mossialos ,&nbsp;Wim Groot ,&nbsp;Milena Pavlova","doi":"10.1016/j.hpopen.2025.100157","DOIUrl":"10.1016/j.hpopen.2025.100157","url":null,"abstract":"<div><div>Private Health Insurance (PHI) in Gulf Cooperation Council (GCC) countries has experienced rapid growth over the past two decades, driven by demographic and economic changes. Although various analyses at the country level have been reported, no study has reviewed PHI systems in the GCC through a methodological approach. We provide a conceptual framework to review, describe and document the development of PHI in the GCC, based on literature from the scoping review. As of December 2023, all GCC countries have laws in place or have promulgated laws establishing mandatory PHI schemes. Most of these schemes are designed for expatriate populations residing in these countries, but there is a trend to extend them to nationals working in the private sector. The health system context plays a role in how PHI emerged and is designed in terms of role, eligibility, and coverage. PHI markets in the region are concentrated and dominated by local companies with performance levels that could be further improved. These markets are maturing and subject to more robust technical and prudential regulations as governments seek to enhance competition. Governments in the region must ensure the sustainable growth of these schemes and a more strategic alignment with health system objectives. Lessons learned from more mature markets are critical for future developments.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100157"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736645","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":"Nursing shortages and migration: a two-decade study of Ireland’s dependence on migrant nurses","authors":"Comfort O. Chima ,&nbsp;Vishnu Renjith ,&nbsp;Niamh Humphries","doi":"10.1016/j.hpopen.2026.100161","DOIUrl":"10.1016/j.hpopen.2026.100161","url":null,"abstract":"<div><h3>Background</h3><div>There has been global concern about nursing shortages and nurse migration, as nurses move in search of better working conditions. Ireland is one of the countries facing nursing shortages. Ireland, like many other countries, has begun to rely heavily on migrant nurses. This study examines the recent trends in the nursing workforce and possible contributing factors to Ireland’s dependence on international nurse recruitment, drawing insights from existing data and literature.</div></div><div><h3>Methodology</h3><div>This paper integrates and analyses secondary data obtained from the Nursing and Midwifery Board of Ireland (NMBI) 2003–2022 and data from the Faculty of Nursing and Midwifery, RCSI, registration register (2015–2022). The population data of Ireland was obtained from the Central Statistics Office (CSO).</div></div><div><h3>Result</h3><div>The data available indicates a heavy reliance on migrant nurses due to a shortage of Irish-trained nurses relative to increased demand for nurses in the period (2003–2022). More than 50% of the Nurses registered in that period were migrant nurses (EU and Non-EU).</div></div><div><h3>Conclusion</h3><div>There is an urgent need for Ireland to increase the domestic training of nurses and midwives, as well as, a need to develop a robust nurse workforce planning system to improve retention and ensure nursing workforce self-sufficiency.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100161"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975901","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":"Good intentions and the costs of inaction: Financial protection in Austria","authors":"Christoph Stegner,&nbsp;Thomas Czypionka","doi":"10.1016/j.hpopen.2025.100159","DOIUrl":"10.1016/j.hpopen.2025.100159","url":null,"abstract":"<div><div>Understanding the financial strain of health care costs borne by households is crucial for assessing the equity and affordability of a health system. Building on an already generous system, Austrian health policy has strived over decades to include more and more people in its Social Health Insurance Schemes and to find ways to lower individual financial burden. Using data from the Austrian household budget survey for the years 2004/05, 2009/10, 2014/15 and 2019/20, this study investigates whether these efforts have been successful. Analyzing expenditures on various health care types, including medicines, medical products, outpatient care, dental care, diagnostic tests and inpatient care, our study aims to determine how the percentage of households experiencing catastrophic health expenditure (CHE) according to WHO definitions has changed over time. Logistic regression analyses were carried out to identify factors associated with CHE. The results reveal an increase in the prevalence of CHE from 2.1 % in 2004/05 to 3.6 % in 2019/20. Across all survey rounds, at least 60% of households experiencing CHE belonged to the poorest consumption quintile. Age, sex, educational attainment and employment status of the head of the household emerged as factors associated with CHE from the regression analysis. The observed rise in CHE is surprising given Austria’s generous health system and the introduction of policies during the study period aimed at expanding the breadth and depth of coverage. It serves as an example for other countries that failing to tackle underlying structural problems in the healthcare system may counteract financial protection policies.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100159"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789675","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":"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":"2025-11-01","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":"Health insurance literacy and the associated factors in Iran: A national-scale study","authors":"Zahra Asadi-Piri ,&nbsp;Foroozan Abdollahi-pour ,&nbsp;Namam Ali Azadi ,&nbsp;Rajabali Daroudi ,&nbsp;Ebrahim Jaafaripooyan","doi":"10.1016/j.hpopen.2025.100150","DOIUrl":"10.1016/j.hpopen.2025.100150","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Health insurance literacy (HIL) plays a vital role in individuals’ ability to understand, select, and use health insurance services. Despite its significance, limited national-level research has been conducted in Iran.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cross-sectional study was conducted from November 2024 to February 2025 with 1,625 beneficiaries of the Iranian Health Insurance Organization (IHIO). A validated researcher-developed questionnaire was used assessing the insured groups’ knowledge, attitudes, information-seeking, utilization of services, digital and financial literacy and numeracy. Data were analyzed using t-tests, ANOVA, and multiple linear regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean HIL score was50.85 ± 20.41. Approximately 25.3% of the participants had low and 35.6% moderate HIL. Significant differences were observed across provinces. The variables associated with the HIL included gender, marital status, occupation, education level, insurance fund type, income, and age. The higher education, employment, and older age were positively associated with the higher HIL scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;HIL allegedly plays an essential role in the informed healthcare decision-making and equitable service utilization. Disparities seemingly exist across the demographic and regional groups in terms of HIL. Therefore, the tailored educational programs, workplace training, and clearer insurance communication tools are recommended to improve the HIL and reduce inequalities in Iran’s healthcare system.&lt;/div&gt;&lt;div&gt;What is already known about the topic?&lt;/div&gt;&lt;div&gt;Health insurance literacy (HIL), a subdomain of health literacy, is essential for informed decision-making and effective use of insurance benefits. Globally, inadequate HIL is linked to the delays in care, increased healthcare costs, and poor service utilization. In Iran, research on HIL has been limited to local studies or tool development, with no national-scale investigation addressing regional disparities or sociodemographic determinants.&lt;/div&gt;&lt;div&gt;What does this study add to the literature?&lt;/div&gt;&lt;div&gt;This is the first nationally representative study of HIL in Iran, covering over 1,625 individuals from diverse insurance funds and provinces. It revealed significant inequalities in HIL related to age, gender, education, employment, income, and geographic location—providing empirical evidence to inform the national health policy making.&lt;/div&gt;&lt;div&gt;What are the policy implications?&lt;/div&gt;&lt;div&gt;Findings underscore the need for targeted and equity-oriented HIL interventions. Policymakers should implement accessible public education campaigns, digital advisory platforms, and workplace-based training to improve HIL among vulnerable groups. Such strategies can support more informed insurance use and promote equitable access to healthcare.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Health literacy, defined as “the capacity of individuals t","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100150"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424829","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":"Implications of U.S. withdrawal from the World Health Organization on health financing in Africa","authors":"Taiwo Oluwaseun Sokunbi ,&nbsp;Abbas Bashir Umar ,&nbsp;Uko Bassey Eyo","doi":"10.1016/j.hpopen.2025.100142","DOIUrl":"10.1016/j.hpopen.2025.100142","url":null,"abstract":"<div><div>The U.S. decision to withdraw from the World Health Organization (WHO) under President Trump’s second term has significant implications for global health financing, particularly in Africa. As the largest contributor to the WHO, the U.S. provided 12–15% of the organization’s total funding between 2022 and 2023, and its withdrawal threatens essential health programs addressing HIV/AIDS, maternal and child health, tuberculosis, and malaria, which heavily rely on external funding. Reduced funding will disproportionately affect low- and middle-income African countries, increasing the financial burden on households and limiting access to critical healthcare services.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100142"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525306","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":"2025-11-01","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":"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":"2025-11-01","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":"2025-11-01","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":"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":"2025-11-01","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}