Health Care Analysis最新文献

{"title":"A Paradigm Shift in Addressing Threats to Science.","authors":"Gian Piero Turchi, Eleonora Pinto, Luisa Orrù","doi":"10.1007/s10728-026-00568-z","DOIUrl":"https://doi.org/10.1007/s10728-026-00568-z","url":null,"abstract":"","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators of Clinical Guideline Implementation in Tertiary Care: A Systematic Literature Review.","authors":"Mina Azizzadeh, Sakineh Hajebrahimi, Ali Janati, Javad Babaie","doi":"10.1007/s10728-026-00566-1","DOIUrl":"https://doi.org/10.1007/s10728-026-00566-1","url":null,"abstract":"<p><p>Clinical guidelines (CGs) can improve the quality of care in tertiary hospitals-but only if they are actually used. Past reviews listed facilitators, but did not explain why some work and others fail. This review fills that gap by asking: Under what conditions do facilitators succeed? We systematically reviewed 6948 records (PubMed, Scopus, Web of Science, Magiran, SID) through Nov 2025, selecting 45 high-quality studies. Using the MMAT tool and analytical thematic synthesis, we looked beyond what works to how and when it works. We found that three groups-policymakers, developers, and implementers-must work together in a cycle. Crucially, their actions only succeed under specific conditions: leadership helps only when it is visible, supported by resources, and accountable-not when it is top-down only, CGs are used more when they fit into daily workflow (e.g., emergency kits)-not just when they are simple or short, policies succeed only when paired with practical support (e.g., payment for guideline-based care, feedback systems). We also found that different health systems need different strategies: centralized systems need strong policy integration; high-autonomy settings need peer-led change; resource-limited settings need simple, adaptable tools. Successful implementation is not about more facilitators-but about better-aligned ones. We recommend a shift from top-down orders to collaborative, context-aware planning, where frontline staff, managers, and policymakers co-design solutions.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Challenges of Hypertension Mass Screening Programs: A Scoping Literature Review.","authors":"Javad Babaie, Nazila Azizi, Leila Doshmangir, Amir Yaghubzadeh Khoei","doi":"10.1007/s10728-026-00565-2","DOIUrl":"https://doi.org/10.1007/s10728-026-00565-2","url":null,"abstract":"","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Patient-Initiated Non-Standard Care (PINSC) Requests: Applying an Ethically Coherent Framework for Shared Decision-Making.","authors":"Joshua T Landry","doi":"10.1007/s10728-026-00567-0","DOIUrl":"https://doi.org/10.1007/s10728-026-00567-0","url":null,"abstract":"<p><p>In current medical decision-making, prioritizing patient autonomy and shared decision-making has reshaped the ethical landscape. Medical decisions are no longer solely driven by a strong physician paternalism, where doctors are assumed to know best, but are increasingly characterized by a sharing of information, collaboration on decisions, and incorporation of patient values and preferences. While this shift promotes shared decision-making and patient-centered care, it has also given rise to additional ethically-complex challenges, including what will be referred to here as Patient-Initiated Non-Standard Care (PINSC) requests. PINSC requests emerge when patients or their surrogate decision-maker(s) seek interventions which fall outside accepted medical guidelines or evidence-based standards of care. This paper recounts various PINSC requests received at several hospitals in Ontario, Canada. Fundamental distinctions between PINSC requests and other cases of informed refusal are then established to highlight their novel ethical complexity, and I argue that this complexity gives rise to significant ethical and professional concerns that warrant increased attention. I then explore the reasons why clinicians often feel obligated to accede to PINSC requests, review the limitations of existing response strategies to addressing them, and propose that a model of shared decision-making called the Professionally-Driven Zone of Patient or Surrogate Discretion, or Professionally-Driven ZPSD, can be used as an ethically-defensible framework for navigating these cases. The Professionally-Driven ZPSD supports clinicians to develop a range of treatment options (\"the zone\") for decision makers to choose from that are ethically permissible, as they would fall between those treatments which cause unjustifiable harm, and those (or that) which would be in the patient's best interests to have if this can be defined.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compassionate Understanding in Dementia Care.","authors":"Steve Matthews","doi":"10.1007/s10728-026-00563-4","DOIUrl":"https://doi.org/10.1007/s10728-026-00563-4","url":null,"abstract":"","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advertising Ban in Healthcare: A Qualitative Study from the Perspective of Private Hospital Managers in Türkiye.","authors":"Tutku Ekiz Kavukoğlu, Gürkan Sert","doi":"10.1007/s10728-026-00564-3","DOIUrl":"https://doi.org/10.1007/s10728-026-00564-3","url":null,"abstract":"","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High Cost of American Health Care: Understanding the Deeper Roots of the Crisis.","authors":"Cyril F Chang, David M Mirvis, Asos Mahmood","doi":"10.1007/s10728-025-00554-x","DOIUrl":"10.1007/s10728-025-00554-x","url":null,"abstract":"<p><p>The recent tragic death of UnitedHealthcare CEO Brian Thompson has renewed public scrutiny of the US health care system and reignited debate over why Americans face disproportionately high health care costs. This essay examines both the widely recognized drivers of excessive costs and the deeper systemic issues that often remain unaddressed yet continue to sustain the crisis. It highlights two critical challenges: the need to target structural barriers and misaligned economic incentives in order to design sustainable reforms, and the persistent political polarization that impedes long-term, meaningful change. The paper concludes by outlining short-term strategies that can generate immediate improvements while laying the foundation for comprehensive and enduring reform.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"1-12"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral Challenges and Responsibilities in Caring for Relatives of Older Nursing Home Residents During the COVID-19 Pandemic in Sweden.","authors":"Pier Jaarsma, My Eklund Saksberg, Therése Bielsten, Suzanne Cahill, Tiny Jaarsma, Petra Gelhaus","doi":"10.1007/s10728-025-00551-0","DOIUrl":"10.1007/s10728-025-00551-0","url":null,"abstract":"<p><p>Caring for relatives of older nursing home residents during COVID-19 was sometimes morally challenging for nursing home nurses. We identified four moral challenges: (1) providing versus withholding information, (2) respecting relatives' wishes versus acting in accordance with professional standards, (3) acting in accordance with versus contrary to advance care plans, and (4) heeding versus ignoring visiting prohibitions. Care ethicist Margaret Urban Walker's framework of moral responsibility together with values listed in the ICN code of ethics for nurses were used as points of departure for reflection on these moral challenges. Each challenge was described, and moral responsibilities were charted and discussed in terms of moral relationships between nursing home nurses and the relatives of older residents, nurses' moral identity as a nurse, and nursing's moral values as listed in the ICN code of ethics for nurses. Nursing home nurses' moral responsibilities could be connected to many moral values of the nursing profession, such as empathy, responsiveness, caring, advocacy, equality, inclusivity, and compassion. However, these values have a limited effect on direct moral action, as different values can be addressed for opposite action alternatives.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"13-27"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming public mental health: a review on global trends, challenges, and pathways to change.","authors":"Olalekan John Okesanya, Tolutope Adebimpe Oso, Uthman Okikiola Adebayo, Jeremiah Ayobami Obadofin, Ridhwan Opeyemi Abdulghaniy, Adebowale Alao Bamigbade, Jerico Bautista Ogaya, Ifeanyi Ngwoke, Mohamed Mustaf Ahmed, Jomar L Aban","doi":"10.1007/s10728-025-00549-8","DOIUrl":"10.1007/s10728-025-00549-8","url":null,"abstract":"<p><p>This review synthesizes global trends, persistent challenges, and actionable pathways for overhauling public mental health systems, with a particular focus on low- and middle-income countries (LMICs). Thematic analysis of our review revealed that mental health disorders now affect nearly one in eight people worldwide, yet up to 75% of those in LMICs receive no treatment due to stigma, underfunding, workforce shortages, and fragmented systems, perpetuating a widening \"treatment and care gap.\" Social inequities, harmful cultural norms, conflict, climate change, and gender disparities further amplify the risk and economic burden, projected to exceed US$6 trillion by 2030. Innovative financing approaches, including public-private partnerships and models from countries such as Norway and Australia, offer promising strategies for sustainable investments. The COVID-19 pandemic intensified mental health challenges but also raised global awareness, with leaders such as the United Nations Secretary-General and the United States Surgeon General foregrounding mental health crises in the public consciousness. Advocacy initiatives, including the FundaMentalSDG campaign, Lancet Commissions, Global Mental Health Action Network, and Global Mental Health Peer Network, have been pivotal in elevating mental health within the Sustainable Development Goals (SDGs) and linking it to social determinants. Emerging solutions include rights-based frameworks that emphasize participation and anti-discrimination, scaling up task-sharing and expanded roles for non-specialists through programs such as the World Health Organization's Mental Health Gap Action Programme, community-based interventions like Zimbabwe's Friendship Bench, and integration of mental health into primary care with dedicated counsellors, structured referral pathways, and digital innovations promising improved access and personalization. Sustained progress requires intersectoral collaboration across health, education, labor, and social sectors; embedding mental health into national health information systems; and investing in culturally adapted promotion and prevention interventions throughout the life course. Strengthening political commitment, global-local leadership, financing frameworks, and workforce capacity, particularly through continuous professional development and lived-experience participation, will accelerate progress toward the SDGs, underscoring the imperative for equitable financing and sustained political will globally.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"57-85"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tariff Conflicts and Entrenched Interests: The Deepening Deadlock of US Healthcare Reform.","authors":"Miao Wang","doi":"10.1007/s10728-025-00542-1","DOIUrl":"10.1007/s10728-025-00542-1","url":null,"abstract":"<p><p>The US healthcare system is characterized by a persistent deadlock, where high costs, low efficiency, and inequity resist fundamental reform. This stalemate is rooted in deep ideological divides, political polarization, a fragmented fiscal structure, and the power of entrenched interest groups. This article analyzes how recent trade protectionist policies, specifically tariffs on pharmaceuticals and their inputs, intersect with this domestic gridlock. It posits a central paradox: a political system incapable of enacting major domestic health reform can simultaneously deploy assertive trade interventions in the same sector. The article argues that these tariffs should not be misconstrued as flawed instruments of healthcare reform. Instead, they represent the application of a distinct sovereigntist and protectionist logic, driven by national security concerns. The consequence is not a failed attempt at a solution, but a collision of policy agendas that actively exacerbates the healthcare system's core dysfunctions. By increasing costs, destabilizing supply chains, and creating new arenas for interest group conflict, tariffs intensify partisan strife and further entrench the reform deadlock. This process, marked by the \"securitization\" of the pharmaceutical industry, signals a critical shift in global health governance, where geopolitical strategy now overrides and complicates the pursuit of domestic public health goals.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"28-42"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}