Health Care Analysis最新文献

{"title":"Strengthening Tobacco Product Regulation: Addressing Challenges and Strategies for Articles 9 and 10 Implementation.","authors":"Sonu Goel, Chirag Goel, Diksha Walia, Leimapokpam Swasticharan, Prakash Chandra Gupta, Sitanshu Sekhar Kar","doi":"10.1007/s10728-025-00553-y","DOIUrl":"10.1007/s10728-025-00553-y","url":null,"abstract":"<p><p>Tobacco use remains a critical global public health challenge, representing the leading preventable cause of morbidity and mortality worldwide. The World Health Organisation's Framework Convention on Tobacco Control, ratified by 183 parties, includes Articles 9 and 10, which regulate the contents and emissions of tobacco products. Like many other WHO-FCTC articles, the implementation of these provisions faces significant challenges. These hurdles include tobacco industry interference, the proliferation of novel tobacco and nicotine products, the complexity of regulating product attractiveness, addictiveness, and toxicity, inadequate testing infrastructure, legal and political barriers, and coordination challenges among the regulatory authorities of different countries. Overcoming these impediments is crucial, as robust enforcement of Articles 9 and 10 holds the potential to reduce the substantial global burden of over 7 million annual deaths attributable to tobacco use. Effective implementation will require integrating these articles into domestic tobacco control legislation, establishing well-equipped testing facilities, fostering multi-sectoral coordination, and bolstering international research collaborations and capacity-building efforts. By surmounting these challenges, countries can harness the full power of the WHO-FCTC to curb the tobacco epidemic.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"899-922"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776160","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":"Severity and Temporality in Healthcare Priority Setting - A Case for A Condition-specific Affectable Time-neutral Approach.","authors":"Lars Sandman, Niklas Juth","doi":"10.1007/s10728-024-00493-z","DOIUrl":"10.1007/s10728-024-00493-z","url":null,"abstract":"<p><p>Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the 'shape' of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"338-355"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510204","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":"The 3D Value Framework for Sustainable Access to Effective Antibiotics.","authors":"Anders Herlitz, Erik Malmqvist, Christian Munthe","doi":"10.1007/s10728-025-00552-z","DOIUrl":"10.1007/s10728-025-00552-z","url":null,"abstract":"<p><p>Sustainable access to effective antibiotics is a main rationale for addressing antimicrobial resistance, for calls to enhance antibiotic supply security and for development support to promote health system capacity in low- and middle-income settings. Standard models for valuing pharmaceuticals fail to capture the full value of sustainable access to effective antibiotics. In effect, assessments of societal or corporate investments to promote such access underestimate their value and the cost of foregoing them. In effect, measures that could address existing sustainability problems in antibiotic supply systems are hampered. We review the features needed to avoid these problems and assess suggestions to address the flaws of existing approaches, such as the STEDI-model. On this basis, we propose the 3D Value Framework, a straightforward and comprehensive model that focusses directly on what types of valuable outcomes there can be related to having sustainable access to effective antibiotics. We also sketch how this model can be used in cost-effectiveness analysis grounding public decision-making and discuss further applications in other settings.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"879-898"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688388","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":"From Habit to Justification: A Dual Process Theory Approach to Primary Care Bypassing in China.","authors":"Bo Li","doi":"10.1007/s10728-025-00548-9","DOIUrl":"10.1007/s10728-025-00548-9","url":null,"abstract":"<p><p>China's tiered healthcare system is designed to guide patients through a two-way referral process, with primary care as the first point of contact. However, prevalent bypassing of lower-tier facilities undermines the system's effectiveness. While previous research has examined healthcare choices, the cognitive drivers of bypassing behaviour remain insufficiently understood. A case study design was employed, involving 23 semi-structured interviews with hypertensive patients in Shenzhen. Deductive thematic analysis, guided by dual process theory, explored the cognitive mechanisms underlying bypassing, focusing on intuitive (System 1) and deliberative (System 2) decision-making. Bypassing behaviour emerged from the interplay between Systems 1 and 2 processes. System 1, driven by automatic heuristics, reinforced habitual hospital use and social norms, maintaining status quo bias and the belief that tertiary hospitals offer superior care. System 2, involving reflective risk assessment, led patients to favour hospitals due to concerns over service quality and adequacy. Importantly, System 1 established bypassing as the default, while System 2 provided retrospective justifications, entrenching this decision. However, a subset of patients, influenced by health status and personal circumstances, exhibited more flexibility, opting for primary care for convenience or accessibility. This delineates the cognitive model's boundary conditions, revealing that behavioural outcomes are not deterministic but contingent on individual and situational factors. The application of dual process theory offers a nuanced understanding of bypassing behaviour within China's tiered healthcare system, emphasising the roles of both instinctive and analytical cognitive processes. Findings suggest the need for multidimensional interventions targeting both cognitive pathways to improve primary care utilisation.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"839-857"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439168","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":"The Use of a Comprehensive Concept of Capability for Wellbeing Assessment: A Best-Fit Framework Synthesis.","authors":"Jasper Ubels, Karla Hernandez-Villafuerte, Erica Niebauer, Michael Schlander","doi":"10.1007/s10728-024-00488-w","DOIUrl":"10.1007/s10728-024-00488-w","url":null,"abstract":"<p><p>Developing an instrument with the capability approach can be challenging, since the capability concept of Sen is ambiguous concerning the burdens that people experience whilst achieving their capabilities. A solution is to develop instruments with a comprehensive concept of capability, such as the concept of 'option-freedom'. This study aims to develop a theoretical framework for instrument development with the concept of option-freedom. A best-fit framework synthesis was conducted with seven qualitative papers by one researcher. Two researchers supported the synthesis by discussing interim results during the synthesis. A priori concepts of option-freedom were used to deductively code against. Themes and subthemes were developed inductively when data did not match a priori themes. Seven paper were identified that fulfilled the eligibility criteria. Four themes emerged from the synthesis. (1) Option Wellbeing represents a range of options that need to be satisfied for individuals to experience wellbeing. (2) Self-Realization represents that there are experiences in an individual's life that have value beyond realizing options. (3) Perceived Access to Options represents the perceived ability of individuals to realize freedoms. (4) Perceived Control represents the experience of having control. Developing an instrument with the proposed framework has two benefits. First, it acknowledges the importance of assessing impediments in realizing capabilities for wellbeing assessment. Secondly, the themes form a broad informational base by including themes related to subjective wellbeing. Future research should study the feasibility of implementing the framework for instrument development.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"300-319"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001005","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":"Synthetic Medical Data vs. The Four Principles: Ethical Trade-Offs and Zombie Data.","authors":"Yael Friedman, Anna Smajdor","doi":"10.1007/s10728-026-00596-9","DOIUrl":"https://doi.org/10.1007/s10728-026-00596-9","url":null,"abstract":"<p><p>Rapid advances in AI for medical applications are accompanied by an increasing demand for vast datasets. Privacy constraints - legal restrictions such as GDPR, as well as more general ethical concerns - pose significant barriers to the acquisition and use of data. Synthetic medical data (SMD) is AI-generated data that mimics real patient information. SMD is being promoted as an ethical solution that preserves privacy while enabling scalable model training. However, as we will show, the use of SMD raises its own set of issues. SMD's emphasis on privacy and scalability subtly embeds ethical and epistemic trade-offs that undermine the principles commonly regarded as being paramount in medical ethics. These trade-offs lack the kind of ethical justification one would expect in decisions that disrupt commonly accepted values and priorities, such as those captured by Beauchamp and Childress' four principles. In the discourse on the ethical advantages of SMD, privacy tends to be treated as a value in its own right. We show that this is a problematic assumption. Transparency, privacy, scalability, and fidelity are all linked in complex ways with the principles of medical ethics. We map these relationships and show that when privacy is privileged over other values, it conflicts with autonomy and beneficence. Our aim here is not to establish that this privileging is wrong per se, but to show that it needs careful analysis before we can accept the idea that SMD is indeed ethically advantageous.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799383","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":"Correction: Ethical Challenges in Research Involving Hospitalized Patients: A Phenomenological Study.","authors":"Moustaq Karim Khan Rony, Dilruba Akther, Umme Rabeya Peu, Md Shafiul Alam, Abu Zafor Md Shaleah, Md Zahirul Alam, Mst Rina Parvin, Ibne Kayesh, Sandra Rumi Madhu, Daifallah M Alrazeeni, Fazila Akter","doi":"10.1007/s10728-026-00594-x","DOIUrl":"10.1007/s10728-026-00594-x","url":null,"abstract":"","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799380","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":"On the Concept of Existential Disease.","authors":"Bjørn Morten Hofmann","doi":"10.1007/s10728-026-00595-w","DOIUrl":"https://doi.org/10.1007/s10728-026-00595-w","url":null,"abstract":"<p><p>Is \"existential disease\" a meaningful concept? This study scrutinizes six arguments in support of the concept. First, putative existential diseases are already discussed in the academic literature, including existential neurosis and existential OCD. Second, existential disease may be understood as occurring in the absence of \"existential health,\" a notion that has received increasing scholarly attention. Third, the very practices of diagnosing \"existential suffering\" and providing \"existential therapy\" appear to entail a concept of existential disease. Fourth, in the same way as physical and mental suffering corresponds to physical and mental disease, existential suffering corresponds to existential disease. Fifth, existential suffering arguably falls under several traditional definitions of disease, thereby supporting the legitimacy of the concept of existential disease. Sixth, medical interventions such as palliative sedation and assisted dying in response to existential suffering-interventions typically reserved for disease-seem to presuppose an existential form of disease. Although most of these arguments face important objections, certain conceptions of disease do warrant the category of existential disease. Nonetheless, there is a substantial risk of medicalizing existential concerns, and it is not clear that framing existential suffering as disease is the best way to respond to those who suffer existentially, especially given that health professionals may not be well equipped to address such forms of distress. Hence, more and better arguments are needed to ascertain the concept of existential disease.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799355","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":"Examining Explicit and Implicit Caste Bias Among Healthcare Providers in India.","authors":"Shivani Yadav, Krishna Ram","doi":"10.1007/s10728-026-00597-8","DOIUrl":"https://doi.org/10.1007/s10728-026-00597-8","url":null,"abstract":"<p><p>Healthcare provisioning reflects the social context in which it operates, where caste-based identities and hierarchies continue to shape institutional behaviour and care delivery. Drawing on social identity theory and research on implicit bias, this study examines how caste - a rigid, hereditary, and endogamous status hierarchy, structures explicit and implicit attitudes among public healthcare providers in India. Using structured survey measures, open-ended responses, and the Implicit Association Test (IAT), we collected data from 106 providers across public health facilities in Uttar Pradesh. Results indicate widespread caste bias: over 60% of providers expressed explicit opposition to affirmative action policies benefiting Scheduled Castes (SC), and 75% of IAT participants demonstrated an automatic preference for Forward Castes. These attitudes were more pronounced among non-SC providers, while SC participants showed greater awareness and sensitivity towards caste discrimination. Beyond documenting prejudice, the study demonstrates how structural inequality and professional discretion interact in resource-constrained institutional settings. The findings highlight how implicit and explicit caste attitudes may operate as micro-level mechanisms reproducing health inequities, even in formally egalitarian public systems. Policy implications include integrating caste-sensitivity training in medical education, strengthening institutional accountability, and diversifying the healthcare workforce to mitigate bias in clinical interactions.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799410","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":"Digital Health Divides: Telehealth Equity in a Global Context-A Narrative Review with an Israeli Case Study.","authors":"Motti Haimi","doi":"10.1007/s10728-026-00591-0","DOIUrl":"https://doi.org/10.1007/s10728-026-00591-0","url":null,"abstract":"<p><p>The COVID-19 pandemic catalyzed unprecedented global expansion of telehealth services, with utilization increasing exponentially from pre-pandemic baselines. While digital health technologies promise to democratize healthcare access, they have simultaneously created and amplified new forms of healthcare disparity. This review distinguishes between health equity - the absence of avoidable, unjust differences in health outcomes across population groups, and health equality- the provision of identical services regardless of differing needs. These concepts, while related, require distinct policy responses. Our aim was to synthesize global evidence on equity challenges in telehealth implementation, identify key barriers to equitable access, and analyze strategies for promoting inclusive digital health delivery, with Israel examined as an in-depth case study illustrating broader themes. A narrative review methodology was employed, searching PubMed/MEDLINE and Google Scholar (January 2020-June 2025) using Boolean search strings combining telehealth-related terms with equity, access, and barrier keywords. Initial searches yielded 847 articles; 623 underwent title/abstract screening after deduplication; 156 met criteria for full-text review; 49 high-quality studies formed the final evidence base. Israel was integrated as an in-depth case study within this global synthesis. Significant telehealth utilization disparities persist globally across age, race/ethnicity, geography, and language groups. Technology access alone is insufficient to ensure equity: cultural barriers, digital literacy gaps, provider readiness, and systemic policy failures produce compound digital disadvantage. Israel's experience demonstrates that even in technologically advanced universal-coverage systems, Arab-Jewish and center-periphery disparities persist despite high smartphone ownership and internet access. Achieving telehealth equity requires multi-layered interventions addressing digital divides, cultural and linguistic barriers, and systemic inequalities. Success depends on equity-first design, multi-modal service delivery, provider training encompassing all available modalities, infrastructure investment, and continuous monitoring of disparate impacts.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632213","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}