Health Economics Policy and Law最新文献

Multiple paths to privatisation in healthcare? Comparing England and Italy beyond the public-private divide. 医疗私有化的多种途径？比较英国和意大利公私部门之间的差异。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-10-15 DOI: 10.1017/S1744133126100760

Neil Lunt, Federico Toth, Mark Exworthy

{"title":"Multiple paths to privatisation in healthcare? Comparing England and Italy beyond the public-private divide.","authors":"Neil Lunt, Federico Toth, Mark Exworthy","doi":"10.1017/S1744133126100760","DOIUrl":"https://doi.org/10.1017/S1744133126100760","url":null,"abstract":"English and Italian national health systems are predominantly funded by general taxation and treat patients primarily free at the point of delivery. Both healthcare systems are facing increasing financial pressures given population ageing, the rise in chronic and non-communicable diseases, and fiscal restraint. In recent years, pressures on public healthcare have revived debate around the role of the private sector, but discussion is mired in a lack of conceptual clarity. We seek to bring greater analytical order by distinguishing seven distinct 'trajectories of privatisation', each reflecting different modes and logics of interaction between public and private actors. We examine two similar health systems - England and Italy - highlight their similarities and differences regarding emerging and established trajectories. There is less evidence of 'hard privatisation', seen as the private share of overall spending; however, both countries are experiencing greater use of on-demand staff and financialisation. In both systems subtler privatisation dynamics (public-private partnerships, managerialism, and entrepreneurialism) are redefining and blurring the boundaries between public and private provision. Public perceptions of perceived privatisation are shaped by direct, tangible experiences of care and out-of-pocket spending. Some privatisation dynamics are mainly driven by behaviour of patients, professionals, and investors rather than by policies.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-19"},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Investment or extraction? Reframing private equity in healthcare. 投资还是开采？重塑医疗领域的私募股权。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-10-07 DOI: 10.1017/S1744133126100759

Mary Bugbee

{"title":"Investment or extraction? Reframing private equity in healthcare.","authors":"Mary Bugbee","doi":"10.1017/S1744133126100759","DOIUrl":"https://doi.org/10.1017/S1744133126100759","url":null,"abstract":"Moral hazard is built into the structure of private equity investments, which incentivises debt-based extraction rather than value-adding investment. To craft effective regulation of private equity's participation in healthcare, and to cut through the industry's talking points, we must reframe and acknowledge private equity 'investment' as 'extraction'. In the U.S. healthcare system, this debt-based extraction has produced higher risks of bankruptcy and financial distress and associated facility closures, cost-cutting that affects patient safety and care, rising healthcare costs, inefficient use of taxpayer dollars, erosion of clinician autonomy, and increased consolidation. Policies that address extractive behaviours are the most targeted and efficient means of safeguarding patient care and may discourage the worst actors from acquiring healthcare providers. As private equity invests in health systems beyond the U.S. where regulatory regimes differ, the fundamentals of its extractive business model remain the same. Regulations must be calibrated to country specifics, but they should address the debt-based extraction built into the very structure of private equity investments. As policy debates continue, it is worth asking why we need private equity's extractive business model in healthcare in the first place.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Drug shortages in Italy: strategic insights and empirical evidence from the Italian pharmaceutical market. 意大利药品短缺：来自意大利制药市场的战略见解和经验证据。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-10-05 DOI: 10.1017/S1744133126100681

Benedetta Dal Canto, Jan Panhuysen, Giaele Moretti, Bruna Vinci, Milena Vainieri

{"title":"Drug shortages in Italy: strategic insights and empirical evidence from the Italian pharmaceutical market.","authors":"Benedetta Dal Canto, Jan Panhuysen, Giaele Moretti, Bruna Vinci, Milena Vainieri","doi":"10.1017/S1744133126100681","DOIUrl":"https://doi.org/10.1017/S1744133126100681","url":null,"abstract":"Drug shortages disrupt healthcare delivery and pose a critical challenge to the resilience of pharmaceutical supply chains. This study investigates the drivers of drug shortages in Italy - Europe's leading pharmaceutical producer - to identify the factors associated with supply disruptions and inform evidence-based health policy. Using national data from 2018 to 2023, we analysed 17,619 drugs across 3,013 groups of substitutes, covering community, dual-dispensed, and hospital distribution channels. Generalised linear mixed models were employed to assess how drug characteristics, market dynamics, and regulatory features influence shortage risk. Shortages were most prevalent among community drugs, where high market fragmentation and low-profit margins contributed to supply instability. Patent protection was associated with lower shortage risk for non-sterile drugs, while sterile drugs remained vulnerable regardless of patent status, likely due to manufacturing complexity. Notably, price effects were age-dependent: higher prices mitigated shortage risk, particularly for older drugs. This study offers a comprehensive evaluation of shortage patterns in a key pharmaceutical market, identifying structural risk factors and market vulnerabilities. The findings provide actionable insights for policymakers aiming to design targeted interventions, strengthen supply chain resilience, and ensure continuous access to essential medicines.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-26"},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating information security in reimbursement decisions for digital health technologies in Germany and Switzerland - stretching the fourth hurdle too far? 评估德国和瑞士数字医疗技术报销决策中的信息安全——将第四个障碍延伸得太远？

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-10-01 DOI: 10.1017/S1744133126100735

Benjamin Wyss, Carl Rudolf Blankart

{"title":"Evaluating information security in reimbursement decisions for digital health technologies in Germany and Switzerland - stretching the fourth hurdle too far?","authors":"Benjamin Wyss, Carl Rudolf Blankart","doi":"10.1017/S1744133126100735","DOIUrl":"https://doi.org/10.1017/S1744133126100735","url":null,"abstract":"Digital health technologies (DHTs) can improve healthcare delivery but also raise concerns about data protection and cybersecurity. Germany and Switzerland take contrasting approaches to these issues in reimbursement decision-making: in Germany, the Fast-Track procedure assigns explicit responsibility to the Federal Institute for Drugs and Medical Devices (BfArM) for evaluating data protection and cybersecurity, whereas in Switzerland no dedicated procedure exists at the reimbursement level, and these issues are treated as having been addressed at the market access stage. This study compares how data protection and cybersecurity are handled in relation to reimbursement decision-making for DHTs in both countries. We conducted a document analysis and semi-structured interviews with experts from industry and public authorities and used reflexive thematic analysis to examine the material. Interviewees in both countries reported uncertainty among stakeholders about the role of reimbursement authorities and identified limited resources and a lack of relevant expertise as important constraints. Our findings suggest that greater reliance on international standards may reduce overlap between market access and reimbursement, support clearer allocation of responsibilities, enable more predictable pathways, and help balance security with innovation. In smaller markets, additional country-specific requirements may discourage market entry and limit patient access to DHTs.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-19"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Litigating the No Surprises Act: how legal challenges undermined cost containment and reshaped provider payments. 诉讼《不意外法案》：法律挑战如何破坏成本控制并重塑供应商支付方式。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-09-30 DOI: 10.1017/S1744133126100723

Lindsey Murtagh, Ayesha Rahim, Erin Fuse Brown

{"title":"Litigating the No Surprises Act: how legal challenges undermined cost containment and reshaped provider payments.","authors":"Lindsey Murtagh, Ayesha Rahim, Erin Fuse Brown","doi":"10.1017/S1744133126100723","DOIUrl":"https://doi.org/10.1017/S1744133126100723","url":null,"abstract":"The No Surprises Act (NSA), signed into law by President Trump over five years ago, marked a significant federal intervention aimed at shielding millions of consumers with private health coverage from unexpected out-of-network medical bills. While the Act is lauded for successfully protecting consumers, its implementation has been plagued by aggressive litigation, with provider-led lawsuits challenging the Act itself as well as every rule issued to implement the protections and countless other lawsuits challenging actions (or inactions) by providers, insurers, and independent dispute resolution (IDR) entities. This litigation has profoundly impacted the Act's cost-saving objectives by eroding its payment methodology and fostering extensive use of the IDR process. This paper chronicles the litigation timeline from the passage of the NSA through April 2026 and its impacts on the implementation, detailing the challenges to the regulatory framework and how adversarial legalism shaped the NSA's trajectory. The paper concludes by offering policy options for Congress, federal agencies, states, and stakeholders to reduce costs and IDR volume to better align with the intent of the NSA.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Institutional tensions in HIV treatment: challenges in providing free antiretroviral drugs under China's 'Four Frees and One Care' policy. 艾滋病毒治疗中的制度紧张：在中国“四免一护”政策下提供免费抗逆转录病毒药物的挑战。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-09-24 DOI: 10.1017/S174413312610070X

Ziyi Xie, Kinglun Ngok, Zhenjie Yang, Zhizhuang Duan

{"title":"Institutional tensions in HIV treatment: challenges in providing free antiretroviral drugs under China's 'Four Frees and One Care' policy.","authors":"Ziyi Xie, Kinglun Ngok, Zhenjie Yang, Zhizhuang Duan","doi":"10.1017/S174413312610070X","DOIUrl":"https://doi.org/10.1017/S174413312610070X","url":null,"abstract":"China's 'Four Frees and One Care' policy provides people living with HIV (PLHIV) with free antiretroviral drugs (ARVs), while the recent inclusion of new ARVs in medical insurance policy has created policy overlap. Guided by the Institutional Analysis and Development (IAD) framework, this qualitative study used semi-structured interviews with 42 Centers for Disease Control and Prevention (CDC) and medical staff across China to examine institutional interactions and tensions in implementing the 'Four Frees and One Care' policy under policy overlap. The findings indicate that CDC and medical institutions exhibit divergent perceptions regarding the scope of beneficiaries for free ARVs, the allocation of responsibilities during implementation, and preferences in ARVs recommendations. CDC staff place greater emphasis on expanding antiretroviral therapy (ART) coverage to achieve public health goals for HIV control at the population level, whereas medical institutions focus more on individual treatment outcomes and the healthcare service performance. This divergence results in CDC favouring the free ARVs policy in practice, while medical institutions are more inclined toward ARVs accessed through medical insurance. Such tensions not only affect the coordination of policy implementation but may also have potential adverse impacts on PLHIV access to ART services, ART adherence, and public health outcomes.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-16"},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mapping digital welfare platforms globally: functional typologies, governance gaps, and policy implications. 绘制全球数字福利平台：功能类型、治理差距和政策影响。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-09-24 DOI: 10.1017/S1744133126100747

Agnese Palvarini

引用次数: 0

An investment too good to be true?: Reassessing the World Health Organization and World Bank return-on-investment estimates for pandemic preparedness. 一项好得令人难以置信的投资？*重新评估世界卫生组织和世界银行对大流行病防范的投资回报率估计。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-08-06 DOI: 10.1017/S174413312610067X

Garrett Wallace Brown, Jean von Agris, Blagovesta Tacheva, David Bell

{"title":"An investment too good to be true?: Reassessing the World Health Organization and World Bank return-on-investment estimates for pandemic preparedness.","authors":"Garrett Wallace Brown, Jean von Agris, Blagovesta Tacheva, David Bell","doi":"10.1017/S174413312610067X","DOIUrl":"https://doi.org/10.1017/S174413312610067X","url":null,"abstract":"The World Health Organization, World Bank, G20 and related health agencies have requested annual investments of US$31.1 billion in pandemic prevention, preparedness and response. To justify these unprecedented costs, they rely on a return-on-investment case developed by WHO and World Bank. Any investment in one area of public health will have knock-on effects on others, through diversion of funds and human resources. Intended outcomes must outweigh alternate investments and be likely to achieve the results on which such comparisons are predicated. This perspective examines the assumptions underlying the WHO and World Bank return-on-investment estimates and outlines implications for equitable and evidence-based global health financing. The examination reveals several problematic assumptions and crude baselines used for comparison - inflating return-on-investment estimates and undermining its use for policymaking. The case is based on improbable assumptions of 100% mitigation of pandemic economic impacts, including rapid vaccine development completely blocking transmission. WHO/World Bank do not disaggregate direct and indirect costs, while the economic impact of comparator diseases appears significantly undervalued. Thus, the return-on-investment case underpinning the current pandemic agenda appears under-evidenced and unreliable, and the apparent over-valuation of pandemic interventions over existing investment in high-burden infectious diseases raises equity concerns, suggesting a reassessment is needed.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EU excess capacity management through member states-driven patient mobility: economic and legal aspects. 通过成员国驱动的病人流动来管理欧盟过剩产能：经济和法律方面。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-08-04 DOI: 10.1017/S1744133126100632

Markus Frischhut, Rosella Levaggi

{"title":"EU excess capacity management through member states-driven patient mobility: economic and legal aspects.","authors":"Markus Frischhut, Rosella Levaggi","doi":"10.1017/S1744133126100632","DOIUrl":"https://doi.org/10.1017/S1744133126100632","url":null,"abstract":"Capacity management plays an increasingly important role in healthcare delivery, both at national and supranational level, in increasing value for money. In this paper, we propose using cross-border patient mobility across European Union (EU) countries to pool demand and reduce excess capacity. In a setting where the number of patients requiring a specific treatment is fixed but the facility requires a fixed capacity that cannot be adapted to demand, we show that cross-border patient mobility may improve welfare. From a legal perspective, we demonstrate that such mobility is compatible with existing EU law (comprising both EU primary and secondary law, namely the Patient Mobility Directive and the Social Security Coordination Regulation) and the case law of the European Court of Justice. These judgments confirm that planning and cost control objectives may justify not only restricting but also encouraging patient mobility, provided non-discrimination and proportionality are respected. In conclusion, this paper offers interdisciplinary solutions for reconciling patients' preferences with member states' planning goals, showing that cross-border healthcare cooperation can enhance efficiency, equity, and solidarity within the current EU legal framework.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-13"},"PeriodicalIF":2.2,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Institutional assembly under constraints: pathways to universal health coverage in Brazil, Rwanda, and China. 约束下的机构集会：巴西、卢旺达和中国实现全民健康覆盖的途径。

IF 2.2 3区医学

Health Economics Policy and Law Pub Date : 2026-07-30 DOI: 10.1017/S1744133126100607

Mengyun Lin, Hanmo Yang, Junjian Yi

{"title":"Institutional assembly under constraints: pathways to universal health coverage in Brazil, Rwanda, and China.","authors":"Mengyun Lin, Hanmo Yang, Junjian Yi","doi":"10.1017/S1744133126100607","DOIUrl":"https://doi.org/10.1017/S1744133126100607","url":null,"abstract":"This paper examines how Brazil, Rwanda, and China have pursued universal health coverage (UHC) beyond classical health system models developed in high-income settings. We introduce the concept of institutional assembly under constraints, offering a complementary framework for understanding UHC pathways in developing countries, where no single trajectory universally applies. Brazil's health system ensures free access at the point of care through tax-based public financing, but limited government spending has produced a dualised system of public and private provision. Rwanda extends coverage to informal and low-income populations through subsidised community-based insurance under strong government stewardship, though the system remains heavily reliant on donor support and household contributions. China employs segmented insurance schemes administered by local governments, integrating payroll-funded coverage for formal-sector workers with publicly subsidised residence-based schemes, achieving rapid scale but embedding regional fragmentation. These cases reflect distinct processes of institutional assembly under constraints, in which health systems are constructed through selective borrowing from classical frameworks combined with institutional innovation rooted in historical legacy, all bounded by fiscal capacity, labour-market structure, and administrative reach.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0