Health Economics Policy and Law最新文献

Making care primary: a renewed investment into primary care. 初级保健：重新对初级保健进行投资。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-07-15 DOI: 10.1017/S174413312510011X

Cameron J Sabet, Bhav Jain, Sandeep Palakodeti

{"title":"Making care primary: a renewed investment into primary care.","authors":"Cameron J Sabet, Bhav Jain, Sandeep Palakodeti","doi":"10.1017/S174413312510011X","DOIUrl":"https://doi.org/10.1017/S174413312510011X","url":null,"abstract":"The Making Care Primary (MCP) model represents a sharp shift in Medicare's approach to primary care, yet its current design risks duplicating failures from prior alternative payment models. Our editorial suggests refinements to address these gaps. To prevent early provider dropout from MCP's rigid track-based system, we propose a sliding-scale infrastructure payment model that adjusts based on practice needs rather than abrupt phase-outs. Given MCP's reliance on community-based organisations (CBOs) for social determinants of health interventions, we also advocate for direct, outcomes-based contracts between providers and CBOs, ensuring accountability for patient outcomes rather than passive referrals. We recommend that MCP enforce data-sharing mandates for commercial insurers and Medicaid agencies, drawing from Washington State's successful Multi-Payer Collaborative, to avoid payer disengagement that plagued previous multi-payer models. To expand beyond conventional quality measures, we propose integrating patient-centred outcomes from the International Consortium for Health Outcomes Measurement, making sure MCP captures meaningful clinical impact. Finally, we propose programme adjustments frequently at two- to three-year intervals to refine risk adjustment methodologies. These approaches could enhance MCP's sustainability, preventing the financial instability and misaligned incentives that undermined past value-based care initiatives.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638328","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

Lead-attributable productivity losses in low- and middle-income countries. 铅在低收入和中等收入国家造成的生产力损失。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-07-03 DOI: 10.1017/S1744133125100121

Bret Ericson, Mary Jean Brown

{"title":"Lead-attributable productivity losses in low- and middle-income countries.","authors":"Bret Ericson, Mary Jean Brown","doi":"10.1017/S1744133125100121","DOIUrl":"https://doi.org/10.1017/S1744133125100121","url":null,"abstract":"This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose-response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-12"},"PeriodicalIF":3.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555237","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

Time for a paradigm shift? Exploring competition regulation and its relationship with the rising global burden of industrial epidemics. 是时候转变思维模式了？探讨竞争管制及其与工业流行病日益加重的全球负担的关系。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-06-11 DOI: 10.1017/S1744133125000131

Benjamin Wood, Sven Gallasch, Nicholas Shaxson, Katherine Sievert, Gary Sacks

{"title":"Time for a paradigm shift? Exploring competition regulation and its relationship with the rising global burden of industrial epidemics.","authors":"Benjamin Wood, Sven Gallasch, Nicholas Shaxson, Katherine Sievert, Gary Sacks","doi":"10.1017/S1744133125000131","DOIUrl":"https://doi.org/10.1017/S1744133125000131","url":null,"abstract":"Competition regulation plays a key role in determining firm size, market structure, and what firms can do with their market power. In this paper, we explore how competition regulation in many countries has largely tolerated rising industry concentration and market power in harmful consumer product industries, which, in turn, has likely facilitated an increase in preventable death and disease associated with such industries (ie. industrial epidemics). One important reason for this tolerance has been the rise of the 'consumer welfare' standard, which contends that competition regulators should only focus on a narrow set of concerns mostly relating to consumer price and output. Yet, recent developments shed light on potential avenues through which competition regulation could work more synergistically with public health policies and programmes. While discussions on how to leverage competition regulation along these lines are invariably contested and complex, we argue that it is critical that public health advocates engage with these discussions.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-17"},"PeriodicalIF":3.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267614","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

Primary care as determinant of COVID-19 and influenza vaccine uptake. 初级保健是COVID-19和流感疫苗接种的决定因素。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-06-11 DOI: 10.1017/S1744133125100108

Zuzana Kotherová, Christophe Premat

{"title":"Primary care as determinant of COVID-19 and influenza vaccine uptake.","authors":"Zuzana Kotherová, Christophe Premat","doi":"10.1017/S1744133125100108","DOIUrl":"https://doi.org/10.1017/S1744133125100108","url":null,"abstract":"This article examines the relationship between primary care (PC) settings and the uptake of COVID-19 and influenza vaccines in 29 European countries. Using multiple linear regression, the study evaluates whether PC settings influence vaccine uptake (VU) for these two vaccines. Based on secondary data, the study shows that people behave differently in the context of COVID-19 and influenza vaccination. Our findings suggest that health systems relied less on PC during the pandemic, not fully using its potential for COVID-19 vaccination. Even if the bivariate correlations highlight the importance of PC, the regression analysis did not verify a direct relation between PC strength and the COVID-19 VU. In contrast, for influenza vaccination, PC strength was the only significant variable. The core research message is that systematic comparative evidence regarding the relation between PC and VU is needed. Based on the belief that appropriate PC setting and adequate general practitioners (GP) involvement in vaccination could contribute to higher VU, the main policy implication of the research is that more attention needs to be paid to PC setting and the role of GPs in vaccination policy.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267613","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

Regulated markets and rationalised myths: an institutional perspective on value-based purchasing in the Netherlands. 规范的市场和合理化的神话：荷兰基于价值的购买的制度视角。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-06-05 DOI: 10.1017/S174413312500012X

Gijs Steinmann, Hester van de Bovenkamp, Antoinette de Bont, Lonneke Timmers, Diana Delnoij

{"title":"Regulated markets and rationalised myths: an institutional perspective on value-based purchasing in the Netherlands.","authors":"Gijs Steinmann, Hester van de Bovenkamp, Antoinette de Bont, Lonneke Timmers, Diana Delnoij","doi":"10.1017/S174413312500012X","DOIUrl":"https://doi.org/10.1017/S174413312500012X","url":null,"abstract":"In the Dutch health care system of regulated competition, health insurers are assigned the crucial role of prudent purchasers and expected to critically contract providers based on the quality and prices of their services. Thus far, however, these organisations have struggled to fulfil this role. This study sheds new light on the purchasing behaviour of Dutch health insurers. We examine how insurers perceive the context in which the value-based purchasing of hospital care should take shape, and we draw on insights from institutional theory to frame our analysis. Our findings are based on a series of semi-structured interviews (n = 18) with employees and representatives of several insurer companies whose combined market shares add up to over 90 per cent of all premium payers. Our analysis highlights an environment in which market mechanisms are tangled up with historically rooted budgeting practices, where insurers are pressured to sustain rather than critique hospitals, and where self-regulating medical professionals are firmly supported by society's deep-seated belief in the quality of their services. Like many other organisations, Dutch health insurers tend to conform to their institutional environment. While this conformity may aid them in organisational stability and survival, it also restricts their ability to purchase prudently.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227186","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

The relationship between enrollees' perceptions of health insurers' tasks and their trust in them. 参保人对健康保险公司任务的认知与对他们的信任之间的关系。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-05-28 DOI: 10.1017/S1744133125000039

Frank J P van der Hulst, Berdien A Prins, Anne E M Brabers, Rob Timans, Judith D de Jong

{"title":"The relationship between enrollees' perceptions of health insurers' tasks and their trust in them.","authors":"Frank J P van der Hulst, Berdien A Prins, Anne E M Brabers, Rob Timans, Judith D de Jong","doi":"10.1017/S1744133125000039","DOIUrl":"https://doi.org/10.1017/S1744133125000039","url":null,"abstract":"Background: Health insurers' role in healthcare systems based on managed competition comprises various tasks. Misconceptions about these tasks may result in low public trust, which may hamper health insurers in performing their tasks. This study examines the relationship between enrollees' perceptions of health insurers' tasks and their trust in them.Methods: A questionnaire in November 2021 asked respondents to indicate to what extent health insurers have to perform certain tasks, whether they actually perform them, and whether they think these tasks are important. Trust was measured using a validated multiple-item scale. The results from 837 respondents (56 per cent response rate) were analysed using multivariate regression models.Results: A larger mismatch between enrollees' expectations about health insurers' tasks and their actual statutory tasks is related to less trust regarding the categories 'controlling healthcare costs' and 'mediation and quality of care'. Second, a larger mismatch between expectations and actually performed tasks is related to less trust for all categories. Importance of tasks only affects this relationship concerning 'informing about price and availability of care'.Conclusions: This study emphasises the importance of reducing enrollees' misconceptions as trust in health insurers is necessary to fulfil their role as purchaser of care.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-25"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162838","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

Judicial claims for access to treatment in the private health insurance sector in Brazil. 巴西私营医疗保险部门获得治疗的司法索赔。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-05-27 DOI: 10.1017/S1744133125000106

Daniel Wei Liang Wang, Natalia Pires de Vasconcelos, Ezequiel Fajreldines Dos Santos, Fernanda Mascarenhas de Souza, Luísa Bolaffi Arantes, Nathalia Molleis Miziara, Bruno da Cunha de Oliveira, Jacqueline Leite de Souza, Ana Maria Malik

{"title":"Judicial claims for access to treatment in the private health insurance sector in Brazil.","authors":"Daniel Wei Liang Wang, Natalia Pires de Vasconcelos, Ezequiel Fajreldines Dos Santos, Fernanda Mascarenhas de Souza, Luísa Bolaffi Arantes, Nathalia Molleis Miziara, Bruno da Cunha de Oliveira, Jacqueline Leite de Souza, Ana Maria Malik","doi":"10.1017/S1744133125000106","DOIUrl":"https://doi.org/10.1017/S1744133125000106","url":null,"abstract":"While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-19"},"PeriodicalIF":3.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152273","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

The still incomplete pursuit of universal access to medicines. 普遍获得药物的努力仍未完成。

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-05-22 DOI: 10.1017/S1744133125000040

Paloma Fernández, Alicia Del Llano, Jaume Vidal, Jaime Espín, Juan E Del Llano

{"title":"The still incomplete pursuit of universal access to medicines.","authors":"Paloma Fernández, Alicia Del Llano, Jaume Vidal, Jaime Espín, Juan E Del Llano","doi":"10.1017/S1744133125000040","DOIUrl":"https://doi.org/10.1017/S1744133125000040","url":null,"abstract":"A substantial share of the global population continues to face barriers to accessing essential medicines. While the pharmaceutical industry's business model has successfully facilitated the development of innovative medications, efforts to promote universal access to medicines (UAM) remain ineffective. This paper critically assesses the existing barriers to global access to medicines, including the role of unsuitable governance, the protection of intellectual property rights, and other market barriers such as shortages, quality shortcomings, and high prices. Furthermore, we explore a number of promising potential strategies that can help towards achieving the UAM. Specifically, we evaluate the evidence from various initiatives, including alternative models of innovation, manufacturing, procurement, intellectual property management, and structural/organisational operations. We argue that the effective realisation of UAM requires a robust framework to implement these initiatives. This framework must strike a delicate balance between addressing public health needs, incentivising research and development, and ensuring affordability. Achieving such a balance encompasses a careful oversight and collaboration between national and international regulatory bodies.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-13"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120796","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

High-risk individuals in voluntary health insurance markets: the elephant in the room? 自愿医疗保险市场中的高风险人群：房间里的大象？

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-05-15 DOI: 10.1017/S1744133125000118

Florian Buchner, Frederik T Schut

{"title":"High-risk individuals in voluntary health insurance markets: the elephant in the room?","authors":"Florian Buchner, Frederik T Schut","doi":"10.1017/S1744133125000118","DOIUrl":"https://doi.org/10.1017/S1744133125000118","url":null,"abstract":"The standard analytical framework of insurance markets by Einav and Finkelstein (EF) focuses on the problem of welfare loss for low-risk individuals. A key assumption of this framework is that demand and cost curves are tightly linked, meaning that people are willing to pay a price equal to their expected cost plus a risk premium. Using data from the German risk-adjustment system we show that the distribution of expected health care costs is extremely skewed. We show that incorporating the extreme skewness of predictable individual health care expenses in the EF framework has important welfare consequences, which are typically overlooked when using this framework for analysing the negative welfare effects of voluntary health insurance markets with asymmetric information. Rather than the welfare loss of low-risk individuals due to underinsurance, the main problem of voluntary health insurance markets is the welfare loss of high-risk individuals not getting access to health insurance and affordable health care. We discuss that among the policy approaches to reduce this problem, mandatory health insurance with mandatory cross subsidies is likely to be the most effective, which is typically not recognised when focusing primarily on the welfare loss for low-risk individuals.","PeriodicalId":46836,"journal":{"name":"Health Economics Policy and Law","volume":" ","pages":"1-14"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081320","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

Has regional decentralisation saved lives during the COVID-19 pandemic? 在COVID-19大流行期间，区域分散是否挽救了生命？

IF 3 3区医学

Health Economics Policy and Law Pub Date : 2025-05-15 DOI: 10.1017/S1744133125000052

Beatriz González López-Valcárcel, Guillem Lopez-Casasnovas

引用次数: 0