International Journal of Health Planning and Management最新文献

{"title":"Purchasing Primary Care Services for Quality Chronic Care: Capitation With Performance Payments in Four Countries.","authors":"Sarah L Barber, Inke Mathauer, Megumi Rosenberg, Nicolas Larrain, Yunguo Liu, Qian Long, Anja Smith, Stevie Ardianto Nappoe, Luca Lorenzoni","doi":"10.1002/hpm.3929","DOIUrl":"https://doi.org/10.1002/hpm.3929","url":null,"abstract":"<p><p>Improving quality of care for chronic conditions is central to addressing the large burden of premature mortality from non-communicable diseases. This paper presents the main results from case studies of health care purchasing arrangements in Chile, China, Indonesia and South Africa, which involved paying providers of primary care services using capitation with performance pay to improve service quality and health outcomes for chronic conditions. In all four settings, changes to payment methods were accompanied by other enabling interventions to provide incentives to deliver health services in a better way, such as training and non-financial incentives. However, the incentives in these programs were insufficient to drive significant changes in provider behaviour needed to improve quality. Design and implementation challenges included voluntary enrolment, quality metrics, performance targets, risk adjustment, payment certainty and levels, and withholding payments. The design and implementation challenges contributed to low patient volume or provider programme uptake resulting in lower-than-expected effects. The findings from this analysis underscore the importance of adjusting quality measures for patient health risk and complexity to avoid penalising health care providers for accepting patients with higher health risks. Relative or progressive quality targets may be more appropriate where wide diversity in providers' capacities exist, particularly in national programs, and may be used to encourage gradual quality improvements over time. Uncertainty about timing and levels of payment may have also undermined impact. Withholding performance payments as a penalty may reduce resources for quality improvements in these settings.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Trend of Digital Technology Adoption in Health Industry: The Industrial Integration and Adaptation to the HITECH Act.","authors":"Jiannan Li","doi":"10.1002/hpm.3935","DOIUrl":"https://doi.org/10.1002/hpm.3935","url":null,"abstract":"<p><strong>Background: </strong>The electronic health records (EHR) serve as an important tool of collecting and storing health information (like demographics, physical activity volume, health care history), and well serve as a digital tool of facilitating industrial integration between health industry and others (e.g., sport industry, information industry). There appears growing digital technology adoption in health industry in response to the Health Information Technology for Economic and Clinical Health (HITECH) Act, and this study is to evaluate this trend.</p><p><strong>Method: </strong>This study uses the nonparametric probability density estimation to depict the distribution of EHR transition rate in different stages, and the distribution of Herfindahl-Hirschman index is used to reveal the concentration/decentralisation degree of its adoption.</p><p><strong>Finding: </strong>Rural and metropolitan regions experience progress in EHR promotion at both the primary stage (signed-up→go-live) and advanced stage (go-live→meaningful use). Rural areas might benefit more from this policy intervention, with a greater increase in the transition rate of EHR promotion at these two stages. The primary stage does not display a salient centralisation/decentralisation trend across specialities in health institutions, whereas the advanced stage displays a salient decentralisation trend as a growing number of specialities in health institutions demonstrate the meaningful use of EHRs. Besides, specialities in health institutions at a lower initial level of meaningful use of EHRs make greater progress at the advanced stage than their counterparts at a higher initial level.</p><p><strong>Conclusion: </strong>The regional gap of EHR transition is narrowing since the HITECH Act. The stimulus effect at the advanced stage is more effective for specialities in health institutions.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Economic Burden of Post-Cancer Treatment Pain Among Cancer Survivors in the United States: A Population-Based Retrospective Longitudinal Study.","authors":"Yves Paul Vincent Mbous, Rowida Mohamed, Uche Osahor, Traci J LeMasters","doi":"10.1002/hpm.3932","DOIUrl":"https://doi.org/10.1002/hpm.3932","url":null,"abstract":"<p><strong>Purpose: </strong>Post-cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long-term incremental healthcare expenditures (total, third-party, and out-of-pocket) and out-of-pocket burden among cancer survivors.</p><p><strong>Methods: </strong>A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self-Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log-link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted.</p><p><strong>Results: </strong>2125 cancer survivors had PCTP. Post-cancer treatment, 10.5%-24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%-5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1-year post-cancer treatment), and severe chronic PCTP, (≥ 5 years post-cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out-of-pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain.</p><p><strong>Conclusion: </strong>These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient-reported outcomes for pain among cancer survivors.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Private Insurers Stimulate the Function of Public Long-Term Care Insurance? Insights From China.","authors":"Yu Yan, Michael G Faure","doi":"10.1002/hpm.3933","DOIUrl":"https://doi.org/10.1002/hpm.3933","url":null,"abstract":"<p><p>In many countries, including China, private insurers are increasingly involved in public long-term care insurance (LTCI) to stimulate its functioning. Our article examines this novel approach from an economic perspective. We then use this framework to evaluate the risk differentiation and control practices of China's 15 LTCI pilots. Using these practical cases, we find that the private insurers' strategies for risk differentiation and control of adverse selection should be restricted, as they may contradict the public policy goals of solidarity and equal access to long-term care. Conversely, the strategies to address moral hazard, particularly in case of small risks and when carefully designed, could better reconcile the public policy goal with the economic goals of cost reduction and providing incentives to avoid overutilisation. Overall, a better strategy may enable private insurers to efficiently utilise their risk management capacity, without severely undermining the public aims of LTCI.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening Health Workforce in Georgia: Identifying Gaps and Integrating Evidence-Based Strategic Planning.","authors":"Giorgi Aladashvili, Mariam Kirvalidze, Aleksandre Tskitishvili, Nikoloz Chelidze, Nikoloz Tvildiani, Giorgi Pkhakadze, Thomas J Bossert, Karsten Lunze, Ilia Nadareishvili","doi":"10.1002/hpm.3922","DOIUrl":"https://doi.org/10.1002/hpm.3922","url":null,"abstract":"<p><p>Health workforce planning is essential for ensuring a resilient and well-functioning healthcare system capable of addressing population needs and responding to crises. In Georgia, an upper-middle-income country, significant challenges remain in the strategic planning, regulation, and management of the health workforce. This policy analysis evaluated health workforce planning approaches in Georgia's dynamic health system context. Health workforce planning in Georgia, guided by the National Health Strategy 2022-2030, prioritises needs-based workforce planning, professional qualifications, and nursing development. However, Georgia faces data inconsistencies, workforce imbalances, and an uneven geographic distribution of healthcare professionals, limiting the efficacy of current policies. The lack of formal health workforce planning, reliance on market-driven approaches, and weak retention strategies contribute to workforce shortages and migration. A centralised planning body, and enhancement in data collection and management, could facilitate the gradual introduction of context-relevant, evidence-based workforce planning methods. By integrating rigorous, long-term workforce planning with intersectoral collaboration and adopting innovative methods like workload-based modelling and hybrid planning methods, Georgia can create a sustainable health workforce aligned with its health system's evolving needs.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to 'Government Don't Know Me and if I Stop, They Won't Know': A Qualitative Study on the Lived Experiences of Volunteer Health Workers in the Nigerian Health System and Their Implications for the Sustainable Development Goal.","authors":"","doi":"10.1002/hpm.3930","DOIUrl":"https://doi.org/10.1002/hpm.3930","url":null,"abstract":"","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Cost and Carbon Output of Musculoskeletal Primary Care Management Decisions: A Retrospective Analysis of Electronic Health Records.","authors":"Alex Braybrooke, Melissa Pegg, Rebecca Naylor, James Bailey, James Scott, Roanna Burgess, Dahai Yu, Simon Wathall, Kelvin P Jordan, Robert Malcolm, Hayden Holmes, George Peat, Anirban Banerjee, Jonathan C Hill","doi":"10.1002/hpm.3919","DOIUrl":"https://doi.org/10.1002/hpm.3919","url":null,"abstract":"<p><strong>Background: </strong>Healthcare accounts for up to 5% of worldwide carbon emissions and costs global economies an estimated $9 trillion annually. Primary care accounts for up to one-fifth of all NHS carbon emissions, with musculoskeletal (MSK) pain accounting for 14%-30% of all primary care consultations.</p><p><strong>Method: </strong>A cost-carbon calculator model was used to undertake a retrospective economic and environmental analysis of resource use for non-inflammatory MSK pain primary care consulters. Data used to populate the model was derived from Electronic Health Records and patient surveys collected during The Multi-level Integrated Data for Musculoskeletal Health Intelligence and ActionS GP Study. The model was utilised to estimate the mean (with 95%CI's) cost and carbon output per MSK consulter, while also examining variations at two levels: (a) the Primary Care Network (PCN), and (b) the consulter's index MSK pain site.</p><p><strong>Results: </strong>One thousand eight hundred seventy-five individuals from 30 NHS primary care practices across 13 PCNs were eligible for EHR and survey data analysis. The mean carbon and cost output per person (over 6 months) was 46.91 kg CO₂e (95% CIs; 45.02, 48.81 kg CO₂e) and £182.65 (95% CIs; £178.69, £190.62), respectively, with substantial variation observed across PCNs. The resource category with the highest carbon footprint was consistently pharmacological intervention across all PCNs. Individuals who consulted for multisite/widespread pain and back pain had the highest mean carbon and cost output respectively.</p><p><strong>Conclusion: </strong>This is the first study, we are aware of, that presents data on both the environmental and economic impact of the primary care of non-inflammatory MSK pain. Future work should focus on benchmarking the cost and carbon output of MSK care pathways and standardising methods that are implemented to influence sustainable practice and policy development.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From 'Sovereign Self-Proclaimed Experts' to 'Impressionable Sceptics'-Developing a Patient Typology to Distinguish Patients' Interactions With Healthcare: A Qualitative Study in Germany.","authors":"Katharina Achstetter, Miriam Blümel, Julia Röttger, Julia Köppen, Katherine Polin, Reinhard Busse","doi":"10.1002/hpm.3923","DOIUrl":"https://doi.org/10.1002/hpm.3923","url":null,"abstract":"<p><strong>Background: </strong>Person-centredness in health systems puts patients and their preferences at the centre of healthcare. However, there is not an 'one size fits all' approach as patients are heterogenous and have varying interactions with and perceptions of healthcare, and assessments of the health system performance. This study aims to explore these patient differences by (1) identifying core attributes of patients that shape their general approach to and interactions with healthcare and (2) deriving specific patient types based on these core attributes.</p><p><strong>Methods: </strong>The qualitative study included content analysis of semi-structured, problem-oriented interviews with 27 participants selected with the aim of maximum variation and heterogeneity (e.g., regarding age, gender, health status, place of living) from the Berlin-Brandenburg region of Germany.</p><p><strong>Results: </strong>Based on the interviews with the participants, three core patient attributes were found that shape interactions with healthcare: (1) taking care of health and illness, (2) the self-assigned patient role, and (3) the patient-assigned healthcare provider role. Seven patient types were identified across (opposing) manifestations of these core attributes, ranging from 'sovereign self-proclaimed experts' (focussing-autonomous-fulfiller) to 'impressionable sceptics' (ignoring-heteronomous-seller).</p><p><strong>Conclusion: </strong>Consideration of the identified patient types and their different ways of engaging with healthcare providers and their varying perceptions of the health system can help to develop strategies to promote person-centredness in health systems. Furthermore, this typology can inform providers about the diverse ways in which patients may perceive healthcare interactions, and it can be useful for the training of future physicians and other healthcare professionals.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational and Service Management Interventions for Improving the Patient Experience With Care: Systematic Review of the Effectiveness.","authors":"Tiago S Jesus, Dongwook Lee, Manrui Zhang, Brocha Z Stern, Jan Struhar, Allen W Heinemann, Neil Jordan, Anne Deutsch","doi":"10.1002/hpm.3916","DOIUrl":"https://doi.org/10.1002/hpm.3916","url":null,"abstract":"<p><strong>Background: </strong>Healthcare managers and administrators increasingly need to develop systems, structures and operations capable of improving the patient experience performance of their organisations or service delivery units.</p><p><strong>Aim: </strong>To systematically review the effectiveness of organizational and service management interventions on standardized patient experience measure scores.</p><p><strong>Methods: </strong>Six scientific databases, speciality journals and snowballing were used to identify English-language, peer-reviewed, contemporary studies (2015-2023) that examined the impact of service management or organizational interventions on the patient experience as a primary outcome. The studies needed to include inferential statistics on standardized, patient-reported experience measures. Two independent reviewers performed the eligibility decisions and risk-of-bias appraisals.</p><p><strong>Results: </strong>Nine papers were finally included. Three papers were on discrete, service-level interventions, including two randomized controlled trials (RCTs) and one pre-post study; one RCT achieved significant improvements by delaying the timing of bedside rounding versus maintaining the early morning schedule. One non-randomized controlled study and two pre-post studies addressed organisation-wide approaches. Among those, one pre-post study achieved significant improvements by having site managers meet regularly with an organizational oversight committee to compare the units' patient-experience performance and setting improvement expectations. Finally, three observational, multi-site comparative studies were included. These addressed self-reported improvement approaches, implementation of a nursing excellence certification programme, and implementation of Patient Experience Offices. The latter was significantly associated with improved patient experience performance.</p><p><strong>Conclusion: </strong>Selected discrete service-level interventions and organizational approaches can lead to better patient experience outcomes, even though the evidence from the pre-post and observational studies should be interpreted with caution.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Willingness to Pay for Basic Health Insurance in the Netherlands: Quantitative and Qualitative Insights.","authors":"M A Meijer, A E M Brabers, N Stadhouders, J D De Jong","doi":"10.1002/hpm.3926","DOIUrl":"https://doi.org/10.1002/hpm.3926","url":null,"abstract":"<p><strong>Background: </strong>Rising healthcare costs could undermine people's willingness to contribute to the healthcare system. Therefore, we investigated people's willingness to pay (WTP) for basic health insurance. We also studied reasons for the willingness or unwillingness to pay.</p><p><strong>Methods: </strong>A mixed methods study was performed. An online survey was sent out to 1500 members of the Dutch Health Care Consumer Panel in May 2023 (51% response rate, N = 760). WTP was assessed using the contingent valuation methodology. Reasons for the willingness or unwillingness to pay were obtained via 15 semi-structured interviews. Thematic analysis was used to analyse the interviews.</p><p><strong>Results: </strong>People were, on average, willing to pay €160 per month for basic health insurance (€153-167 95% CI). Of the respondents, 58% (N = 443) was willing to pay more than the lowest monthly premium of €140 in 2023. WTP was positively correlated to income, age, and education. The interviews indicated that the ability to pay, healthcare consumption, care included in the basic health insurance package, organisation of the health insurance system, coverage of risk, and accessibility of care play a role in people's willingness or unwillingness to pay.</p><p><strong>Conclusions: </strong>Most people in the Netherlands were willing to pay more for basic health insurance than the current lowest premium. People valued that health insurance allowed them and others to access healthcare services. As the premium is expected to increase in the coming years, support for the healthcare system may erode, as interviews indicated that the ability to pay is an important condition of the WTP.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}