International Journal of Health Planning and Management最新文献

{"title":"The amended international health regulations: Implications and challenges for domestic legal frameworks.","authors":"Sarah Emami, Cedric Aperce","doi":"10.1002/hpm.3853","DOIUrl":"https://doi.org/10.1002/hpm.3853","url":null,"abstract":"<p><p>The World Health Organisation's International Health Regulations were amended in May 2024, with a number of implications for countries to amend their legal and institutional frameworks. This perspective highlights two key areas of focus in the amendments-the importance of multisectoral coordination and subnational work - and explores their links to health security challenges and to concrete country experiences. National legal and institutional frameworks constitute a key enabling mechanism for effective public health systems capable of preventing, detecting, and responding promptly to public health events and emergencies, and the recent IHR amendments provide a new impetus for WHO Member States to make these changes.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477703","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":"Turning the global health and care workforce crisis into action: The pathway to effective evidence-based policy and implementation.","authors":"Tiago Correia, Ellen Kuhlmann, Gabriela Lotta, André Beja, Rita Morais, Tomas Zapata, James Campbell","doi":"10.1002/hpm.3860","DOIUrl":"https://doi.org/10.1002/hpm.3860","url":null,"abstract":"<p><p>The global health and care workforce (HCWF) is facing an evolving crisis, requiring urgent and sustained action. There is a critical need for enhanced workforce planning, management, and leadership, which are currently at risk of being overshadowed by political inertia, particularly in the post-COVID-19 context. A comprehensive approach tailored to the specific needs of different countries is outlined here, offering actionable insights for policymakers and stakeholders to address the HCWF crisis effectively. Key areas for critical analysis and improvement include identifying major challenges, developing policies that effectively address the HCWF crisis, and strengthening the implementation of evidence-based policies. These areas are detailed based on recent developments in the international debate, with the aim of providing comprehensive guidance for understanding the problems and identifying clear actions for improvement.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477704","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":"Long-term effects of establishing outpatient pooling funds on financial protection: Empirical evidence from a quasi-natural experiment in China.","authors":"Tao Zhang, Minyan Chen","doi":"10.1002/hpm.3859","DOIUrl":"https://doi.org/10.1002/hpm.3859","url":null,"abstract":"<p><strong>Background: </strong>A limited benefit package for outpatient care in Chinese universal health coverage led to high out-of-pocket outpatient payments, and even medical impoverishment. The outpatient pooling fund model was introduced in China's Urban Employee Basic Medical Insurance to reduce cost-sharing for outpatient care. This study attempts to examine the dynamic effects of the outpatient pooling scheme on financial risk protection for its enrollees.</p><p><strong>Methods: </strong>A total of 18,097 individual-level observations covering 52 prefectures were extracted from six waves of China Health and Nutrition Survey (2000-2015). The difference-in-differences model with multiple periods and event study were employed to investigate the dynamic effects of reform on catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and potential mechanisms.</p><p><strong>Results: </strong>Our results showed outpatient pooling scheme generated a significant effect on reducing the probability of incurring CHE (β = -0.004, 95% CI = -0.009 to -0.006) and IHE (β = -0.007, 95% CI = -0.012 to -0.001), especially for elderly people over 60 years old. The realization of this effect may depend on the reduction of outpatient cost-sharing, increased outpatient care utilization, as well as decreased inpatient care utilization after reform. However, event study found the effectiveness of outpatient pooling reducing CHE and IHE occurrences appeared to be weak even insignificant in more recent years relative to the initial years of policy implementation.</p><p><strong>Conclusions: </strong>Establishing an outpatient pooling system is effective to alleviate the financial risk caused by health expenditures in China. Optimising health service delivery aimed at enhancing health insurance purchasing efficiency are deemed imperative for sustaining the policy effectiveness.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394273","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":"Strategically communicating inclusion efforts at hospitals: Trust-signalling for community engagement.","authors":"Arjun Rajkhowa, Megan Sharp, Barbara Kelly, Birgit Lang, Andrea Rizzi, Robyn Woodward-Kron","doi":"10.1002/hpm.3855","DOIUrl":"https://doi.org/10.1002/hpm.3855","url":null,"abstract":"<p><p>Trust is a challenging and complex concept and takes on particular significance in the context of community engagement and communication in healthcare. For the purpose of making health services more inclusive and of tackling discrimination where it occurs, there is a need to articulate a vision for inclusion that communities of historically disadvantaged or stigmatised patients can trust. This article considers examples of diversity and inclusion 'signals' on the public websites of two large public hospitals in Melbourne, Australia. We suggest that there is value in public communications reaffirming respect for diversity and a commitment to inclusion in health services. We also make the case for interdisciplinary research into how trust-signalling strategies, that is, rhetorical strategies employed to reassure or convince, are developed by and for health services for the purposes of community engagement, and the specific effects that they may engender. Websites' framing of messages that affirm institutional commitments to fostering an inclusive environment and addressing barriers can serve as a means of explicitly encouraging patients and healthcare workers from marginalised communities to overcome potential obstacles to fuller healthcare engagement and workforce participation respectively.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394274","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":"Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.","authors":"Junnan Jiang, Zhibing Zhang, Tuo Bingbing","doi":"10.1002/hpm.3858","DOIUrl":"https://doi.org/10.1002/hpm.3858","url":null,"abstract":"<p><strong>Background: </strong>The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid.</p><p><strong>Purpose: </strong>This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare.</p><p><strong>Methods: </strong>24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy.</p><p><strong>Results: </strong>The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2 days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent.</p><p><strong>Conclusions: </strong>Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394272","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":"Acceptability of innovative department community-based health insurance in central Mali: A mixed methods study.","authors":"Pauline Boivin, Andrainolo Ravalihasy, Dansiné Diarra, Fodé Sissoko, Seydou Diabaté, Yacouba Diarra, Laurence Touré, Valéry Ridde","doi":"10.1002/hpm.3857","DOIUrl":"10.1002/hpm.3857","url":null,"abstract":"<p><p>As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community-based health insurance (CBHI) -considered one of the pillars of this programme- must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed-method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon et al. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above-average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378433","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 what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.","authors":"Sharon Downie, Belinda Gavaghan, Megan D'Atri, Liza-Jane McBride, Andrea Kirk-Brown, Terry P Haines","doi":"10.1002/hpm.3850","DOIUrl":"https://doi.org/10.1002/hpm.3850","url":null,"abstract":"<p><strong>Background: </strong>Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined.</p><p><strong>Methods: </strong>A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions.</p><p><strong>Results: </strong>Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct.</p><p><strong>Conclusion: </strong>Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373193","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":"Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo.","authors":"Marie-Douce Primeau, Marie Jobin-Gelinas, Cécile Maleko Mayabanza, Maguy Mayaza, Geneviève Blouin","doi":"10.1002/hpm.3854","DOIUrl":"https://doi.org/10.1002/hpm.3854","url":null,"abstract":"<p><strong>Background: </strong>Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents.</p><p><strong>Aims and methods: </strong>Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n = 55; WC2: Adolescents user committee (AUC) n = 63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative.</p><p><strong>Results: </strong>Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49 years old (increase of 283% for Makala and 23% for Maluku II)).</p><p><strong>Conclusions: </strong>Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366956","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":"Illicit drug use in Limerick City: A stakeholder and policy analysis using multiple streams model.","authors":"Yaa Asuaba Duopah, Lisa Moran, Khalifa Elmusharaf, Dervla Kelly","doi":"10.1002/hpm.3856","DOIUrl":"https://doi.org/10.1002/hpm.3856","url":null,"abstract":"<p><strong>Background: </strong>The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development.</p><p><strong>Methodology: </strong>The study is qualitative and uses a hybrid technique that combines document, content, and stakeholder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematic search for grey literature were adopted as the search strategy.</p><p><strong>Results: </strong>Problem Stream: Illicit drug use and its related problems have changed. The increasing availability of drugs, increasing usage and changes in the types of drugs being used have led to increased drug-related crimes, adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug-related problems in the region. Policy Stream: The current national drug strategy 2017-2025 which informs action plans in Limerick is the first to focus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction-related services, which have evolved rapidly since their first introduction. The Mid-West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands-on approach has been adopted in the creation of strategies to tackle the drug problem.</p><p><strong>Conclusion: </strong>The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long-lasting drug policies.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336952","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":"Waiting for surgery after hip fracture-Health and/or economic risk?","authors":"Franziska Saxer, Christoph Hatz, Werner Vach","doi":"10.1002/hpm.3851","DOIUrl":"https://doi.org/10.1002/hpm.3851","url":null,"abstract":"<p><strong>Objectives: </strong>Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time.</p><p><strong>Methods: </strong>Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues.</p><p><strong>Results: </strong>In total, 2572 patients aged ≥60 years with low-energy hip fractures were included. Waiting times >48 h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10 days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs.</p><p><strong>Conclusions: </strong>While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336953","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}