Health Policy最新文献

{"title":"Common institutional ownership and the erosion of competition in the American health insurance market: A quantitative analysis","authors":"Kevin Smith","doi":"10.1016/j.healthpol.2025.105316","DOIUrl":"10.1016/j.healthpol.2025.105316","url":null,"abstract":"<div><h3>Background</h3><div>Empirical studies have shown that when large institutional investors and private equity funds own a significant stake in multiple publicly traded firms within an industry, this common ownership may lead to anti-competitive behavior. In 2010, the Affordable Care Act (ACA) was passed. This law created health insurance exchanges that allowed for Americans to purchase health insurance plans directly on a marketplace. The insurers on this marketplace have common institutional owners, that could influence the level of competition in these markets.</div></div><div><h3>Objective</h3><div>To assess the causal effects of common ownership on competition in the US health insurance market.</div></div><div><h3>Methods</h3><div>To identify the causal impact of common ownership, I use two empirical strategies: the Arellano-Bond Dynamic Panel Model and Bartik-style Instruments. Data on firm ownership came the paper, “Common Ownership Data: Scraped SEC form 13F filings for 1999-2017” by Matthew Backus, Christopher Conlon, and Michael Sinkinson.</div></div><div><h3>Results</h3><div>The results show that a one standard deviation increase in common ownership leads to a 7.7 % increase in monthly premiums charged for certain health insurance plans. This finding is robust to different model specifications and suggests that common ownership reduces competition in the health insurance exchanges.</div></div><div><h3>Conclusions</h3><div>The results from this paper indicate that policymakers and regulators need to formulate policies that limit the amount that institutional investors and private equity funds can own of companies in the health insurance industry in the US. Additionally, policymakers need to make more data on firm ownership available, as the data that is available has quality issues.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105316"},"PeriodicalIF":3.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824152","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}

{"title":"Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022","authors":"Qing Xia ,&nbsp;Steven M McPhail ,&nbsp;Clifford Afoakwah ,&nbsp;Linh K Vo ,&nbsp;Megumi Lim ,&nbsp;David Brain ,&nbsp;John Paul Kuwornu ,&nbsp;Hannah E. Carter","doi":"10.1016/j.healthpol.2025.105319","DOIUrl":"10.1016/j.healthpol.2025.105319","url":null,"abstract":"<div><h3>Background</h3><div>Since the introduction of cost-utility analysis (CUA) in the 1990s, its methodologies and applications have evolved significantly in Australia.</div></div><div><h3>Objectives</h3><div>To provide a comprehensive overview of the volume, trends, and characteristics of the application of CUA in healthcare decision-making.</div></div><div><h3>Methods</h3><div>Bibliometric analysis of published CUAs identified from the Cost-Effectiveness Analysis Registry, a `1comprehensive source of CUA data between 1992 and 2022. Multinomial logistic regression models were conducted to explore the associations between ICERs and variables including sponsorship, perspective, and discount rate.</div></div><div><h3>Results</h3><div><em>N</em> = 484 unique Australian-based CUAs were analysed. Over the last three decades, the volume and quality of CUAs in Australia have steadily increased. Commonly evaluated interventions included pharmaceuticals (21.5 %), health education/behaviour (18.0 %), and models of care (16.6 %), while diseases of circulatory system, cancers, and metabolic diseases were the most studied health conditions. Only nine CUAs involved First Nations people. Most CUAs (72.9 %) were conducted from a healthcare payer perspective, with only 19.0 % adopting a societal perspective. Approximately half of studies applied a 5 % discount rate, and 50.4 % used a $50,000 WTP threshold. 14.7 % CUAs were sponsored by industry. Regression analyses showed that industry sponsorship, societal perspective, and lower discount rate were positively associated with lower ICERs.</div></div><div><h3>Conclusions</h3><div>The increasing volume of CUAs underscores the importance of efficient allocation of scare resources in Australian health system. However, gaps remain, particularly in the inclusion of First Nations populations and the societal costs. Further research is needed to address these gaps and to evaluate the impact of sponsorship and discounting on CUA outcomes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105319"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826300","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}

{"title":"The ethics of behaviour-based insurance models: Solidarity-based concerns in Germany's statutory health insurance","authors":"Carl Justus Bredthauer ,&nbsp;Eva Kuhn ,&nbsp;Alena Buyx","doi":"10.1016/j.healthpol.2025.105318","DOIUrl":"10.1016/j.healthpol.2025.105318","url":null,"abstract":"<div><div>Sickness funds have begun to harness digital behavioural data to incentivise physical activity in their members. This ethical and societal effects of this phenomenon remain largely unclear, especially in solidarity-based insurance systems. Therefore, this study analysed the risks and benefits of such programmes with respect to solidarity against the background of recent efforts by German statutory health insurance funds to integrate digital tracking data into their bonus programmes. Key, potential benefits include new forms of solidarity that may emerge based on sharing personal health data. The incentives introduced by these reward programmes could lead to efficiency gains used to benefit society. However, three conceptual pitfalls have been identified: First, the data gathering method may penalise certain vulnerable groups. Such discrimination could, however, be avoided by minimising barriers to participation. Second, digitally mediated bonus programmes may create deadweight effects, i.e. beneficiaries are likely to already be healthy and active. Consequently, behavioural targets should be designed to consider individual prerequisites. Lastly, linking premiums to behaviour might diminish solidarity with poor risks within statutory health insurances and between statutory and private health insurance. Hence, this study aimed to stimulate debate on the ethical and societal implications of the systemic integration of eHealth innovations into healthcare systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105318"},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837919","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}

{"title":"Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe","authors":"Brigitte Michelsen ,&nbsp;Mikkel Østergaard ,&nbsp;Michael John Nissen ,&nbsp;Adrian Ciurea ,&nbsp;Burkhard Möller ,&nbsp;Lykke Midtbøll Ørnbjerg ,&nbsp;Pavel Horák ,&nbsp;Bente Glintborg ,&nbsp;Alan MacDonald ,&nbsp;Karin Laas ,&nbsp;Tuulikki Sokka-Isler ,&nbsp;Bjorn Gudbjornsson ,&nbsp;Florenzo Iannone ,&nbsp;Pasoon Hellamand ,&nbsp;Tore Kristian Kvien ,&nbsp;Ana Maria Rodrigues ,&nbsp;Catalin Codreanu ,&nbsp;Ziga Rotar ,&nbsp;Isabel Castrejón ,&nbsp;Johan Karlsson Wallman ,&nbsp;Merete Lund Hetland","doi":"10.1016/j.healthpol.2025.105311","DOIUrl":"10.1016/j.healthpol.2025.105311","url":null,"abstract":"<div><h3>Background</h3><div>Studies on national policies for biologics are warranted.</div></div><div><h3>Objectives</h3><div>To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries’ socio-economic status.</div></div><div><h3>Methods</h3><div>An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.</div></div><div><h3>Results</h3><div>National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.</div></div><div><h3>Conclusion</h3><div>The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105311"},"PeriodicalIF":3.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833693","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}

{"title":"What are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries","authors":"Matthew Tracey ,&nbsp;Katharine Schulmann ,&nbsp;Florian Tille ,&nbsp;Thomas Rice ,&nbsp;Julien Mercille ,&nbsp;Rob Timans ,&nbsp;Sara Allin ,&nbsp;Alexis Dottin ,&nbsp;Sanna Syrjälä ,&nbsp;Tiia Sotamaa ,&nbsp;Ilmo Keskimäki ,&nbsp;Bernd Rechel","doi":"10.1016/j.healthpol.2025.105312","DOIUrl":"10.1016/j.healthpol.2025.105312","url":null,"abstract":"<div><div>Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent — and how — subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105312"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837920","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}

{"title":"Time to completion of conditions required by Health Canada after approving new drugs: A cohort study","authors":"Joel Lexchin","doi":"10.1016/j.healthpol.2025.105314","DOIUrl":"10.1016/j.healthpol.2025.105314","url":null,"abstract":"<div><h3>Background</h3><div>To ensure that promising drugs for serious illnesses reach Canadians in a timely manner, Health Canada can approve them conditionally provided companies commit to conducting confirmatory studies to verify the benefits.</div></div><div><h3>Objective</h3><div>To determine how long it takes until the conditions are fulfilled and if certain factors affect that length of time.</div></div><div><h3>Methods</h3><div>A list of conditional approvals for new drugs and new indications for existing drugs to the end of 2024 was compiled from Health Canada databases. Orphan drug status was determined from the US Food and Drug Administration databases. Kaplan-Meier survival curves were constructed to determine how long it took to complete the studies.</div></div><div><h3>Results</h3><div>There were 153 conditional approvals: 91 were fulfilled, 45 have not been fulfilled as of January 18, 2025 and 17 were withdrawn. The median time for fulfillment was 1200 (IQR 777, 1852) days. Orphan drug status and whether the conditional approval was for a new drug or a new indication for an existing drug did not affect the time to completion.</div></div><div><h3>Conclusions</h3><div>Some NOC/c take considerable time to be fulfilled. Health Canada should require studies to be underway at the time that a NOC/c is granted except in exceptional circumstances and it should be transparent about the completion date for confirmatory studies and provided detailed reports about any delays. In the case of delays that cannot be justified it should be given the power to impose significant financial penalties on manufacturers through the NOC/c pathway being converted from a policy into legislation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105314"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of access to healthcare services as a condition for territorial equity. A methodological approach for sparsely populated rural areas","authors":"Héctor Martínez Sánchez-Mateos,&nbsp;Ángel Raúl Ruiz Pulpón","doi":"10.1016/j.healthpol.2025.105310","DOIUrl":"10.1016/j.healthpol.2025.105310","url":null,"abstract":"<div><div>Access to basic healthcare services poses a significant challenge for sparsely populated rural areas within the European Union, impacting fundamental principles such as territorial equity. This challenge is intensified by current demographic trends, including depopulation and ageing, which affect both the availability of healthcare professionals and the increased demand for efficient healthcare services for the older population. To address this issue, the present study adopts a methodological approach that uses distance and transport time to measure the accessibility of different rural municipalities to healthcare facilities. This study focuses on the Autonomous Region of Castilla-La Mancha (Spain) as a representative territory for the abovementioned demographic dynamics. The main results indicate a clear relationship between negative demographic indicators and poorer healthcare access, especially in rural areas with limited transportation infrastructure. Access to primary healthcare is generally well distributed, with &gt;90 % of rural population living within 15 min of a basic healthcare facility, while hospitals are less accessible for the rural population, with &gt;40 % of the sample needing 30 min to reach one. The sample is also highly sensitive to the population density and ageing rates. As a significant contribution, a universal methodology is presented that can be applied to other rural territories with a significant ageing population, enabling territorial planning policies to optimize quality healthcare in line with the active ageing policies promoted by the United Nations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105310"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817362","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}

{"title":"The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada","authors":"Caroline King ,&nbsp;M. Ruth Lavergne ,&nbsp;Kimberlyn McGrail ,&nbsp;Erin Strumpf ,&nbsp;QC-BC Patient Enrolment Project Team","doi":"10.1016/j.healthpol.2025.105313","DOIUrl":"10.1016/j.healthpol.2025.105313","url":null,"abstract":"<div><div>Affiliation, defined as having a usual source of care, revealed by patterns of repeated interactions between the patient and a clinician over time, can influence patients’ care experience, continuity of care and health outcomes. Many jurisdictions implement primary care enrolment policies, with the motivation to increase affiliation and thereby improve downstream patient outcomes. However, there is little evidence on the impacts of these policies on patient-physician affiliation.</div><div>Using health administrative data, we evaluated the population-level effects of two policies that encourage primary care enrolment on affiliation in Quebec, Canada. We used quasi-experimental study designs (difference-in-difference and interrupted-time-series) to estimate changes in affiliation that could be attributed to the introduction of these policies. The 2003 policy targeted the enrolment of elderly and/or chronically ill patients, whereas the 2009 policy targeted the general population. We used three measures of patient-physician affiliation: dichotomous and continuous usual provider continuity, and the Reporting a Regular Medical Doctor (RRMD) index.</div><div>Our analyses for both policies did not yield substantively important changes in our outcomes at the population level. Our effect estimates for both policies were stable under several robustness checks specific to each method. Our results suggest that policies that encourage enrolment do not, on their own, have an impact on patient-physician affiliation. If enrolment policies are not sufficient to increase patient-physician affiliation, further research is needed to understand the factors that influence both affiliation and other downstream outcomes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105313"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821493","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}

{"title":"Twenty years evaluating the health impact of urban policies in the city of Barcelona","authors":"María-José López ,&nbsp;Katherine Pérez ,&nbsp;Xavier Continente ,&nbsp;Carme Borrell","doi":"10.1016/j.healthpol.2025.105306","DOIUrl":"10.1016/j.healthpol.2025.105306","url":null,"abstract":"<div><div>The objective of this study is to describe the evaluation of the impact of non-health policies in health in the city of Barcelona, describing the main methodologies used and the main outcomes measured, as well as sharing some of the lessons learned during these years.</div><div>We reviewed the health evaluation of urban policies carried out by the Public Health Agency of Barcelona during the last 20 years, excluding those promoted by the health sector. For each evaluation we have described the evaluative design, the methodology used to collect data and the main outcomes measured.</div><div>More than 20 non-health policies have been evaluated in terms of health in the city of Barcelona. In most cases a quasi-experimental design has been used, having measured outcomes related to health and health-determinants, using quantitative methodology in all cases, combined with qualitative methodology in some evaluations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105306"},"PeriodicalIF":3.6,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783089","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}

{"title":"Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption","authors":"Noémie Malléjac ,&nbsp;Zeynep Or","doi":"10.1016/j.healthpol.2025.105309","DOIUrl":"10.1016/j.healthpol.2025.105309","url":null,"abstract":"<div><div>The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated.</div><div>Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105309"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}