Health Policy最新文献

Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework 识别患有罕见疾病的老年人在健康方面面临的不平等：系统文献综述及伦理范围和资源分配框架建议。

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-26 DOI: 10.1016/j.healthpol.2024.105176

{"title":"Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework","authors":"","doi":"10.1016/j.healthpol.2024.105176","DOIUrl":"10.1016/j.healthpol.2024.105176","url":null,"abstract":"<div><div>Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an <em>Ethical Spectrum and Resource Allocation Framework</em>, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332746","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}

引用次数: 0

Exploring assisted dying policies for mature minors: A cross jurisdiction comparison of the Netherlands, Belgium & Canada 探索针对成年未成年人的协助死亡政策：荷兰、比利时和加拿大的跨司法管辖区比较。

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-24 DOI: 10.1016/j.healthpol.2024.105172

{"title":"Exploring assisted dying policies for mature minors: A cross jurisdiction comparison of the Netherlands, Belgium & Canada","authors":"","doi":"10.1016/j.healthpol.2024.105172","DOIUrl":"10.1016/j.healthpol.2024.105172","url":null,"abstract":"<div><div>Medical Assistance in Dying (MAID) was decriminalized in Canada in 2016 for individuals 18 years or older who met eligibility criteria. Currently, individuals younger than 18 years are legally permitted to access an assisted death in the Netherlands and Belgium, but not in Canada. To-date, no work has compared factors shaping the policy processes and outcomes in these three countries. Therefore, our objective was to explore the legalities of assisted dying for minors in the Netherlands and Belgium, along with how each jurisdiction arrived at their respective policies and why the trajectory differed in Canada. After screening and compiling peer-reviewed and grey literature, we used Yanow's interpretive method for comparative work to review included materials. We framed findings using Hajer's discourse coalition theory. The Dutch and Belgian contexts relied upon a parliamentary approach in legalizing assisted dying for mature minors that emphasized suffering, whereas Canada's approach was initiated by a Supreme Court of Canada decision and emphasized human rights. While the Netherlands and Belgium viewed mature minors as capable to make decisions about assisted dying, the Canadian position on mature minors’ decisional capacity with respect to assisted dying remains unsettled. This work contributes to understanding how context and sociopolitical values shape assisted dying legislations and treatment of mature minors, while highlighting areas requiring further study amid ongoing debate in Canada.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332745","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

Health effects of introducing an unconditional child benefit in Poland: Evidence from a difference in differences analysis 波兰引入无条件儿童福利对健康的影响：差异分析的证据

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-21 DOI: 10.1016/j.healthpol.2024.105169

引用次数: 0

Freedom of choice for specialized consultation in Portugal: An observational analysis of response to hospital quality 葡萄牙专科门诊的自由选择：对医院质量反应的观察分析

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-17 DOI: 10.1016/j.healthpol.2024.105163

{"title":"Freedom of choice for specialized consultation in Portugal: An observational analysis of response to hospital quality","authors":"","doi":"10.1016/j.healthpol.2024.105163","DOIUrl":"10.1016/j.healthpol.2024.105163","url":null,"abstract":"<div><h3>Background</h3><p>Portugal introduced freedom of choice for initial specialist consultations in 2016 to boost quality via competition. However, for tangible benefits, specialized care demand must be quality-elastic. This research probes the relation between choosing hospital out the residence area and their quality traits.</p></div><div><h3>Methods</h3><p>We used data for all primary consultation requests from primary care centres to hospitals from 1/1/2017 to 31/12/2018 (<em>n</em> = 3,346,335). We modelled the choice of a hospital as a function of its quality characteristics, adjusting for area-based socioeconomic variables using logistic regressions.</p></div><div><h3>Results</h3><p>Results indicate that patients and their general practitioners consider quality indicators when choosing a hospital. Higher mortality, longer waiting times and higher readmission rates at the hospital of origin were positively associated with the patient's choice. Freedom of choice is less used when the distance to the hospital of origin increases. Similar patterns were observed for larger hospitals and those with academic status.</p></div><div><h3>Discussion</h3><p>This study underscores the relevance of quality considerations in hospital selection by both patients and their general practitioners (GPs). The implications are two-fold. Firstly, improving quality appears as a factor to increase attractiveness, so that hospital competition may lead to improved health outcomes. Secondly, it highlights that hospital financing should include an activity dimension in which “money follows the patient”, otherwise no financial incentive exists to improve quality. Hence, the current hospital financing model and the limited possibility to choose in certain areas limit the potential of quality improvement based on enhanced attractivity. Decision makers should be aware that quality is a driver of patient choice, as our study demonstrates, and adapt the system to take advantage of this reality.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241318","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

Enhancing rural community engagement through palliative care networks: A scoping review 通过姑息关怀网络加强农村社区参与：范围界定审查

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-14 DOI: 10.1016/j.healthpol.2024.105165

{"title":"Enhancing rural community engagement through palliative care networks: A scoping review","authors":"","doi":"10.1016/j.healthpol.2024.105165","DOIUrl":"10.1016/j.healthpol.2024.105165","url":null,"abstract":"<div><p>Palliative care is a crucial discipline that alleviates suffering and enhances the quality of life for patients with life-limiting illnesses and their families. However, there is gap globally between the need for and availability of these services. Integrated health service networks offer a promising solution to address this gap in rural areas, by coordinating care across different levels and sectors. This scoping review aimed at identifying the key characteristics of palliative care networks in rural communities. A broad search without time limits was conducted in four databases. Analysis and synthesis were conducted using Latent Dirichlet Allocation topic modeling. Sixteen studies were included, revealing four key themes regarding the development of palliative care networks in rural areas: community engagement is essential to secure the reach of rural networks, tailored approaches acknowledging diversity enrich these networks, team-centric efforts involving stakeholder coordination ensure successful implementation, and a multifaceted approach—empowering non-traditional stakeholders and incorporating technology resources into primary health services—dynamizes palliative care delivery in rural areas. These findings underscore the potential of collaborative and innovative approaches to enhance the accessibility and effectiveness of palliative care in underserved rural communities. Further cost-effectiveness studies are warranted to better understand the impact these strategies can have on health systems.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001751/pdfft?md5=055aac68c7df71e3cd4fbbad5142865c&pid=1-s2.0-S0168851024001751-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241320","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}

引用次数: 0

Development of a practical framework and indicators for monitoring integrated long-term health and care needs and service use 为监测长期健康和护理综合需求及服务使用情况制定实用框架和指标

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-14 DOI: 10.1016/j.healthpol.2024.105167

{"title":"Development of a practical framework and indicators for monitoring integrated long-term health and care needs and service use","authors":"","doi":"10.1016/j.healthpol.2024.105167","DOIUrl":"10.1016/j.healthpol.2024.105167","url":null,"abstract":"<div><div>This case study presents an evidence-building approach to support policy planning for integrated health and care delivery for older adults. We developed an integrated needs-assessment framework to monitor the complex long-term medical and care needs of older individuals, using routinely collected, standardized needs-assessment and utilization data from the public health and long-term care (LTC) insurance systems in South Korea. We also developed a set of misuse indicators and analyzed service utilization patterns, while accounting for their varying types of needs. Approximately 11 % of older Koreans were identified as having complex long-term medical and care needs, which were categorized into four distinct need groups. More than one-third of those in the higher-medical/lower-care needs group stayed in LTC hospitals for six months or more during the year, and about one-third of those in the higher-medical/higher-care needs group inappropriately resided in LTC facilities, where medical services are limited. The newly developed integrated needs-assessment framework and misuse indicator set provide practical tools for monitoring the extent and nature of complex needs, as well as patterns of over- or under-utilization of health and care services over time. The empirical evidence gathered here highlights the need for reforms in South Korea's health and LTC systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318532","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}

引用次数: 0

Drug company methodologies used for reporting in the UK pharmaceutical industry payment transparency database between 2015 and 2019: A content analysis 2015 年至 2019 年英国制药业支付透明度数据库中用于报告的制药公司方法：内容分析

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-13 DOI: 10.1016/j.healthpol.2024.105155

{"title":"Drug company methodologies used for reporting in the UK pharmaceutical industry payment transparency database between 2015 and 2019: A content analysis","authors":"","doi":"10.1016/j.healthpol.2024.105155","DOIUrl":"10.1016/j.healthpol.2024.105155","url":null,"abstract":"<div><p>Pharmaceutical companies spend hundreds of millions of pounds on marketing/R&D-related payments annually to healthcare organisations and healthcare professionals. UK pharmaceutical industry self-regulatory bodies require member companies who sign up to their code of conduct to publish details of their payments. They are also required to publish the methodologies underlying these payments, namely methodological notes. This study aimed to analyse UK pharmaceutical companies’ methodological notes and their adherence to the Association of the British Pharmaceutical Industry code of conduct and other relevant guidance. We conducted a content analysis of methodological notes for the years 2015, 2017 and 2019 and assessed companies’ adherence to self-regulatory bodies’ requirements and recommendations for methodology disclosure. Overall, 90 companies made payment disclosures in all three years, publishing 269 methodological notes. We found gaps in adherence to self-regulatory requirements. Only 3 (3.3 %) companies provided clear information for all self-regulatory body recommendations and regulations in all of their notes. Companies also varied in their approaches to important areas. For example, of the 244 notes with clear information on VAT management, 36.1 % (<em>N</em> = 88) included VAT, 30.3 % (<em>N</em> = 74) excluded VAT, and 33.6 % (<em>N</em> = 82) had multiple rules for VAT. There was evidence of widespread non-adherence to self-regulatory requirements. This suggests flaws with self-regulation and a need for greater enforcement of rules or consideration of a publicly mandated disclosure system.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001659/pdfft?md5=3930c97b0726126c5af9dd67e6e39f18&pid=1-s2.0-S0168851024001659-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274713","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}

引用次数: 0

The modernisation of newborn screening as a pan-European challenge – An international delphi study 新生儿筛查现代化是一项泛欧挑战--国际德尔菲研究

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-13 DOI: 10.1016/j.healthpol.2024.105162

{"title":"The modernisation of newborn screening as a pan-European challenge – An international delphi study","authors":"","doi":"10.1016/j.healthpol.2024.105162","DOIUrl":"10.1016/j.healthpol.2024.105162","url":null,"abstract":"<div><p>Newborn screening is a public health measure to diagnose rare diseases at birth, thereby minimising negative effects of late treatment. Genomic technologies promise an unprecedented expansion of screened diseases at low cost and with transformative potential for newborn screening programmes. However, barriers to the public funding of genomic newborn screening are poorly understood, particularly in light of the heterogenous European newborn screening landscape. This study therefore aims to understand whether international newborn screening experts share a common understanding of the barriers to fund genomic newborn screening. For this purpose, we convened 21 European newborn screening experts across a range of professions and national backgrounds in a Delphi study. Stable consensus, determined via the Wilcoxon matched-pairs signed-ranks test, was found via three consecutive survey rounds for all presented barriers. Experts generally judged the scenario of genomic newborn screening being available to every newborn in seven years to be unlikely, identifying treatability and the absence of counselling and a skilled workforce as the most significant barriers to public funding. We identify value re-definition for rare disease treatments, centralisation of genomic expertise, and international research consortia as avenues for pan-European actions which build on the consensus achieved by our Delphi panel.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001726/pdfft?md5=611a821cac48f8e22762cd2f82d05cd1&pid=1-s2.0-S0168851024001726-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274712","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}

引用次数: 0

Availability and financing of CAR-T cell therapies: A cross-country comparative analysis CAR-T 细胞疗法的可用性和融资：跨国比较分析

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-12 DOI: 10.1016/j.healthpol.2024.105153

{"title":"Availability and financing of CAR-T cell therapies: A cross-country comparative analysis","authors":"","doi":"10.1016/j.healthpol.2024.105153","DOIUrl":"10.1016/j.healthpol.2024.105153","url":null,"abstract":"<div><p>Chimeric antigen receptor T-cell therapies (CAR-T therapies) are a type of advanced therapy medicinal product (ATMP) that belong to a new generation of personalised cancer immunotherapies. This paper compares the approval, availability and financing of CAR-T cell therapies in ten countries. It also examines the implementation of this type of ATMP within the health care system, describing the organizational elements of CAR-T therapy delivery and the challenges of ensuring equitable access to all those in need, taking a more systems-oriented view. It finds that the availability of CAR-T therapies varies across countries, reflecting the heterogeneity in the organization and financing of specialised care, particularly oncology care. Countries have been cautious in designing reimbursement models for CAR-T cell therapies, establishing limited managed entry arrangements under public payers, either based on outcomes or as an evidence development scheme to allow for the study of real-world therapeutic efficacy. The delivery model of CAR-T therapies is concentrated around existing experienced cancer centres and highlights the need for high networking and referral capacity. Some countries have transparent and systematic eligibility criteria to help ensure more equitable access to therapies. Overall, as with other pharmaceuticals, there is limited transparency in pricing, eligibility criteria and budgeting decisions in this therapeutic area.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001635/pdfft?md5=d4356a856954e0927cfb22e96cb669a4&pid=1-s2.0-S0168851024001635-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168096","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}

引用次数: 0

The challenges of regulatory pluralism 监管多元化的挑战

IF 3.6 3区医学

Health Policy Pub Date : 2024-09-12 DOI: 10.1016/j.healthpol.2024.105164

{"title":"The challenges of regulatory pluralism","authors":"","doi":"10.1016/j.healthpol.2024.105164","DOIUrl":"10.1016/j.healthpol.2024.105164","url":null,"abstract":"<div><p>Countries with small and/or less-resourced regulatory authorities that operate outside of a larger medical product regulatory system face a regulatory strategy dilemma. These countries may rely on foreign well-resourced regulators by recognising the regulatory decisions of large systems and following suit (<em>regulatory reliance</em>); alternatively, such countries may extend formal decision recognition to regulators in multiple other jurisdictions with similar oversight and public health goals, following a system which we call <em>regulatory pluralism</em>. In this policy comment, we discuss three potential limitations to regulatory pluralism: (i) regulatory escape, in which manufacturers exploit regulatory variation and choose the lowest regulatory threshold for their product; (ii) increased fragmentation and complexity for countries adopting this approach, which may, in turn, lead to inconsistent processes; and (iii) loss of international bargaining power in developing regulatory policies. We argue that regulatory pluralism has important long-term implications, which may not be readily apparent to policy makers opting for such an approach. We advocate for the long-term value of an alternative approach relying on greater collaboration between regulatory authorities, which may relieve administrative pressures on countries with small or less-resourced regulatory authorities, regardless of whether countries pursue a strategy of domestic regulation or regulatory pluralism.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016885102400174X/pdfft?md5=52ddd124a0abd5f85bcb72049b197b6c&pid=1-s2.0-S016885102400174X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274711","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}

引用次数: 0