Health Policy最新文献

{"title":"Optimisation of the hospital network reform in Slovakia between 2020 and 2025.","authors":"Matej Misik","doi":"10.1016/j.healthpol.2026.105798","DOIUrl":"https://doi.org/10.1016/j.healthpol.2026.105798","url":null,"abstract":"<p><strong>Background: </strong>Slovakia adopted a comprehensive hospital network reform in 2021 (Act 540/2021 Coll.) under its Recovery and Resilience Plan (RRP), motivated by a fragmented network of small, low-volume hospitals and limited transparency on services, quality and waiting times.</p><p><strong>Reform content: </strong>The reform reorganises hospitals into five statutory levels, each defined by a portfolio of medical programmes, maximum waiting times, minimum case volumes and quality indicators. This paper provides a policy and regulatory overview of the reform's design, its content and the trajectory of its implementation.</p><p><strong>Expected results: </strong>The reform aims to concentrate complex care, improve clinical outcomes, reduce variation, shorten waiting times and improve efficiency. Although the legislative architecture was largely in place by end-2023, core operational pillars are still unfinished: the quality-indicator decree was only adopted in mid-2025, with first availability for categorisation in 2027; staffing-norm legislation has yet to enter the legislative process; minimum-volume thresholds have been repeatedly revised downward; and no provider has so far been excluded from the network on volume grounds.</p><p><strong>Policy implications: </strong>The roll-out has been affected by political interference, repeated amendments, delays and politically driven re-categorisations, illustrating the gap between a legalistic design and its political execution. Policy implications stress the importance of aligned payment systems, sustained stakeholder engagement and systematic evaluation against the reform's stated objectives. Outcomes for efficiency, waiting times and treatable mortality will be the subject of future quantitative research as administrative data become available.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"175 ","pages":"105798"},"PeriodicalIF":4.7,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302244","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":"Building system capacity for home visits for patients near the end of life: A mixed-methods study in Canada.","authors":"Madeline McCoy, Sabah Tasnim, Hannah Millward, Jessica Roy, William Hall, Colleen Webber, Carol Bennett, Amy T Hsu, Sarina R Isenberg","doi":"10.1016/j.healthpol.2026.105810","DOIUrl":"https://doi.org/10.1016/j.healthpol.2026.105810","url":null,"abstract":"<p><strong>Background: </strong>Despite known benefits, many Canadians do not receive adequate physician and nurse practitioner (NP) home visits in their last year of life, in part due to the declining providers who deliver this care. Factors influencing providers' decisions to deliver home visits in end-of-life contexts remain poorly understood.</p><p><strong>Objectives: </strong>To examine the influence of various enablers and barriers on physician and NP provision of home visits near the end of life and identify policy actions to enable delivery.</p><p><strong>Methods: </strong>Explanatory sequential mixed-methods study, including a pan-Canadian survey of physicians and NPs who do and do not provide home visits, followed by qualitative interviews with a subset of participants to explore findings and identify policy solutions.</p><p><strong>Results: </strong>78 participants completed the survey with 16 participating in interviews. Both home visit providers (i.e., those providing home visits at the time of the study) and non-providers (i.e., those not providing home visits at the time of the study) identified improving access for patients unable to attend clinic-based care as an enabler. Both groups identified heavy workloads and staff shortages as barriers, but differed with providers emphasizing travel distance and non-providers highlighting demands that compete with other responsibilities. Participants' policy recommendations included enhanced training and mentorship, team-based models with support staff, improved remuneration and flexibility, expanded NP autonomy, integration of virtual care, and investment in dedicated home visiting teams.</p><p><strong>Conclusion: </strong>Expanding home visits will require system-level interventions that reduce heavy workloads and create conditions to enable uptake among non-providers and sustainability among providers.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"175 ","pages":"105810"},"PeriodicalIF":4.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302275","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":"Design and impact of value-based payment: a scoping review of schemes implemented or active between 2010 and 2024.","authors":"Seda Kumru, Zeynep Or","doi":"10.1016/j.healthpol.2026.105809","DOIUrl":"https://doi.org/10.1016/j.healthpol.2026.105809","url":null,"abstract":"<p><strong>Background: </strong>Value-based payment (VBP) schemes have emerged as alternatives or complements to traditional payment models, to realign financial incentives toward quality, efficiency, and patient-centered outcomes. Despite their rapid expansion, no recent review synthesizes both design features and reported impacts.</p><p><strong>Objective: </strong>To provide an overview of recent VBP schemes, highlighting policy objectives, design parameters, and reported impacts, without focusing on specific countries or care settings.</p><p><strong>Methods: </strong>A scoping review was conducted following JBI methodology. Searches in Medline (via PubMed) and Web of Science identified English-language peer-reviewed articles, systematic or scoping reviews published between January 2015 and July 2024. The review focused on large-scale VBP schemes implemented after 2010 or active between 2010 and 2024. Studies were included if they described a VBP scheme and/or evaluated its impact using quantitative evaluation methods. Gray literature supplemented information on identified models.</p><p><strong>Results: </strong>We identified 61 VBP schemes across 15 countries: 38 pay-for-performance, 18 bundled payment, and 5 shared savings. Common objectives included improving cost efficiency (40%) and care coordination (38%). One-third targeted multiple care settings, and about half focused on multiple conditions. Among the 41 VBP schemes that underwent impact evaluation, positive effects were most frequently observed for clinical process (n = 14), followed by efficiency (n = 11), patient outcomes (n = 11).</p><p><strong>Conclusion: </strong>Although VBP schemes hold considerable promise, the ability of these programs to deliver desired outcomes depends heavily on their specific design and the context in which they are implemented. Continuous evaluation and iterative refinement are essential to ensure these programs achieve measurable improvements in quality, efficiency, and patient experience.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"175 ","pages":"105809"},"PeriodicalIF":4.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302211","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":"Beyond proximity in emergency department choice: A commentary on Taiwo et al.","authors":"Ahmet Nurhak Çakir","doi":"10.1016/j.healthpol.2026.105811","DOIUrl":"https://doi.org/10.1016/j.healthpol.2026.105811","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"175 ","pages":"105811"},"PeriodicalIF":4.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290026","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":"Experiences and social constructions of loneliness in later life: Collaborative focus group discussions in Germany","authors":"Andrea Kastl ,&nbsp;Ulrike Fettke ,&nbsp;Leonhard Dobusch","doi":"10.1016/j.healthpol.2026.105575","DOIUrl":"10.1016/j.healthpol.2026.105575","url":null,"abstract":"<div><h3>Background</h3><div>Ageing in place (AIP) policies seek to address the growing demand for healthcare needs among ageing populations. Loneliness has been identified as a challenge to AIP, as the number of people living alone at home is growing.</div></div><div><h3>Objective</h3><div>To understand older adults’ perspectives on loneliness associated with AIP and to use these insights to inform health professional practice and health policy for the development of patient-centered solutions.</div></div><div><h3>Methods</h3><div>To identify issues of significance to the participants, we employed collaborative focus group discussions (FGD). From a set of eight topics presented, participants selected topics to discuss. Loneliness emerged as a prominent theme in the discussions. Six FGDs among twenty-seven older adults and patients of rehabilitation clinics were conducted.</div></div><div><h3>Results</h3><div>The methodological approach provided unparalleled access to older adults' experiences of loneliness. The study’s participants experience poor quality of social contact and associate loneliness with negative physical and mental consequences. While mobility loss and physical inaccessibility are described as factors for becoming lonely, preventive strategies, such as reevaluating social contacts in the absence of intimacy, suggest that the distinction between emotional and social loneliness may coincide in lived experience, indicating that preventive measures should consider their fluid boundaries.</div></div><div><h3>Conclusion</h3><div>Assessing loneliness requires taking individual perspectives into account, as mere quantification of social contacts is insufficient for evaluation or intervention design. To help cope with loneliness, health professionals are an important social interface and can become a substitute for close relationships. This should be reflected in professional roles and in developing complementary technologies and policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105575"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114804","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 determines earnings of self-employed physicians in Austria? Evidence from quantile regressions using linked tax records","authors":"Christoph Stegner,&nbsp;Miriam Reiss,&nbsp;Thomas Czypionka","doi":"10.1016/j.healthpol.2026.105568","DOIUrl":"10.1016/j.healthpol.2026.105568","url":null,"abstract":"<div><h3>Background</h3><div>Shortage of healthcare workers is a growing challenge and financial remuneration may influence recruitment efforts. In Austria, self-employed physicians can either work as contracted or non-contracted physicians. While non-contracted practices are expanding, sickness funds face increasing difficulties in recruiting contracted physicians.</div></div><div><h3>Objective</h3><div>To analyze physician income, its key determinants and whether financial incentives could help SHI funds address recruitment challenges.</div></div><div><h3>Methods</h3><div>We used data from the Federal Ministry of Finance and the Federation of Social Security Institutions to derive descriptive statistics for self-employed physicians. In-depth data on contracted physicians enabled us to explore determinants of their income using quantile regressions.</div></div><div><h3>Results</h3><div>In 2022, contracted GPs had median annual earnings of EUR 191,649 before taxes, while contracted specialists earned EUR 210,988. Among GPs, an additional consultation was associated with an increase in earnings of EUR 11.70. Being a male GP corresponded with higher earnings of EUR 6763 compared to female GPs. For specialists, each additional consultation increased earnings by EUR 27.94, and being female was associated with decreased earnings of EUR 13,413. Due to missing data on key variables, regression analysis was not possible for non-contracted physicians, but their median income was EUR 100,849.</div></div><div><h3>Conclusion</h3><div>Given higher earnings of contracted physicians compared to their non-contracted peers, it seems unlikely that increased financial incentives would help SHI funds in recruiting contracted physicians.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105568"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144691","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 social media turn in medicine: platform-based marketization of health care, ethics, professionalism, and lessons from Turkey","authors":"Bülent Özlek","doi":"10.1016/j.healthpol.2026.105577","DOIUrl":"10.1016/j.healthpol.2026.105577","url":null,"abstract":"<div><div>The growing integration of social media into medical practice is transforming how professionalism, ethics, and visibility are defined in contemporary health systems. In Turkey, this transformation has unfolded rapidly under the combined pressures of marketization, digital communication, and structural challenges in the public health sector. Physicians increasingly navigate an “economy of visibility,” where online engagement and personal branding intersect with professional legitimacy. Drawing on the Turkish experience, this commentary situates these developments within global trends, highlighting how digital platforms reshape professional identity, public trust, and the moral foundations of care. It argues that sustaining ethical integrity in the digital era requires renewed attention to self-regulation, education, and governance. The lessons from Turkey’s experience have broader relevance for policymakers seeking to reconcile technological innovation with the ethical and social responsibilities of the medical field.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105577"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174429","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":"Made in Europe – assessing the feasibility of reshoring active pharmaceutical ingredient production to Europe","authors":"Verena Knoll ,&nbsp;Caroline Steigenberger ,&nbsp;Stefan Fischer ,&nbsp;Sabine Vogler","doi":"10.1016/j.healthpol.2026.105566","DOIUrl":"10.1016/j.healthpol.2026.105566","url":null,"abstract":"<div><h3>Background</h3><div>As global reliance on Asian production of active pharmaceutical ingredients (APIs) grows, the relocation of API production to Europe (reshoring) has been discussed as a potential solution to decrease dependency on Asia and potentially prevent future medicine shortages. However, it is not yet well understood whether its implementation would be feasible, and under which conditions.</div></div><div><h3>Objective</h3><div>This study aims to explore expert and stakeholder assessment of the feasibility of reshoring API production to Europe based on identified barriers, enablers and prerequisites for implementing this measure.</div></div><div><h3>Methods</h3><div>A literature review of peer-reviewed articles and grey literature was complemented by focus group interviews with stakeholders from Austria, France, and Spain, representing policy-makers, industry, and researchers.</div></div><div><h3>Results</h3><div>The findings suggest that reshoring is considered feasible if certain conditions are met, such as financial incentives and committed stakeholder support. A coordinated European policy approach and advancements in production technologies are perceived as further enabling factors. However, challenges such as higher production costs and perceived lower profits in Europe compared to Asian markets may impede the reshoring of API production. The stakeholders’ assessments also varied across countries: French and Spanish stakeholders considered reshoring as realistic, whereas Austrian stakeholders tended to be more hesitant. Stakeholders of all studied countries stressed the importance of strengthening existing local API production.</div></div><div><h3>Conclusion</h3><div>While reshoring may increase the resilience of the supply chain, it is rather a supportive measure for supply chain stability than a standalone solution to prevent medicine shortages.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105566"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133687","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":"Staff awareness and engagement with the Green Plan: A cross-sectional survey of one of the largest NHS trusts in the UK","authors":"Vishal Madan","doi":"10.1016/j.healthpol.2026.105576","DOIUrl":"10.1016/j.healthpol.2026.105576","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare systems globally are working to reduce their environmental impact, with the NHS committing to becoming the first carbon-neutral national health system. The Health and Care Act 2022 introduced statutory duties for NHS trusts and integrated care boards to consider climate change in their operations, requiring all trusts to develop board-approved Green Plans aligned with national net zero targets. Staff engagement is crucial for implementing sustainability initiatives; however, the extent to which healthcare workers are aware of and engaged with institutional green plans remains less known.</div></div><div><h3>Objective</h3><div>To assess staff awareness, knowledge, and engagement with the Northern Care Alliance NHS Foundation Trust (NCA) Green Plan 2021.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of NCA staff (January-February 2025) assessed awareness and engagement with the Green Plan. Data on awareness levels, knowledge of targets, training experience, and implementation barriers were gathered, and suggestions for improvement were provided. Statistical significance was set at <em>p</em> &lt; 0.05 for all analyses. Thematic analysis of open-ended responses followed Braun and Clarke's approach.</div></div><div><h3>Results</h3><div>Among 175 respondents, 96 (55 %) were unaware of the Green Plan, with 2 (1 %) \"extremely aware.\" Knowledge gaps were evident: 124 (71 %) had not read the plan or knew where to find it; 122–149 (70–85 %) could not identify when it started, or its targets. Only 5 (3 %) received Green Plan training. While 153 (87 %) viewed it as important for NCA's future, just 46 (26 %) changed their work practices. Staff aware of the Green Plan were significantly more likely to change practices than those unaware (53 % vs 2 %, <em>p</em> &lt; 0·001). Barriers to engagement included lack of information (median score 5/5), unclear guidance, limited time, and competing priorities (all scoring 4/5).</div></div><div><h3>Conclusions</h3><div>Findings reveal gaps in awareness, knowledge, and implementation of NCA's Green Plan, despite strong support for sustainability initiatives. The correlation between awareness and behaviour change indicates that targeted communication and training could enhance staff engagement with sustainability efforts.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105576"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121104","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":"Integrated care in the Baltic countries over a five-year period: an expert-informed cross-country analysis of progress, challenges and future directions","authors":"Nathan Shuftan ,&nbsp;Giada Scarpetti ,&nbsp;Katherine Polin ,&nbsp;Kaija Kasekamp ,&nbsp;Daiga Behmane ,&nbsp;Liubove Murauskiene ,&nbsp;Verena Struckmann","doi":"10.1016/j.healthpol.2025.105526","DOIUrl":"10.1016/j.healthpol.2025.105526","url":null,"abstract":"<div><h3>Background</h3><div>In Estonia, Latvia, and Lithuania, the push for care integration has gained momentum, being seen as an innovative approach to allocate resources more efficiently and improve patient outcomes.</div></div><div><h3>Objective</h3><div>This study investigates the progress of integrating care in the Baltic countries from 2019 to 2024 to detail key learnings.</div></div><div><h3>Methods</h3><div>We undertook a cross-country study to better understand the progress in care integration in the Baltics with a two-round, 21-item questionnaire on the adoption of integrated care reforms in 2019 and 2024. Responses were analyzed to capture countries’ policy environments and their conduciveness to the uptake of integrated care. Country-specific experiences with implementation of care were further explored via case studies of pilot programmes.</div></div><div><h3>Results</h3><div>The pace of implementing integrating care varied. Existing barriers, workforce challenges and payment schemes have impeded integration across health and social care. Despite this, political commitment across successive governments to new and innovative service delivery and collaboration for chronic care management underscores an important prerequisite toward achieving more integrated and person-centred healthcare. The three case studies illustrate hurdles that come with shifting care settings and expanding roles for some workers.</div></div><div><h3>Conclusions</h3><div>Integrating care across providers and the social and health sectors is an incremental process that needs long-term political support to address persistent barriers. The Baltic countries’ experiences indicate challenges in bringing together stakeholders in areas such as data interoperability, new financing models and reorganization of workforce and skills mixing. Further work should advance evidence on patient-centred solutions for evolving needs.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105526"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068330","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}