Health Policy最新文献

{"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}

{"title":"Hybrid threats require hybrid solutions: A roadmap for healthcare security","authors":"Petrut Gogalniceanu","doi":"10.1016/j.healthpol.2026.105565","DOIUrl":"10.1016/j.healthpol.2026.105565","url":null,"abstract":"<div><div>Health systems are increasingly disrupted by hybrid threats, which include scientific espionage, sabotage of healthcare infrastructure, disinformation campaigns, and cyberattacks. These threats undermine not only patient safety, service continuity, workforce trust and public confidence, but also national security. As a result, attacks on healthcare have emerged as a new instrument of geopolitical power. In an era defined by whole-of-society disruption, a roadmap is required to strengthen healthcare resilience through an integrated approach emerging from health security ecosystems.</div><div>Building effective health security ecosystems requires action across four interdependent priorities (STEP framework): (a) <strong>Security awareness and medical intelligence</strong> (MEDINT) that provide indications and warnings of hybrid disruptions; (b) <strong>Technology integration</strong> to provide an operational edge; (c) <strong>Education and upskilling</strong> of the health workforce to function under conditions of sustained disruption; and (d) <strong>Partnerships</strong> across public, private, and academic sectors. Embedding the <strong>STEP framework</strong> in policymaking, clinical practice, and research can mitigate hybrid threats and address critical health system vulnerabilities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"166 ","pages":"Article 105565"},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006659","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":"Pancreatic cancer mortality and associated productivity losses in Spain: A population-based estimate (2013–2022)","authors":"Josep Darbà ,&nbsp;Meritxell Ascanio ,&nbsp;Antonio Rodríguez","doi":"10.1016/j.healthpol.2026.105564","DOIUrl":"10.1016/j.healthpol.2026.105564","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer remains as the cancer type with the poorest prognosis, characterized by rising incidence and mortality rates. This disease imposes a substantial economic burden, including productivity losses resulting from premature mortality.</div></div><div><h3>Objective</h3><div>This study aims to estimate productivity losses due to premature deaths from pancreatic cancer in Spain during the period 2013–2022.</div></div><div><h3>Methods</h3><div>Productivity costs were quantified using a simulation model based on the human capital method. Data on mortality rates, average salaries, and employment rates were obtained from the Spanish Instituto Nacional de Estadística for the entire study period.</div></div><div><h3>Results</h3><div>Between 2013 and 2022, the number of deaths due to pancreatic cancer in Spain increased from 6039 to 7973 and, by 2022, pancreatic cancer became the leading cause of death among digestive system tumours. This rise was accompanied by an increase in Years of Potential Labour Productive Life Lost due to premature death (YPLPLL): for men, YPLPLL grew from 8146 in 2013 to 9650 in 2022, and for women, from 4699 to 6053 over the same period. Consequently, labour productivity losses were estimated at €253.40 million in 2013, rising to €406.20 million in 2022, with a cumulative cost of €3253.97 million during the study period.</div></div><div><h3>Conclusions</h3><div>These findings provide valuable insights into the societal costs of pancreatic cancer in Spain. Investments in targeted strategies focusing on prevention, early detection, and advanced-stage therapies for pancreatic cancer have the potential to significantly reduce its future economic and health impacts.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105564"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977552","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":"Small countries face specific challenges in health workforce sustainability, but policy responses are a testbed for resilience for all countries","authors":"Erica Richardson ,&nbsp;Natasha Azzopardi-Muscat ,&nbsp;Marios Kantaris ,&nbsp;Anne-Charlotte Lorcy ,&nbsp;Bernd Rechel ,&nbsp;Nathan Shuftan ,&nbsp;Ewout van Ginneken ,&nbsp;Gemma A Williams","doi":"10.1016/j.healthpol.2025.105545","DOIUrl":"10.1016/j.healthpol.2025.105545","url":null,"abstract":"<div><div>While countries across Europe are facing challenges in building and sustaining a health workforce, small countries (official population of under 2 million people) face specific challenges that go beyond resource constraint. Limited population size constrains training capacity, specialist care provision, and career development opportunities, making these systems highly vulnerable to workforce shortages.</div><div>Experiences in Cyprus, Luxembourg, North Macedonia, and the Caribbean Netherlands illustrate these dynamics. Cyprus and Luxembourg have expanded in-country medical education and postgraduate training to reduce the need for training abroad. In contrast, North Macedonia trains sufficient health professionals but struggles with outmigration. Island territories face additional logistical and geographic barriers. The Caribbean Netherlands rely on rotations and cross-border care for many healthcare services.</div><div>Small countries are like a microscope that magnifies both the problems and the policy responses and may thus serve as a testbed for all health systems confronting workforce challenges. Small country experiences underscore the need for collaborative solutions to respond to the health workforce crisis, including enhanced training opportunities, mitigation of migration risks and improved retention. Ensuring resilience of the health workforce in the face of demographic and mobility pressures requires effective planning and integrated strategies addressing remuneration, working conditions, and professional development across all roles and sectors.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105545"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799070","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":"Health access reforms in the Caribbean Netherlands from 2010-2023","authors":"Nathan Shuftan ,&nbsp;Jane O’Flynn ,&nbsp;Judith Meijer ,&nbsp;Robert Borst ,&nbsp;Soraya Verstraeten ,&nbsp;Dorette Courtar ,&nbsp;Giovanni Frans ,&nbsp;Amy van der Linden ,&nbsp;Indira Madhuban ,&nbsp;Michael Mercuur ,&nbsp;Ewout van Ginneken","doi":"10.1016/j.healthpol.2025.105540","DOIUrl":"10.1016/j.healthpol.2025.105540","url":null,"abstract":"<div><h3>Background</h3><div>In 2010, the islands of Bonaire, Sint Eustatius and Saba became part of the Netherlands, one of the four constituent countries within the Kingdom of the Netherlands. Public administration, including the health system, was reformed, with the Dutch Government aiming for a “level of facilities acceptable within the Netherlands, taking into account the specific circumstances on the islands”.</div></div><div><h3>Reform content</h3><div>The Dutch Health Ministry became responsible for legislating, financing and policy in a health system with limited stakeholders. The health policy agenda focused on building a public, tax-financed insurance system and improving and expanding service provision by (1) general practitioners, (2) medical specialists (on- and off-island), (3) nursing homes, home and youth care, (4) pharmaceutical care and (5) mental health services. Several providers on the islands were established post-2010 to improve care availability and standards.</div></div><div><h3>Results</h3><div>The health budget doubled in a decade, on-island facilities have been upgraded or newly established, availability and quality of care and certain specialist services have increased, and a mandatory, universal health insurance coverage for all legal residents with high financial protection (within the system) and broad benefits was introduced.</div></div><div><h3>Conclusions</h3><div>Following developments to reach an “acceptable” level, the next ministerial goal is to move towards levels of care that are “equivalent” to those in the European Netherlands. However, persistent gaps in the data landscape hinder an evidence-based approach to policymaking and need to be addressed in order to obtain a more comprehensive picture on the performance of the health system, which is also relevant for other health systems in the Caribbean Region.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105540"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718898","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}