Health Policy最新文献

{"title":"Large language models in radiology workflows: An exploratory study of generative AI for non-visual tasks in the German healthcare system","authors":"Stefanie Steinhauser ,&nbsp;Sabrina Welsch","doi":"10.1016/j.healthpol.2025.105444","DOIUrl":"10.1016/j.healthpol.2025.105444","url":null,"abstract":"<div><h3>Background</h3><div>Large language models (LLMs) are gaining attention for their potential to enhance radiology workflows by addressing challenges such as increasing workloads and staff shortages. However, limited knowledge among radiologists and concerns about their practical implementation and ethical implications present challenges.</div></div><div><h3>Objective</h3><div>This study investigates radiologists' perspectives on the use of LLMs, exploring their potential benefits, challenges, and impact on workflows and professional roles.</div></div><div><h3>Methods</h3><div>An exploratory, qualitative study was conducted using 12 semi-structured interviews with radiology experts. Data were analyzed to assess participants' awareness, attitudes, and perceived applications of LLMs in radiology.</div></div><div><h3>Results</h3><div>LLMs were identified as promising tools for reducing workloads by streamlining tasks like summarizing clinical histories and generating standardized reports, improving communication and efficiency. Participants expressed openness to LLM integration but noted concerns about their impact on human interaction, ethical standards, and liability. The role of radiologists is expected to evolve with LLM adoption, with a shift toward data stewardship and interprofessional collaboration. Barriers to implementation included limited awareness, regulatory constraints, and outdated infrastructure.</div></div><div><h3>Conclusions</h3><div>The integration of LLMs is hindered by regulatory challenges, outdated infrastructure, and limited awareness among radiologists. Policymakers should establish clear, practical regulations to address liability and ethical concerns while ensuring compliance with privacy standards. Investments in modernizing clinical infrastructure and expanding training programs are critical to enable radiologists to effectively use these tools. By addressing these barriers, LLMs can enhance efficiency, reduce workloads, and improve patient care, while preserving the central role of radiologists in diagnostic and therapeutic processes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105444"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093015","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":"We should care about informal carers: Reforms are needed to improve their health and wellbeing","authors":"Natalie Winter Dr ,&nbsp;Rebecca Haddock Adj A/Prof","doi":"10.1016/j.healthpol.2025.105437","DOIUrl":"10.1016/j.healthpol.2025.105437","url":null,"abstract":"<div><div>Informal carers-those who provide unpaid care for people with health concerns or age-related needs- frequently experience negative impacts on their own physical, mental, and social wellbeing. Health systems should respond to these impacts by explicitly recognising and addressing the support needs of informal carers. Positive outcomes for this underserved population group, sustain delivery of care, and reduce further burden on the healthcare system.</div><div>Three changes are needed to improve how health systems support carers. First, there must be a stronger and more systematic focus on carers’ wellbeing, including through the expansion of patient-centered care models to explicitly include carers. This should involve co-designing healthcare systems in ways that create space for carers as active partners in care. Second, carers’ needs should be routinely identified and assessed in clinical practice using standardised tools, ideally integrated into electronic health records. Third, clinicians must be supported to provide care for carers when needed—this requires a systemic approach that includes dedicated funding, targeted education, and protected clinical time to address carer wellbeing as part of routine care.</div><div>Embedding these reforms in policy and practice would not only improve health outcomes for carers but also strengthen the resilience and sustainability of healthcare systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105437"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093059","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 matters most to the population in case of chronic conditions? Results from a discrete choice experiment in Italy","authors":"Milena Vainieri ,&nbsp;Veronica Spataro ,&nbsp;Sabina De Rosis ,&nbsp;Filippo Quattrone ,&nbsp;Sabina Nuti","doi":"10.1016/j.healthpol.2025.105420","DOIUrl":"10.1016/j.healthpol.2025.105420","url":null,"abstract":"<div><div>Relational continuity, care coordination, and teamwork are widely recognized as key components of quality in primary care. This study investigates population preferences regarding organizational models of primary care, with a particular focus on the roles of general practitioners, specialists, and nurses. A Discrete Choice Experiment (DCE) was conducted through a nationwide online cross-sectional survey, employing a full factorial experimental design with 20 randomly selected choice sets to minimize cognitive burden. The attributes examined included coordination, relational continuity, and teamwork.</div><div>Data were collected from a representative sample of 2,553 respondents across Italy in early 2021. Results underscore the centrality of teamwork (OR=1.85 in mild and 2.31 in severe chronic conditions), followed by relational continuity (OR=1.60 in mild and 1.55 in severe conditions). Coordination ranks third (OR=1.31) for mild conditions but reaches parity with relational continuity in the context of severe chronic conditions. These findings offer robust evidence of differentiated preferences based on chronic disease severity and support the design of tailored primary care models.</div><div>In conclusion, this analysis highlights the importance of incorporating coordination, relational continuity, and teamwork in the configuration of primary care services, offering policy-relevant insights for adapting delivery models to the needs of patients with varying levels of chronicity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105420"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925178","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":"Impacts of social determinants on the transient and persistent inefficiency of health systems in OECD countries","authors":"Ezgi Önen Efecan ,&nbsp;Volkan Efecan","doi":"10.1016/j.healthpol.2025.105433","DOIUrl":"10.1016/j.healthpol.2025.105433","url":null,"abstract":"<div><div>This study examines the impact of social determinants on the transient and persistent technical inefficiency of health systems in OECD countries between 2010 and 2020. To estimate inefficiency, panel efficiency models—True Random Effects (TRE) and Generalised True Random Effects (GTRE) models—are employed. The results reveal that the overall inefficiency of OECD countries is largely attributable to long-term policies. Furthermore, transient inefficiency increases, on average, by 1.6 % for every 1 % increase in the unemployment rate, while persistent inefficiency increases, on average, by 6.8 % for every 1 % increase in income inequality. To enhance the long-term efficiency of health systems, governments should address unemployment, education and income inequality. This study represents the first cross-country evaluation to consider unemployment, education, income inequality, and population as social determinants of health system efficiency, employing two competing stochastic frontier models at the country level.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105433"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088218","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":"Urgent action needed to address the epidemiological threat of prolonged war in Gaza","authors":"Hanane EL Hafa","doi":"10.1016/j.healthpol.2025.105438","DOIUrl":"10.1016/j.healthpol.2025.105438","url":null,"abstract":"<div><div>The prolonged war in Gaza has led to the near-total collapse of the healthcare system, leaving over two million people without access to essential medical services, clean water, electricity, or basic sanitation. Many hospitals have been bombed or are barely functioning due to extreme constraints. Healthcare personnel are overwhelmed, injured, or forced to work under dangerous conditions. Essential medicines and vaccines are critically lacking. In this context, the risk of large-scale outbreaks of infectious diseases—such as cholera, hepatitis A, measles, and typhoid fever—is rapidly increasing, especially among displaced populations living in overcrowded and unsanitary conditions.</div><div>This policy comment highlights the urgent need for coordinated international action to prevent a major public health catastrophe. It calls for the immediate protection of remaining health infrastructure, restoration of disease surveillance systems, and facilitation of humanitarian access for medical supplies and personnel. Without swift intervention, thousands more lives could be lost—not just to violence, but to entirely preventable and treatable illnesses.</div><div>Protecting public health during war is not optional—it is a binding duty under international law, and a pressing moral imperative for the global community.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105438"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088198","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 role of private equity in the German outpatient sector","authors":"Beate Jochimsen ,&nbsp;Bernhard Gibis","doi":"10.1016/j.healthpol.2025.105389","DOIUrl":"10.1016/j.healthpol.2025.105389","url":null,"abstract":"<div><div>Outpatient medical care in Germany has traditionally been delivered by self-employed physicians, primarily in solo or small group practices. A 2004 reform allowed corporate private investors, to finance outpatient care for the first time. Since then, the establishment of so-called medical care centres (MCCs) has become a staple of public healthcare. From the outset, concerns have been raised that economic interests could conflict with the values of a public health system. However, there is a notable lack of empirical evidence to support this potential conflict. This study seeks to narrow the empirical gap using three methodological approaches: a scoping review, identification of relevant data sources, and a brief case study. Our findings indicate that, to date, there is no empirical evidence suggesting a decline in the quality or scope of healthcare services when MCCs are financed by private equity investors. Nonetheless, the potential emergence of oligopolistic structures and a lack of transparency in provider ownership and structure call for careful regulatory oversight. Policy recommendations include strengthening the data infrastructure with respect to medical outcomes, costs, and provider characteristics (e.g. ownership or affiliations), and safeguarding medical decision-making from profit-driven influence by owners. As rising private investment, including private-equity, in outpatient care is observed across nearly all healthcare systems, an internationally comparative approach is essential.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105389"},"PeriodicalIF":3.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654452","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":"A new integrated conceptual framework of health insurance literacy: Results of a critical interpretive synthesis","authors":"Reut Ron ,&nbsp;Paula Feder-Bubis ,&nbsp;Kierstin Trocha ,&nbsp;Moriah Ellen","doi":"10.1016/j.healthpol.2025.105394","DOIUrl":"10.1016/j.healthpol.2025.105394","url":null,"abstract":"<div><div>Health insurance literacy (HIL) is the knowledge, ability, and confidence to find and understand health insurance information, and choose, purchase and use an insurance plan. Despite the increasing volume of research on HIL, the approaches to this field remain fragmented.</div><div>This review paper aims to develop a conceptual framework delineating the attributes, personal contexts, and environmental influences, which either influence or are influenced by an individual's HIL level.</div><div>We have adopted a critical interpretive synthesis approach with purposive sampling and inductive analysis, integrating all existing models from the literature, with additional findings. The CIS methodology emphasizes iterative data synthesis to generate theory from diverse sources, ceasing data extraction upon achieving theoretical saturation. This reflects the stage at which further data collection no longer yields new conceptual insights.</div><div>Four databases were systematically screened in September 2020 and July 2023, yielding 6096 articles. Following a review of titles and abstracts, 388 papers were deemed relevant, and 76 were included in the final synthesis. The resulting framework consists of eight categories, 17 subcategories, and 129 codes, with HIL level as its core. Other components include individual predictors, external influences, skills and abilities, perceptions and beliefs, preferences, decision-making processes, and outcomes.</div><div>This framework provides a comprehensive tool for guiding interventions and research aimed at improving HIL. It allows researchers and policymakers to address the diverse and interconnected factors influencing HIL and to develop targeted, evidence-based strategies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105394"},"PeriodicalIF":3.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634555","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 use of social return on investment approaches to evaluate integrated long-term care in high-income countries: A scoping review","authors":"Susana Ramalho Marques ,&nbsp;Ricardo Rodrigues ,&nbsp;Jürgen Zerth ,&nbsp;Carola Orrego","doi":"10.1016/j.healthpol.2025.105414","DOIUrl":"10.1016/j.healthpol.2025.105414","url":null,"abstract":"<div><h3>Background</h3><div>The increasing number of older adults with complex care needs underscores the urgent need for improved coordination between health and social services, emphasizing the importance of integrated care models. The Social Return on Investment (SROI) framework is a valuable tool for evaluating the social, economic, and environmental impact of healthcare interventions, including integrated long-term care (LTC) solutions. However, a gap remains in reviews specifically analyzing its application to integrated LTC interventions.</div></div><div><h3>Objective</h3><div>To examine how SROI has been used to evaluate integrated LTC interventions, particularly for older adults.</div></div><div><h3>Methods</h3><div>A scoping review of peer-reviewed and grey literature was conducted, covering January 2012 to June 2024, through MEDLINE, CINAHL, Google Scholar, and citation searches. Three independent reviewers assessed study eligibility, following PRISMA guidelines. Data were extracted using PICOS terms and organized into summary tables detailing study characteristics and SROI findings.</div></div><div><h3>Results</h3><div>Out of 556 screened papers, only 11 studies met the inclusion criteria, with most conducted in the UK. SROI evaluations focused on Personal and Community Resources, such as improved physical and mental health and social connections, while Public Resource benefits, including reduced healthcare workloads, were noted in seven studies. Financial proxies came from sources like HACT Social Value Bank and Global Value Exchange. All studies reported positive SROI ratios, though methodological limitations affect interpretation.</div></div><div><h3>Conclusions</h3><div>The application of SROI to integrated LTC remains limited, primarily UK-based and reliant on context-specific methodologies. Expanding its use requires standardized methods, broader geographic representation, and localized proxies for more accurate evaluations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105414"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852167","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":"Strengthening primary health care: The new contribution of midwives to gynecological care in France","authors":"Quitterie Roquebert ,&nbsp;Henri Panjo ,&nbsp;Carine Franc","doi":"10.1016/j.healthpol.2025.105397","DOIUrl":"10.1016/j.healthpol.2025.105397","url":null,"abstract":"<div><div>Many OECD countries are implementing reforms that redefine the roles of healthcare professionals to improve access to care and enhance the efficiency of the healthcare sector. In 2009, in a context of a shortage of gynecological primary care, France introduced a reform that expanded midwives’ scope of practice to include gynecological care for non-pregnant women, alongside their traditional roles in pregnancy and childbirth. This paper explores the effect of this reform on women’s healthcare utilization and examines how this effect varies according to women’s characteristics. Using administrative data on healthcare utilization among French women, we analyze changes in the probability of consulting a midwife between 2007 and 2017 among non-pregnant women aged 15 to 55. Our results show an increase in midwives’ use following the reform, particularly among recently pregnant women and those living in areas with poor access to healthcare services. Overall, the effect of the reform extending the primary care roles of health professionals on the use of care depends strongly on the provision of information about these new skills to the general public. Furthermore, we show that this reform is likely to strengthen the gynecological primary care supply in disadvantaged areas.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105397"},"PeriodicalIF":3.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654453","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 use of discrete choice experiments in evaluating telehealth: a systematic review","authors":"Feby Savira ,&nbsp;Madison Frith ,&nbsp;Dieu Nguyen ,&nbsp;Richard Norman ,&nbsp;Deniz Senyel ,&nbsp;James Boyd ,&nbsp;Suzanne Robinson","doi":"10.1016/j.healthpol.2025.105421","DOIUrl":"10.1016/j.healthpol.2025.105421","url":null,"abstract":"<div><h3>Background</h3><div>There is a growing body of evidence from discrete choice experiments related to telehealth. Discrete choice experiments offer valuable insights in informing the design and evaluation of telehealth services and supporting the telehealth implementation and policy.</div></div><div><h3>Objective</h3><div>This review aims to examine studies assessing consumer preferences for telehealth using discrete choice experiments.</div></div><div><h3>Methods</h3><div>A systematic review was conducted, searching five health and multidisciplinary databases from inception until 4 April 2024. Grey literature searches, hand-searching, and reference list checks were also performed.</div></div><div><h3>Results</h3><div>Of 2832 studies screened, 52 met the inclusion criteria. Most studies were conducted from the patient perspective (n=47/52, 90 %) and covered a wide range of populations and settings. Of the included studies eligible for quality assessment, 68 % (n=23/34) received high-quality ratings, while others were assessed as moderate. Studies comparing face-to-face consultations with telehealth generally found a preference for face-to-face appointments. Telehealth is viewed more favourably if it can be offered at a lower cost, reduces wait times, and is part of a comprehensive care plan. Telehealth tends to be preferred by younger patients and clinicians, those digitally literate, and those with less severe or more private and stigmatised health conditions.</div></div><div><h3>Conclusion</h3><div>While face-to-face consultations are generally preferred, telehealth is viewed as advantageous if it reduces costs, shortens wait times, and is integrated into comprehensive care. The findings highlight the importance of considering these attributes when designing telehealth preference studies and informing the adoption and design of telehealth services.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105421"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931573","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}