Health PolicyPub Date : 2024-05-14DOI: 10.1016/j.healthpol.2024.105079
Mauro Laudicella , Paolo Li Donni , Vincenzo Prete
{"title":"Healthcare utilisation by diabetic patients in Denmark: the role of primary care in reducing emergency visits","authors":"Mauro Laudicella , Paolo Li Donni , Vincenzo Prete","doi":"10.1016/j.healthpol.2024.105079","DOIUrl":"10.1016/j.healthpol.2024.105079","url":null,"abstract":"<div><p>Improving the management of diabetic patients is receiving increasing attention in the health policy agenda due to increasing prevalence in the population and raising pressure on healthcare resources. This paper examines the determinants of healthcare services utilisation in patients with type-2 diabetes, investigating the potential substitution effect of general practice visits on the utilisation of emergency department visits. By using rich longitudinal data from Denmark and a bivariate econometric model, our analysis highlights primary care services that are more effective in preventing emergency department visits and socioeconomic groups of patients with a weak substitution response. Our results suggest that empowering primary care services, such as preventive assessment visits, may contribute to reducing emergency department visits significantly. Moreover, special attention should be devoted to vulnerable groups, such as patients from low socioeconomic background and older patients, who may find more difficult achieving a large substitution response.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"145 ","pages":"Article 105079"},"PeriodicalIF":3.3,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000897/pdfft?md5=751cf5c7dd69c048196164a03cd3350c&pid=1-s2.0-S0168851024000897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035340","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}
Health PolicyPub Date : 2024-05-11DOI: 10.1016/j.healthpol.2024.105081
Maria Vandoni, Barbara D'Avanzo, Angelo Barbato
{"title":"The transition towards community-based mental health care in the European Union: Current realities and prospects","authors":"Maria Vandoni, Barbara D'Avanzo, Angelo Barbato","doi":"10.1016/j.healthpol.2024.105081","DOIUrl":"10.1016/j.healthpol.2024.105081","url":null,"abstract":"<div><p>The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105081"},"PeriodicalIF":3.3,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946495","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":"Is the EU steering national social and health policy making? A case-study on Finland's national reform","authors":"Noora Heinonen , Meri Koivusalo , Ilmo Keskimäki , Liina-Kaisa Tynkkynen","doi":"10.1016/j.healthpol.2024.105078","DOIUrl":"10.1016/j.healthpol.2024.105078","url":null,"abstract":"<div><p>As part of the European Semester, Finland received country-specific recommendations (CSRs) in 2013–2020 that encouraged the reform of national social and health services. These recommendations were part of efforts to balance public finances and implement public-sector structural reforms. Finland has been struggling to reform the national social and health care system since 2005. Only on 1 January 2023 did the new wellbeing services counties become liable for organizing social, health, and rescue services. Studying the CSRs for Finland enables us to understand better what genuinely occurs at the EU member state level. This data-driven case study aims to disclose the relevance of the European Semester for Finland in the pursuit of a national social and health system reform. The mixed-method approach is based on the research tradition of governance, and the study contains features of data sourcing and methodological triangulation. Empirically, the research material consists of Finland's official policy documents and anonymous semi-structured elite interviews. The study highlights that although the received CSRs on the need to restructure social and health services corresponded to Finland's views, their influence to national reform efforts was limited. The CSRs were administered according to the established formal routines, but separately from the national reform preparations. The CSRs, however, delivered implicit steering, which were considered to affect social and health policy making in various ways.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"145 ","pages":"Article 105078"},"PeriodicalIF":3.3,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000885/pdfft?md5=7b01abe0ca4a758447c2db9dc014d264&pid=1-s2.0-S0168851024000885-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032597","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}
Health PolicyPub Date : 2024-05-06DOI: 10.1016/j.healthpol.2024.105080
Arturo Felippini , Luiza Vasconcelos Biglia , Tácio de Mendonça Lima , Patricia Melo Aguiar
{"title":"HTA criteria adopted in different models of public healthcare systems for orphan drugs: A scoping review","authors":"Arturo Felippini , Luiza Vasconcelos Biglia , Tácio de Mendonça Lima , Patricia Melo Aguiar","doi":"10.1016/j.healthpol.2024.105080","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105080","url":null,"abstract":"<div><p>Access to drugs for rare diseases constitutes a challenge to healthcare systems, especially those with public funding. This study aimed to map and summarize the criteria used by HTA agencies in different healthcare systems to evaluate reimbursement recommendations for orphan drugs. A comprehensive literature search was performed on the databases PubMed, LILACS, Scopus, and Embase and the gray literature (Google Scholar and websites of HTA agencies). Publications addressing the criteria used by HTA agencies in countries with public healthcare systems when evaluating reimbursement recommendations for orphan drugs were included. This scoping review included 23 studies published between 2014 and 2023, mostly consisting of reviews of HTA reports, guidance documents, and original articles. The criteria were mapped from 19 countries and ranked within three models of healthcare systems (National Health System, National Health Insurance, and Social Health Insurance). All models shared concerns about unmet needs and disease nature. In addition, NHS countries (e.g., United Kingdom, Sweden, and Italy) prioritized innovation and system-level impact, while SHI countries (e.g., Germany, France, the Netherlands) usually valued budget impact and employed expedited evaluation processes. This review provides a comprehensive understanding of the general tendencies of each healthcare system model in establishing differentiated criteria to address the challenges posed by the limited evidence and investment in the field of rare diseases.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105080"},"PeriodicalIF":3.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905582","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}
Health PolicyPub Date : 2024-04-24DOI: 10.1016/j.healthpol.2024.105077
Samuel Rigby , Rachel Greenley , Anneli Uuskula , Anna Tisler , Maria Suurna , Maris Jesse , Marc Bardou , Martin McKee , CBIG-SCREEN Consortium
{"title":"Expanding eligibility and improving quality of cervical cancer screening in Estonia: The 2021 reforms","authors":"Samuel Rigby , Rachel Greenley , Anneli Uuskula , Anna Tisler , Maria Suurna , Maris Jesse , Marc Bardou , Martin McKee , CBIG-SCREEN Consortium","doi":"10.1016/j.healthpol.2024.105077","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105077","url":null,"abstract":"<div><p>Estonia has one of the highest death rates from cervical cancer in the European Union despite having had a population-based screening programme for over 15 years.</p><p>In 2021, this high disease burden, alongside a new national cancer prevention plan, prompted a series of cervical cancer screening programme reforms to address low screening uptake and evidence of variable screening test quality.</p><p>The reforms had three main elements: expansion of eligibility to all women aged 30–65 regardless of insurance status; increasing test provision by enabling family physicians to take screening samples and introducing self-sampling; and improving testing procedures, replacing cytology with HPV testing as the primary screening test.</p><p>Although the impact of these changes is yet to be seen, early signs suggest increased programme participation. However, at 51 %, further action to address barriers to uptake will likely be necessary.</p><p>If Estonia is to avoid another period of policy dormancy, as happened between 2006 and 2021, greater clarity on screening programme accountability is required. The establishment of the National Cancer Screening Group may enable this. The first test will be the delivery of an end<span>-</span>to-end evaluation of the reformed programme, with an emphasis on equity of access. The next step will be to develop and deliver solutions that respond to these needs.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105077"},"PeriodicalIF":3.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000873/pdfft?md5=9f109599d8c88ee0ad6e6b0b1f285360&pid=1-s2.0-S0168851024000873-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140650057","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}
Health PolicyPub Date : 2024-04-22DOI: 10.1016/j.healthpol.2024.105076
Kittiphong Thiboonboon , Richard De Abreu Lourenco, Paula Cronin, Terence Khoo, Stephen Goodall
{"title":"Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes–A Review to Identify Methodological Issues","authors":"Kittiphong Thiboonboon , Richard De Abreu Lourenco, Paula Cronin, Terence Khoo, Stephen Goodall","doi":"10.1016/j.healthpol.2024.105076","DOIUrl":"10.1016/j.healthpol.2024.105076","url":null,"abstract":"<div><h3>Introduction</h3><p>Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes.</p></div><div><h3>Methods</h3><p>A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity.</p></div><div><h3>Results</h3><p>Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality.</p></div><div><h3>Conclusion</h3><p>Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105076"},"PeriodicalIF":3.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000861/pdfft?md5=25095eb448f80ae609e0ff28403dbf18&pid=1-s2.0-S0168851024000861-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765727","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}
Health PolicyPub Date : 2024-04-17DOI: 10.1016/j.healthpol.2024.105073
Tim Chambers , Andrew Anglemyer , Andrew Tzer-Yeu Chen , Michael G. Baker
{"title":"An evaluation of the COVID-19 self-service digital contact tracing system in New Zealand","authors":"Tim Chambers , Andrew Anglemyer , Andrew Tzer-Yeu Chen , Michael G. Baker","doi":"10.1016/j.healthpol.2024.105073","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105073","url":null,"abstract":"<div><h3>Background</h3><p>Digital contact tracing (DCT) aims to improve time-to-isolation (timeliness) and find more potentially exposed individuals (sensitivity) to enhance the utility of contact tracing. The aim of this study was to evaluate the public uptake of a DCT self-service survey and its integration with the Bluetooth exposure notification system within the New Zealand Covid Tracer App (NZCTA).</p></div><div><h3>Methods</h3><p>We adopted a retrospective cohort study design using community COVID-19 cases from February 2022 to August 2022 in New Zealand (1.2 million cases). We examined the proportion of cases completing a self-service survey and the time to complete the survey by age, sex and ethnicity.</p></div><div><h3>Results</h3><p>Overall, 66 % of cases completed their self-service survey. Completion was influenced by age, sex and ethnicity. The median completion time was 1.8 h (IQR 0.2, 17.2), with 95 % of those completing this survey doing so within 48 h of case identification. Around 13 % of all survey completers also uploaded their Bluetooth data, which resulted in an average of 663 cases per day notifying 4.5 contacts per case.</p></div><div><h3>Conclusion</h3><p>The combination of high public uptake and rapid response times suggest self-service DCT could be a useful tool for future outbreaks, particularly if implemented in conjunction with manual processes and other DCT tools (e.g. Bluetooth) to address issues related to performance (sensitivity, timeliness), effectiveness, and health equity.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105073"},"PeriodicalIF":3.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000836/pdfft?md5=012d2204a952b1862e89480c103b6feb&pid=1-s2.0-S0168851024000836-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632584","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}
Health PolicyPub Date : 2024-04-16DOI: 10.1016/j.healthpol.2024.105075
Lydia Kapiriri , Beverly M. Essue
{"title":"Lessons learned from a global analysis of priority setting practices in pandemic response planning","authors":"Lydia Kapiriri , Beverly M. Essue","doi":"10.1016/j.healthpol.2024.105075","DOIUrl":"10.1016/j.healthpol.2024.105075","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105075"},"PeriodicalIF":3.3,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780066","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}
Health PolicyPub Date : 2024-04-16DOI: 10.1016/j.healthpol.2024.105074
Vera Benedetto , Francesca Ferrè , Sabina Nuti
{"title":"Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy","authors":"Vera Benedetto , Francesca Ferrè , Sabina Nuti","doi":"10.1016/j.healthpol.2024.105074","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105074","url":null,"abstract":"<div><p>Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO<sub>2</sub> equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO<sub>2</sub>-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105074"},"PeriodicalIF":3.3,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000848/pdfft?md5=1393cde3a193f955d9e73df89a66f350&pid=1-s2.0-S0168851024000848-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632583","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}
Health PolicyPub Date : 2024-04-07DOI: 10.1016/j.healthpol.2024.105064
Wei Zhang , Daphne P. Guh , Paul Grootendorst , Aidan Hollis , Aslam H. Anis
{"title":"The impact of changing the reference countries on the list prices for patented medicines in Canada: A policy analysis","authors":"Wei Zhang , Daphne P. Guh , Paul Grootendorst , Aidan Hollis , Aslam H. Anis","doi":"10.1016/j.healthpol.2024.105064","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105064","url":null,"abstract":"<div><p>Background: Canada's Patented Medicine Prices Review Board (PMPRB) uses external and internal reference pricing (IRP) to regulate patented drug list prices. PMPRB has changed external reference countries from 7 to 11 to include countries with prices closer to the OECD median. We examined the impact on the list prices for patented medicines had the amendment been implemented from 2013.</p><p>Methods: Using IQVIA MIDAS® quarterly sales data, we selected branded products that were launched in Canada in 2013–2018. The list price for each product in each country was calculated as its average annual price during the 3rd year post Canadian launch. The median international price (MIP) was the median of the list prices of PMPRB7 (MIP7) and PMPRB11 (MIP11). We assumed the same IRP would be (scenario 1) or would not be used (scenario 2).</p><p>Results: Among the selected 400 products, 80.3 % (321) had MIP7 and MIP11 (launched in at least one reference country); 18.3 % did not have MIP11. The total current expenditures were $7,134.4 M. In scenario 1, MIP11 would not be binding for most products and expenditures would decline only by 0.7 %. If IRP were abolished, expenditures might decline by 14.1 % if the launching sequence would not change.</p><p>Conclusions: MIP11 might not be binding for most medicines. The impact depends on whether to retain the IRP and approaches taken for medicines without MIP11.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"144 ","pages":"Article 105064"},"PeriodicalIF":3.3,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000745/pdfft?md5=1e36c207821807721c891654e825048f&pid=1-s2.0-S0168851024000745-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547216","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}