Health Policy最新文献

{"title":"Making integrated care happen: Middle managers' views on leadership for promoting multidisciplinary collaboration at the early stage of the Finnish social and healthcare reform.","authors":"Soila Karreinen, Satu Paatela, Henna Paananen, Moona Huhtakangas, Markku Satokangas, Harri Jalonen, Liina-Kaisa Tynkkynen","doi":"10.1016/j.healthpol.2025.105320","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105320","url":null,"abstract":"<p><p>Different forms of health and social care integration are promoted in many countries to address the complex needs of the population. This qualitative study explores integrative leadership from the perspective of middle managers. The study examines how national and regional integration aspirations are converted into micro-level multidisciplinary collaborations through leadership actions in primary health and social services. The study was conducted at the early stages of major social and health services reform in Finland. The data forms a cross-section of 11 interviews with middle-level managers from different sectors in a new wellbeing services county. Thematic analysis revealed that managers view integrated care positively, considering it efficient and useful. Their main goal is to create public value, including cost-efficiency. The managers believe that their task is to promote multidisciplinary collaboration by developing visions, structures and processes that support professionals in implementing changes in daily work. Many aspects of integrative leadership, such as shared goals and collaborative processes, were identified. More contradictory issues, such as tensions and conflicts between stakeholders, complex accountabilities, legitimacy and power imbalances, were almost absent in the data. These issues should be addressed in organisations, and their role should be studied further as a potential barrier to the successful implementation of integrated care.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105320"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026198","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":"Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022","authors":"Qing Xia ,&nbsp;Steven M McPhail ,&nbsp;Clifford Afoakwah ,&nbsp;Linh K Vo ,&nbsp;Megumi Lim ,&nbsp;David Brain ,&nbsp;John Paul Kuwornu ,&nbsp;Hannah E. Carter","doi":"10.1016/j.healthpol.2025.105319","DOIUrl":"10.1016/j.healthpol.2025.105319","url":null,"abstract":"<div><h3>Background</h3><div>Since the introduction of cost-utility analysis (CUA) in the 1990s, its methodologies and applications have evolved significantly in Australia.</div></div><div><h3>Objectives</h3><div>To provide a comprehensive overview of the volume, trends, and characteristics of the application of CUA in healthcare decision-making.</div></div><div><h3>Methods</h3><div>Bibliometric analysis of published CUAs identified from the Cost-Effectiveness Analysis Registry, a `1comprehensive source of CUA data between 1992 and 2022. Multinomial logistic regression models were conducted to explore the associations between ICERs and variables including sponsorship, perspective, and discount rate.</div></div><div><h3>Results</h3><div><em>N</em> = 484 unique Australian-based CUAs were analysed. Over the last three decades, the volume and quality of CUAs in Australia have steadily increased. Commonly evaluated interventions included pharmaceuticals (21.5 %), health education/behaviour (18.0 %), and models of care (16.6 %), while diseases of circulatory system, cancers, and metabolic diseases were the most studied health conditions. Only nine CUAs involved First Nations people. Most CUAs (72.9 %) were conducted from a healthcare payer perspective, with only 19.0 % adopting a societal perspective. Approximately half of studies applied a 5 % discount rate, and 50.4 % used a $50,000 WTP threshold. 14.7 % CUAs were sponsored by industry. Regression analyses showed that industry sponsorship, societal perspective, and lower discount rate were positively associated with lower ICERs.</div></div><div><h3>Conclusions</h3><div>The increasing volume of CUAs underscores the importance of efficient allocation of scare resources in Australian health system. However, gaps remain, particularly in the inclusion of First Nations populations and the societal costs. Further research is needed to address these gaps and to evaluate the impact of sponsorship and discounting on CUA outcomes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105319"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826300","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":"Contact time in GP Care: Descriptive patterns and a scoping review of the literature","authors":"Simon Reif ,&nbsp;Jan Köhler ,&nbsp;Sabrina Schubert ,&nbsp;Benedikt Stelter","doi":"10.1016/j.healthpol.2025.105315","DOIUrl":"10.1016/j.healthpol.2025.105315","url":null,"abstract":"<div><h3>Background</h3><div>Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations.</div></div><div><h3>Objective</h3><div>To study the determinants and consequences of the length of consultations in GP care.</div></div><div><h3>Method</h3><div>We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters.</div></div><div><h3>Results</h3><div>We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies.</div></div><div><h3>Conclusion</h3><div>Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105315"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864002","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 ethics of behaviour-based insurance models: Solidarity-based concerns in Germany's statutory health insurance","authors":"Carl Justus Bredthauer ,&nbsp;Eva Kuhn ,&nbsp;Alena Buyx","doi":"10.1016/j.healthpol.2025.105318","DOIUrl":"10.1016/j.healthpol.2025.105318","url":null,"abstract":"<div><div>Sickness funds have begun to harness digital behavioural data to incentivise physical activity in their members. This ethical and societal effects of this phenomenon remain largely unclear, especially in solidarity-based insurance systems. Therefore, this study analysed the risks and benefits of such programmes with respect to solidarity against the background of recent efforts by German statutory health insurance funds to integrate digital tracking data into their bonus programmes. Key, potential benefits include new forms of solidarity that may emerge based on sharing personal health data. The incentives introduced by these reward programmes could lead to efficiency gains used to benefit society. However, three conceptual pitfalls have been identified: First, the data gathering method may penalise certain vulnerable groups. Such discrimination could, however, be avoided by minimising barriers to participation. Second, digitally mediated bonus programmes may create deadweight effects, i.e. beneficiaries are likely to already be healthy and active. Consequently, behavioural targets should be designed to consider individual prerequisites. Lastly, linking premiums to behaviour might diminish solidarity with poor risks within statutory health insurances and between statutory and private health insurance. Hence, this study aimed to stimulate debate on the ethical and societal implications of the systemic integration of eHealth innovations into healthcare systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105318"},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837919","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":"Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe","authors":"Brigitte Michelsen ,&nbsp;Mikkel Østergaard ,&nbsp;Michael John Nissen ,&nbsp;Adrian Ciurea ,&nbsp;Burkhard Möller ,&nbsp;Lykke Midtbøll Ørnbjerg ,&nbsp;Pavel Horák ,&nbsp;Bente Glintborg ,&nbsp;Alan MacDonald ,&nbsp;Karin Laas ,&nbsp;Tuulikki Sokka-Isler ,&nbsp;Bjorn Gudbjornsson ,&nbsp;Florenzo Iannone ,&nbsp;Pasoon Hellamand ,&nbsp;Tore Kristian Kvien ,&nbsp;Ana Maria Rodrigues ,&nbsp;Catalin Codreanu ,&nbsp;Ziga Rotar ,&nbsp;Isabel Castrejón ,&nbsp;Johan Karlsson Wallman ,&nbsp;Merete Lund Hetland","doi":"10.1016/j.healthpol.2025.105311","DOIUrl":"10.1016/j.healthpol.2025.105311","url":null,"abstract":"<div><h3>Background</h3><div>Studies on national policies for biologics are warranted.</div></div><div><h3>Objectives</h3><div>To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries’ socio-economic status.</div></div><div><h3>Methods</h3><div>An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.</div></div><div><h3>Results</h3><div>National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.</div></div><div><h3>Conclusion</h3><div>The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105311"},"PeriodicalIF":3.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833693","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 are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries","authors":"Matthew Tracey ,&nbsp;Katharine Schulmann ,&nbsp;Florian Tille ,&nbsp;Thomas Rice ,&nbsp;Julien Mercille ,&nbsp;Rob Timans ,&nbsp;Sara Allin ,&nbsp;Alexis Dottin ,&nbsp;Sanna Syrjälä ,&nbsp;Tiia Sotamaa ,&nbsp;Ilmo Keskimäki ,&nbsp;Bernd Rechel","doi":"10.1016/j.healthpol.2025.105312","DOIUrl":"10.1016/j.healthpol.2025.105312","url":null,"abstract":"<div><div>Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent — and how — subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105312"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837920","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":"Time to completion of conditions required by Health Canada after approving new drugs: A cohort study","authors":"Joel Lexchin","doi":"10.1016/j.healthpol.2025.105314","DOIUrl":"10.1016/j.healthpol.2025.105314","url":null,"abstract":"<div><h3>Background</h3><div>To ensure that promising drugs for serious illnesses reach Canadians in a timely manner, Health Canada can approve them conditionally provided companies commit to conducting confirmatory studies to verify the benefits.</div></div><div><h3>Objective</h3><div>To determine how long it takes until the conditions are fulfilled and if certain factors affect that length of time.</div></div><div><h3>Methods</h3><div>A list of conditional approvals for new drugs and new indications for existing drugs to the end of 2024 was compiled from Health Canada databases. Orphan drug status was determined from the US Food and Drug Administration databases. Kaplan-Meier survival curves were constructed to determine how long it took to complete the studies.</div></div><div><h3>Results</h3><div>There were 153 conditional approvals: 91 were fulfilled, 45 have not been fulfilled as of January 18, 2025 and 17 were withdrawn. The median time for fulfillment was 1200 (IQR 777, 1852) days. Orphan drug status and whether the conditional approval was for a new drug or a new indication for an existing drug did not affect the time to completion.</div></div><div><h3>Conclusions</h3><div>Some NOC/c take considerable time to be fulfilled. Health Canada should require studies to be underway at the time that a NOC/c is granted except in exceptional circumstances and it should be transparent about the completion date for confirmatory studies and provided detailed reports about any delays. In the case of delays that cannot be justified it should be given the power to impose significant financial penalties on manufacturers through the NOC/c pathway being converted from a policy into legislation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105314"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799349","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}

{"title":"The challenge of access to healthcare services as a condition for territorial equity. A methodological approach for sparsely populated rural areas","authors":"Héctor Martínez Sánchez-Mateos,&nbsp;Ángel Raúl Ruiz Pulpón","doi":"10.1016/j.healthpol.2025.105310","DOIUrl":"10.1016/j.healthpol.2025.105310","url":null,"abstract":"<div><div>Access to basic healthcare services poses a significant challenge for sparsely populated rural areas within the European Union, impacting fundamental principles such as territorial equity. This challenge is intensified by current demographic trends, including depopulation and ageing, which affect both the availability of healthcare professionals and the increased demand for efficient healthcare services for the older population. To address this issue, the present study adopts a methodological approach that uses distance and transport time to measure the accessibility of different rural municipalities to healthcare facilities. This study focuses on the Autonomous Region of Castilla-La Mancha (Spain) as a representative territory for the abovementioned demographic dynamics. The main results indicate a clear relationship between negative demographic indicators and poorer healthcare access, especially in rural areas with limited transportation infrastructure. Access to primary healthcare is generally well distributed, with &gt;90 % of rural population living within 15 min of a basic healthcare facility, while hospitals are less accessible for the rural population, with &gt;40 % of the sample needing 30 min to reach one. The sample is also highly sensitive to the population density and ageing rates. As a significant contribution, a universal methodology is presented that can be applied to other rural territories with a significant ageing population, enabling territorial planning policies to optimize quality healthcare in line with the active ageing policies promoted by the United Nations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105310"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817362","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 effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada","authors":"Caroline King ,&nbsp;M. Ruth Lavergne ,&nbsp;Kimberlyn McGrail ,&nbsp;Erin Strumpf ,&nbsp;QC-BC Patient Enrolment Project Team","doi":"10.1016/j.healthpol.2025.105313","DOIUrl":"10.1016/j.healthpol.2025.105313","url":null,"abstract":"<div><div>Affiliation, defined as having a usual source of care, revealed by patterns of repeated interactions between the patient and a clinician over time, can influence patients’ care experience, continuity of care and health outcomes. Many jurisdictions implement primary care enrolment policies, with the motivation to increase affiliation and thereby improve downstream patient outcomes. However, there is little evidence on the impacts of these policies on patient-physician affiliation.</div><div>Using health administrative data, we evaluated the population-level effects of two policies that encourage primary care enrolment on affiliation in Quebec, Canada. We used quasi-experimental study designs (difference-in-difference and interrupted-time-series) to estimate changes in affiliation that could be attributed to the introduction of these policies. The 2003 policy targeted the enrolment of elderly and/or chronically ill patients, whereas the 2009 policy targeted the general population. We used three measures of patient-physician affiliation: dichotomous and continuous usual provider continuity, and the Reporting a Regular Medical Doctor (RRMD) index.</div><div>Our analyses for both policies did not yield substantively important changes in our outcomes at the population level. Our effect estimates for both policies were stable under several robustness checks specific to each method. Our results suggest that policies that encourage enrolment do not, on their own, have an impact on patient-physician affiliation. If enrolment policies are not sufficient to increase patient-physician affiliation, further research is needed to understand the factors that influence both affiliation and other downstream outcomes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105313"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821493","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":"Twenty years evaluating the health impact of urban policies in the city of Barcelona","authors":"María-José López ,&nbsp;Katherine Pérez ,&nbsp;Xavier Continente ,&nbsp;Carme Borrell","doi":"10.1016/j.healthpol.2025.105306","DOIUrl":"10.1016/j.healthpol.2025.105306","url":null,"abstract":"<div><div>The objective of this study is to describe the evaluation of the impact of non-health policies in health in the city of Barcelona, describing the main methodologies used and the main outcomes measured, as well as sharing some of the lessons learned during these years.</div><div>We reviewed the health evaluation of urban policies carried out by the Public Health Agency of Barcelona during the last 20 years, excluding those promoted by the health sector. For each evaluation we have described the evaluative design, the methodology used to collect data and the main outcomes measured.</div><div>More than 20 non-health policies have been evaluated in terms of health in the city of Barcelona. In most cases a quasi-experimental design has been used, having measured outcomes related to health and health-determinants, using quantitative methodology in all cases, combined with qualitative methodology in some evaluations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105306"},"PeriodicalIF":3.6,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783089","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}