Health Policy最新文献

{"title":"Immigrants’ self-perceived barriers to healthcare: A systematic review of quantitative evidence in European countries","authors":"Chiara Allegri,&nbsp;Elisa Barbiano di Belgiojoso,&nbsp;Stefania Maria Lorenza Rimoldi","doi":"10.1016/j.healthpol.2025.105268","DOIUrl":"10.1016/j.healthpol.2025.105268","url":null,"abstract":"<div><h3>Background</h3><div>with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing.</div></div><div><h3>Methods</h3><div>we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential).</div></div><div><h3>Results</h3><div>linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned.</div></div><div><h3>Discussion</h3><div>policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants’ needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results’ robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105268"},"PeriodicalIF":3.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454841","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":"Forgone Care of doctor's visits in Germany – Results from three cross-sectional surveys","authors":"Christine Haeger ,&nbsp;Raphael Kohl ,&nbsp;Julie L. O'Sullivan ,&nbsp;Susanne Schnitzer","doi":"10.1016/j.healthpol.2025.105273","DOIUrl":"10.1016/j.healthpol.2025.105273","url":null,"abstract":"<div><h3>Background</h3><div>Forgone care, defined as not using health care despite needing it, leads to adverse outcomes such as increased emergency care use. Our study uses data from German representative surveys (2016, 2021, 2022) to examine the frequency, demographics, and reasons for forgone care.</div></div><div><h3>Methods</h3><div>Multiple logistic regression models of individual cohorts and pooled data were used to assess the likelihood of forgoing a doctor's visit. Reasons for forgone care were analyzed descriptively and further clustered in different types of barriers.</div></div><div><h3>Results</h3><div>Of 10,122 participants, 21 % reported forgone care in the past year: 22 % in 2016, 18 % in 2021, and 20 % in 2022. The likelihood of forgone care is highest among women (OR: 1.22 [1.09; 1.37]) and younger adults aged 18–44 years (OR: 1.19 [1.05; 1.34]), whereas participants in partnerships were less likely to forgo care (OR: 0.77 [0.69; 0.87]). Barriers were categorized as systemic (e.g. waiting time; 39 %), psychological (e.g. fear of diagnosis; 22 %), and physical (e.g. difficulty reaching the doctor; 19 %). Younger adults and members of the workforce cited systemic barriers most often, whereas older adults (65+) cited psychological and physical barriers.</div></div><div><h3>Discussion</h3><div>Targeted interventions for vulnerable groups are needed that reduce barriers for forgone care. Recommendations include more accessible doctor's offices, improved appointment systems, expanded telemedicine, and flexible hours.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105273"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509169","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 impact of eliminating out-of-pocket payments for medicines on low-income households: a controlled interrupted time series analysis using linked administrative data from British Columbia","authors":"Kartik Sharma ,&nbsp;Lucy Cheng ,&nbsp;Colin R. Dormuth ,&nbsp;Kimberlyn M. McGrail ,&nbsp;Mary A. De Vera ,&nbsp;Fiona Clement ,&nbsp;Rita K. McCracken ,&nbsp;Muhammed Mamdani ,&nbsp;Michael R. Law","doi":"10.1016/j.healthpol.2025.105270","DOIUrl":"10.1016/j.healthpol.2025.105270","url":null,"abstract":"<div><h3>Background</h3><div>There is interest in reducing out-of-pocket payments for prescription medicines, but the effects of such interventions remain unclear.</div></div><div><h3>Objective</h3><div>To study the impact of changes to the public prescription drug insurance program in British Columbia (BC), Canada that eliminated copayments for low-income households.</div></div><div><h3>Methods</h3><div>We used administrative data from 2017 to 2021 from Population Data BC and a controlled interrupted time-series design to examine a 2019 policy that eliminated copayments for households with incomes below $13,750. Households with incomes over $45,000—who experienced no changes in public coverage—served as a control. Our primary outcomes were prescription drug expenditures and the number of prescriptions dispensed. We also conducted a pre-post analysis to study impacts on dispensing and expenditures across therapeutic classes.</div></div><div><h3>Results</h3><div>The intervention cohort included 9,095 patients representing 8,011 households with an average age of 48.4. The control cohort included 820,395 patients representing 471,778 households with an average age of 51.1. Copayment elimination led to a level increase of $3.85 (95 % CI: $1.13 - $7.03) in monthly drug expenditures and had no impact on the trend. The mean number of prescriptions dispensed had a level increase of 0.07 (95 % CI: 0.04 – 0.09) and the rate of dispensing increased by 0.006 prescriptions monthly (95 % CI: 0.002 – 0.010). Copayment elimination was associated with increased expenditures and dispensing across most therapeutic classes.</div></div><div><h3>Interpretation</h3><div>Copayment elimination for low-income households in BC led to significant increases in prescription drug expenditures and dispensing across drug classes. Eliminating copayments appears to be effective at improving access to medicines for lower-income families.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105270"},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518917","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":"Determinants and associated costs of unmet healthcare need and their association with resource allocation. Insights from Finland","authors":"Lien Nguyen,&nbsp;Unto Häkkinen","doi":"10.1016/j.healthpol.2025.105272","DOIUrl":"10.1016/j.healthpol.2025.105272","url":null,"abstract":"<div><div>The Finnish counties’ allocation formulae for welfare services are based on utilisation collected from national registers and do not account for unmet needs. We investigated factors associated with self-reported unmet healthcare need and associated costs of primary and total healthcare, as well as the association between regional variation in unmet needs and utilisation-based need. The 2017–2018 FinSote survey data were matched with 2017 register data (n = 13,800). Costs of healthcare visits were used as a proxy for utilisation. We applied three logit regressions to explore factors related to self-reported unmet need and eight two-part models to analyse cost data. Analysis weights were developed and used. Those reporting unmet need were female, unemployed and foreign-born, and had multiple morbidities and poor self-assessed health. The highest income quintile and good self-rated quality of life were negatively associated with self-reported unmet need. A person with unmet needs spent an additional €32.2–183.9 and €269.7–963.7 yearly on primary and total healthcare, respectively. Regional differences in self-reported unmet need were not fully correlated with the need indices used in the regional resource allocation. To account for unmet need in budget allocations, self-reported unmet need and quality of life data should be collected more extensively and routinely. Addressing unmet need should be viewed as a long-term investment in primary care to reduce avoidable health inequalities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105272"},"PeriodicalIF":3.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508385","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":"Unveiling patterns and drivers of immigrant health integration policies: A model-based cluster and panel data analysis in MIPEX countries","authors":"Cheng Chow","doi":"10.1016/j.healthpol.2025.105267","DOIUrl":"10.1016/j.healthpol.2025.105267","url":null,"abstract":"<div><h3>Background</h3><div>The integration of immigrant health is a complex process with significant implications for both immigrants and host communities, yet the policies guiding such integration display considerable variation across nations and remain substantially underexplored. This study aims to examine the patterns of health integration policies across countries, identify their distinct characteristics, and investigate the drivers shaping these policies at a global scale.</div></div><div><h3>Method</h3><div>We analyzed data from the Migrant Integration Policy Index (MIPEX) using a cluster analysis of health integration policies in 56 countries. Publicly available international datasets on healthcare capacity, migration dynamics, and institutional development were integrated into a panel data analysis to explore the factors driving these policies.</div></div><div><h3>Findings</h3><div>The analysis identifies three distinct patterns of health integration policies: supportive, restrictive, and generalized. Key drivers include healthcare expenditure, migrant acceptance, and economic development, indicating the interplay of health system capacity, public attitudes, and institutional efficacy in shaping policy performance of immigrant health integration.</div></div><div><h3>Conclusion</h3><div>This research advances understanding of how health integration policies are structured globally and how migration dynamics, institutional factors, and healthcare capacity influence these policies. The findings offer insights into the policy environments that shape immigrant health integration and suggest policy recommendations to promote health equity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105267"},"PeriodicalIF":3.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429551","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":"Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance","authors":"Elenka Brenna","doi":"10.1016/j.healthpol.2025.105271","DOIUrl":"10.1016/j.healthpol.2025.105271","url":null,"abstract":"<div><div>In the Italian NHS, over the last decades, a growing share of population opted for a Voluntary Health Insurance (VHI) in order to privately access healthcare services and bypass the increasingly long waiting times of the public system.</div><div>The study analyses whether and to what extent the presence of a VHI may condition the choice of privately accessing healthcare services. Information on different access fees, specifically “full price”, “copayment price” and “no price”, are furnished for both specialist visits and diagnostic tests; the analysis is focused on these services.</div><div>Data is drawn from the European Health Interview Survey, and is modelled through Propensity Score Matching to find possible differences in the choice of accessing private, rather than public, healthcare services by individuals with VHI.</div><div>Results show a higher likelihood of accessing private specialist (+7.3 %) and diagnostic care (+7.3 %) by patients with a VHI compared to patients without VHI; conversely, having a VHI decreases the probability of seeking NHS care, through copayment, by respectively 5.1 % and 6.3 %. These findings suggest that the spread of VHI may reduce the burden on the NHS and increase the availability of diagnostic and specialist services for patients without integrative coverage.</div><div>On the other side, the analysis shows that income, education and employment status are directly related to the probability of having a VHI, raising concern on possible inequalities across socioeconomic classes in the access to healthcare services. Policy implications are not univocal and claim for a deeper insight into these aspects by both scholars and policymakers.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105271"},"PeriodicalIF":3.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454840","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":"Identification of health-related needs: The needs examination, evaluation and dissemination (NEED) assessment framework","authors":"Charline Maertens de Noordhout ,&nbsp;Muriel Levy ,&nbsp;Rani Claerman ,&nbsp;Mats de Jaeger ,&nbsp;Robby De Pauw ,&nbsp;Laurence Kohn ,&nbsp;Claudia Schönborn ,&nbsp;Irina Cleemput","doi":"10.1016/j.healthpol.2025.105263","DOIUrl":"10.1016/j.healthpol.2025.105263","url":null,"abstract":"<div><div>Innovation in healthcare is highly supply-driven, leading to underinvestment in less profitable health areas, unmet needs and inefficient use of public resources. This study proposes a framework to structure the identification of health-related patient and societal needs across different health conditions, supporting the evolution towards needs-driven healthcare policy and innovation. The Needs Examination, Evaluation and Dissemination (NEED) assessment framework was based on the results of two systematic literature reviews and stakeholder and expert consultation. The first review concerned patient needs criteria and the second concerned societal needs criteria. Relevant publications in Ovid Medline® or Embase®, in English, French or Dutch were included. The NEED framework addresses patient, societal, and future needs across health, healthcare, and social domains. Patient-level needs encompass five criteria in the health domain (e.g., impact on quality of life), four in the healthcare domain (e.g., burden of treatment) and four in the social domain (e.g., impact on social life). Societal needs encompass four health needs criteria (e.g., transmissibility), two healthcare needs criteria (e.g., value for money) and two social needs criteria (e.g., productivity losses). Future needs criteria (2) consider future burden of disease and economic burden. Equity is recognised as a transverse dimension, requiring unmet needs data disaggregated by population sub-groups. Each criterion is associated with one or more measurable indicators. This framework represents an important first step towards a more needs-driven healthcare policy and innovation landscape.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105263"},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578322","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":"Needs of non-pharmacological management versus sedation or general anesthesia for dental treatment in older adults with special needs: A systematic review","authors":"Kamheang Vacharaksa ,&nbsp;Ticha Thongrakard ,&nbsp;Anjalee Vacharaksa","doi":"10.1016/j.healthpol.2025.105262","DOIUrl":"10.1016/j.healthpol.2025.105262","url":null,"abstract":"<div><h3>Background</h3><div>Adults with special needs have dental problems requiring treatment; however, patient management could be extremely difficult under local anesthesia. This review aimed to compare the needs of pharmacological approaches versus non-pharmacological approach for dental treatment to adults with special needs.</div></div><div><h3>Methods</h3><div>This systematic review was registered in PROSPERO (CRD42024528488). The systematic search was conducted in databases: PUBMED; EBSCO; SCOPUS, April 10, 2024. Clinical studies published in English from 2000 to June 2024, demonstrating the needs for pharmacological as compared with non-pharmacological approach in older adults over 18 years old were included. The primary outcome was the completion of dental treatment.</div></div><div><h3>Results</h3><div>Titles and abstracts were screened after the initial search, then forty studies were identified for potential inclusion. After retrieving full‐text studies, Information relevant to objectives and outcome measures was recorded by using a data extraction form and analyzed again by three reviewers. Only 2 articles were eligible and included.</div></div><div><h3>Conclusions</h3><div>The best patient management approach could not be conclusive. Pharmacological approach remains necessary in many situations. Preparation of health care setting and multidisciplinary team is important to ensure patient safety. Further studies focusing on older adults with special needs are needed.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105262"},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418855","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":"Health economic evaluation evidence of interventions for peripartum depression: A scoping review","authors":"Gülcan Tecirli ,&nbsp;Mehtap Çakmak Barsbay ,&nbsp;Greg Sheaf ,&nbsp;Nurettin Öner ,&nbsp;Ana Ganho-Ávila ,&nbsp;Roser Palau-Costafreda ,&nbsp;Inês Ribeiro ,&nbsp;Eva Lassemo ,&nbsp;Elizabeth Camacho ,&nbsp;Pedro Lopes Ferreira ,&nbsp;Annette Bauer","doi":"10.1016/j.healthpol.2025.105264","DOIUrl":"10.1016/j.healthpol.2025.105264","url":null,"abstract":"<div><div>This scoping review provides a broad overview of the existing literature on economic evaluations of preventive, screening, and treatment programmes for peripartum depression (PPD). PPD is one of the leading causes of disease-related disability among women. However, PPD often goes undiagnosed and untreated, with as many as half of cases not being identified.</div><div>We followed the PICO-P (publication type) structure. Databases were searched from inception until 30 June 2023. The intervention stage in the studies was classified as prevention, screening, treatment, screening and treatment, and prevention and treatment. The health economics methods of the studies were divided into cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, cost-minimisation analysis, return of investment, and multiple. Ultimately, 38 studies were included for extraction and evaluation.</div><div>Several interventions for PPD may be cost effective, including peer support, psychological therapies, and screening strategies using tools like the Edinburgh Postnatal Depression Scale (EPDS). However, study limitations include heterogeneity across studies, methodological limitations, and limited generalisability to diverse populations.</div><div>The cost-effectiveness results of PPD interventions may differ across different health systems, partly due to differences in the amount and distribution of resources available. By implementing suggested policy recommendations, policymakers can significantly improve the identification, treatment, and prevention of PPD, ultimately improving the health and well-being of mothers, children, and families.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105264"},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464798","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":"Avoidable visits to UK emergency departments from the patient perspective: A recursive bivariate probit approach","authors":"Chiara Calastri ,&nbsp;John Buckell ,&nbsp;Romain Crastes dit Sourd","doi":"10.1016/j.healthpol.2025.105265","DOIUrl":"10.1016/j.healthpol.2025.105265","url":null,"abstract":"<div><div>Unsustainably high numbers of patients attending emergency departments (ED) is a serious issue worldwide, with consequences for the quality and timeliness of emergency care. Avoidable visits, i.e. unnecessary or that should be dealt with elsewhere, exacerbate this issue. Most studies focussed on avoidable attendances use clinical data collected by hospital staff, while this study relies on survey data collected from patients asked to recall their last ED attendance and reflect on its necessity. We apply a Recursive Bivariate Probit model to quantify the factors affecting patients' perception of an ED visit being avoidable (or not), unveiling how it relates to socio-demographic and contextual factors. We find that patients who do not trust their General Practitioner (GP) are less likely to think their ED visit was avoidable. The perception of whether an ED visit was avoidable is also associated with symptoms experienced, patients’ ethnicity and waiting time for a GP appointment.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105265"},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464949","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}