Health Policy最新文献

{"title":"Judicious resource managers or administrative intermediaries: A systematic review of family physician perspectives on the administrative process of referring patients to other clinicians in high income countries","authors":"Asiana Elma ,&nbsp;Alison K. Scholes ,&nbsp;Alexander Singer ,&nbsp;Jennifer Shuldiner ,&nbsp;Katrina Shen ,&nbsp;Ian Scott ,&nbsp;Danielle O’Toole ,&nbsp;Deena M. Hamza ,&nbsp;Lawrence Grierson ,&nbsp;Russell Dawe ,&nbsp;Alexandra Cernat ,&nbsp;Meredith Vanstone","doi":"10.1016/j.healthpol.2025.105527","DOIUrl":"10.1016/j.healthpol.2025.105527","url":null,"abstract":"<div><h3>Background</h3><div>Family physicians play a key role in coordinating and managing patient referrals to specialist care. While central to patient care, the referral process has been described as a disproportionately time-consuming and administratively demanding process, contributing to family physician burnout, stress, and attrition. Given the growing recognition of how administrative burden contributes to burnout, stress, and physician attrition from family medicine, it is crucial to examine the nature and impacts of this workload.</div></div><div><h3>Objective</h3><div>To describe the range of perspectives and experiences of family physicians on the referral process.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of mixed-methods studies using a convergent integrative synthesis approach. Eligible studies were peer-reviewed, conducted in OECD countries, and published between 2012-2025. Quantitative data were transformed into portable narrative statements to enable integrated analysis with qualitative data. Constant comparative analysis was applied across different countries and study outcomes.</div></div><div><h3>Results</h3><div>Thirty-one studies were included, conducted in 13 high-income countries. The referral process was characterized as requiring clinical, technological, and social competence, involving decisions about whether and how to refer, and constructing and following up on referrals. This work was further complicated by strained and fragmented healthcare systems, positioning family physicians in the role of bridging system gaps for patients. These challenges resulted in additional paperwork, unnecessary referrals, delays, and rejections, which exacerbated system inefficiencies as opposed to improving resource use. Ultimately, this contributed to physician burnout, reduced professional autonomy, and job dissatisfaction.</div></div><div><h3>Conclusions</h3><div>Ameliorating referral-related burden will require system-level reform and examination of intra-professional power structures.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105527"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750316","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":"Social policies, health systems, and care delivery: Policy implications of eight papers in empirical health economics","authors":"Chiara Seghieri ,&nbsp;Luigi Siciliani ,&nbsp;John Mullay","doi":"10.1016/j.healthpol.2025.105547","DOIUrl":"10.1016/j.healthpol.2025.105547","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105547"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866396","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 composite and synthetic index of potentially avoidable hospitalization in adults to assess primary care quality: an application across Italian geopolitical areas","authors":"Aurora Heidar Alizadeh ,&nbsp;Marcello Cuomo ,&nbsp;Alessandra Burgio ,&nbsp;Alessandro Solipaca ,&nbsp;Paola Arcaro ,&nbsp;Danilo Catania ,&nbsp;Barbara Giordani ,&nbsp;Walter Ricciardi ,&nbsp;Giovanni Baglio ,&nbsp;Gianfranco Damiani","doi":"10.1016/j.healthpol.2025.105528","DOIUrl":"10.1016/j.healthpol.2025.105528","url":null,"abstract":"<div><h3>Background</h3><div>Avoidable hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are key proxy indicators of Primary Care (PC) services quality. Challenges in Italy's National Health Service, worsened by COVID-19, have spurred outpatient care reforms to ultimately reduce avoidable hospitalizations.</div></div><div><h3>Objective</h3><div>To provide a synthetic, composite and cross-national index of avoidable hospitalizations in adults, for evaluating PC services performance.</div></div><div><h3>Methods</h3><div>Nine avoidable hospitalization indicators for 2017-2019 and 2020-2022 were calculated from discharge data of Italian hospitals. Their standardized z-scores, grouped into five nosological areas, were equally weighted to ensure balanced representation. A final synthetic index for each area was classified into one of five Jenks clusters.</div></div><div><h3>Results</h3><div>The national hospitalization rate decreased from 148.17 per 1,000 residents in 2017-2019 to 125.98 in 2020-2022. Before COVID-19, the “low” clusters were 11, whereas the “high” clusters were 14. In 2020-2022, the \"low\" and \"high\" clusters changed to 13 and 10, showing a mild improvement. The “medium-low” and “medium-high” clusters reported significant changes, from 29 to 39 and from 29 to 20, respectively. The “medium” clusters have remained essentially unchanged (from 36 to 37).</div></div><div><h3>Conclusions</h3><div>The index distribution offers three main insights: consistently low values suggest efficient PC services; high values may indicate weak strategies or ineffective PC policies; heterogeneous distribution shows fragmented policies, implying better integration and evaluation. Despite potential biases involving patient behaviors and healthcare system factors, the synthetic index offers an evaluation tool for PC performance, reducing access inequalities, and guiding targeted improvements.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105528"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718899","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 impact of the new ‘guard rails’ for price negotiations on pharmaceutical expenditure in Germany: A simulation exercise and retrospective analysis","authors":"C. Kranich ,&nbsp;D. Möller ,&nbsp;C.M. Dintsios","doi":"10.1016/j.healthpol.2025.105537","DOIUrl":"10.1016/j.healthpol.2025.105537","url":null,"abstract":"<div><h3>Background</h3><div>Due to increasing pharmaceutical expenditures, Germany implemented 'guardrails' for price negotiations at the end of 2022, as part of the ‘Statutory Health Insurance Financial Stabilization Act’. They regulate the pricing of benefit-assessed pharmaceuticals with comparators under data exclusivity, to generate savings</div></div><div><h3>Objective</h3><div>We aimed at quantifying the targeted savings from a payer perspective.</div></div><div><h3>Methods</h3><div>A retrospective implementation of the ‘guard rails’ for new benefit-assessed pharmaceuticals in the period 2020 – 2022 on a subpopulation basis after application of specific exclusion criteria was chosen to estimate their potential savings by means of a simulated budget impact analysis. Comprehensive prescription data and pharmaceutical retail prices were utilized to ensure comparability over time.</div></div><div><h3>Results</h3><div>The analysis included 38 products with 82 subpopulations encompassing approximately 870,000 patients. The difference between negotiated prices and those regulated by the ‘guard rails’ in terms of annual therapeutic costs was statistically significant (p=0.01, CI95%: €1145,925.47 – €8914,501.69). If the ‘guard rails’ had been implemented earlier, pharmaceutical expenditure for the assessed subpopulations could have been reduced by €191.14 million, with oncological products accounting for €117.20 million (61.3% of total savings) in the examined period.</div></div><div><h3>Conclusions</h3><div>Despite the significant potential savings identified in this analysis, the actual annual savings are inconsistent and challenging to predict as they largely depend on the number of new product launches and the extent of their added benefit demonstrated. The application of the ‘guard rails’ remains rather complex and legally ambiguous, suggesting that further contentious discussions are likely in the future.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105537"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750315","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":"Impact of prospective payment systems: An umbrella review of systematic reviews","authors":"Mélanie Lefèvre,&nbsp;Koen Van den Heede,&nbsp;Carine Van de Voorde","doi":"10.1016/j.healthpol.2025.105552","DOIUrl":"10.1016/j.healthpol.2025.105552","url":null,"abstract":"<div><h3>Background</h3><div>Prospective payment systems are widely used in OECD countries and beyond to reimburse hospital care.</div></div><div><h3>Objective</h3><div>To evaluate the impact of prospective payments systems on the quality of patient care, healthcare efficiency, volume of activity, and hospital costs.</div></div><div><h3>Methods</h3><div>Umbrella review by searching three electronic databases for systematic reviews with or without meta-analyses published between 2014 and July 2025. The quality of the included studies was assessed with AMSTAR 2, and tables were constructed to display the characteristics and results of the retrieved publications.</div></div><div><h3>Results</h3><div>Ten systematic reviews were identified that evaluated the impact of prospective payment systems on healthcare efficiency, quality of care, volume of activity and costs. Most of the included reviews drew upon relatively recent primary studies and were of moderate to high methodological quality. Regarding efficiency, most reviews demonstrated that the implementation of prospective payment systems leads to a reduction in hospital length of stay. The umbrella review did not identify substantial evidence of a negative impact on the quality of care. The impact on healthcare costs was less consistently reported, and findings were inconclusive. The evidence on activity volume is also mixed.</div></div><div><h3>Conclusions</h3><div>This review supports the theoretical assumption that prospective payment systems incentivise greater efficiency in healthcare delivery, without detrimental effects on quality of care. However, these conclusions are limited by the heterogeneity of the included payment programmes, contexts, and accompanying interventions, that make it challenging to attribute observed impacts directly to the payment system.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105552"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939086","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":"Editorial for the special issue How do Health Systems and Health contribute to the Sustainable Development Goals?","authors":"Luigi Siciliani ,&nbsp;Jonathan Cylus ,&nbsp;Michelle Falkenbach ,&nbsp;Josep Figueras ,&nbsp;Scott Greer ,&nbsp;Matthias Wismar","doi":"10.1016/j.healthpol.2025.105546","DOIUrl":"10.1016/j.healthpol.2025.105546","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105546"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828710","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":"National policy responses to address loneliness: A global scoping review of 194 WHO member states","authors":"Nina Goldman ,&nbsp;Melek Alemdar ,&nbsp;Herlind Megges ,&nbsp;Naka Matsumoto ,&nbsp;Eric Schoenmakers ,&nbsp;Pauline van den Berg ,&nbsp;Mathias Lasgaard ,&nbsp;Julie Christiansen ,&nbsp;Niina Junttila ,&nbsp;Andreas Goldman ,&nbsp;Debora Draxl ,&nbsp;Austen El-Osta ,&nbsp;Pamela Qualter","doi":"10.1016/j.healthpol.2025.105553","DOIUrl":"10.1016/j.healthpol.2025.105553","url":null,"abstract":"<div><h3>Background</h3><div>Loneliness is associated with adverse physical and mental health outcomes. It affects individuals across all age groups and geographical regions.</div></div><div><h3>Objective</h3><div>To characterise the extent that WHO Member States address loneliness, social isolation and social connection through national policies.</div></div><div><h3>Methods</h3><div>We searched government websites using key terms. A matrix was used to extract data, followed by in-depth document analysis.</div></div><div><h3>Results</h3><div>By February 2025, only eight WHO Member States (Denmark, UK (England, Scotland, Wales), Finland, Germany, Netherlands, Sweden, Japan, USA) had policies directly addressing loneliness, social isolation or social connection. Policymakers validated the findings. Common policy aims included building a more connected society, addressing loneliness as a wider societal challenge rather than just an individual issue, and supporting both individuals and organisations to manage loneliness. Key recommendations in these policies often highlighted the need to increase knowledge through research, raise public awareness to reduce stigma, promote cross-sectoral collaboration, integrate loneliness into government policy and implement community-based approaches. National policies emerged following societal activism, initiatives from government departments or a large-scale research project.</div></div><div><h3>Conclusion</h3><div>Various policies are in place to help address loneliness at the national level. To maximise impact, policies require adequate funding. To date, none of the national policies had undergone rigorous evaluation concerning their effectiveness. This review highlights the growing political focus on loneliness and provides a starting point for those seeking to understand, develop or strengthen national strategies to address loneliness, social isolation or social connection.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105553"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913936","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":"Survey data collection during the COVID-19 pandemic in Germany: Recommendations for an improved data collection infrastructure","authors":"Tobias Gummer ,&nbsp;Karolina von Glasenapp ,&nbsp;Thomas Skora ,&nbsp;Elias Naumann ,&nbsp;Saskia Bartholomäus ,&nbsp;Sophia Piesch","doi":"10.1016/j.healthpol.2025.105551","DOIUrl":"10.1016/j.healthpol.2025.105551","url":null,"abstract":"<div><div>The COVID-19 pandemic created a high demand for rapid data collection while also posing major challenges to collecting timely, high-quality population survey data on public health, and health-related behavior and attitudes. In the Survey Data Collection during the COVID-19 Pandemic (SDCCP) project, we examined how data collection standards evolved during the pandemic and what challenges the national survey infrastructure in Germany was facing. Our findings revealed trade-offs between speed and data quality and a lack of preparedness for rapid data collection. Existing surveys struggled to remain operational and maintain their high standards, whereas newly established surveys were more likely to implement survey designs associated with lower data quality. In this policy comment, we recommend targeted investments in methodological research, operational nationwide emergency planning, and policy changes to support closer collaboration between survey infrastructures.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105551"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835314","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":"Nurse-led models of care and their potential to improve primary healthcare for refugees in Germany: A qualitative multiple-case study","authors":"Andreas W. Gold ,&nbsp;Clara Perplies ,&nbsp;Kayvan Bozorgmehr","doi":"10.1016/j.healthpol.2025.105529","DOIUrl":"10.1016/j.healthpol.2025.105529","url":null,"abstract":"<div><h3>Background</h3><div>Fragmented health systems can lead to over-, under-, or misuse of services. Specific challenges arise for newly arrived population groups, such as refugees, who encounter barriers to health services. These include legal restrictions and language discordance with service providers, that further exacerbate these issues. Although nurses can play an important role in improving the response of the health system, little is known about their scope of practice and their role in caring for refugees in primary healthcare contexts.</div></div><div><h3>Objective</h3><div>To investigate key characteristics of three nurse-led models of care for refugees in Germany, the roles and responsibilities of nurses and to describe their potential to improve coordination and continuity.</div></div><div><h3>Methods</h3><div>A qualitative, multiple-case study was conducted using a purposeful sampling strategy. Data collection included semi-structured interviews with three programme managers and five nurses from three operational nurse-led models of care in Germany, a social network questionnaire and a review of documents. Data analysis comprised developing logic models and using qualitative content and social network analysis methods.</div></div><div><h3>Results</h3><div>Examined models involve nurses by allowing for independent management of tasks such as observation, counselling, and care coordination, providing support to patients and linking them to other healthcare services. In the absence of specific training programmes, nurses rely on-the-job learning.</div></div><div><h3>Conclusions</h3><div>Nurse-led models of care can effectively improve healthcare for refugees. Policymakers should recognise and advance nursing practice through legislative measures and sustainable funding models. In order to prepare nurses for working in these settings, nursing curricula should incorporate refugee-specific aspects.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"165 ","pages":"Article 105529"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783609","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":"Impact of COVID-19 on primary care consultation mode in England: An interrupted time series analysis","authors":"Nicoletta Mesiano ,&nbsp;Rita Santos","doi":"10.1016/j.healthpol.2025.105502","DOIUrl":"10.1016/j.healthpol.2025.105502","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic significantly disrupted healthcare delivery worldwide, and general practice in England was no exception. The adoption of remote consultations in primary care increased sharply during the pandemic. However, there is no evidence that the adoption of remote consultation will continue in the long term.</div></div><div><h3>Objective</h3><div>Analyse the long-term effects on primary care face-to-face and telephone consultations in England after the change towards remote consultation during COVID-19 pandemic.</div></div><div><h3>Method</h3><div>We use Interrupted Time Series analysis to understand the long-term effects on primary care face-to-face and telephone consultations in England at both national and regional levels.</div></div><div><h3>Results</h3><div>There was a shift in consultation patterns during and after the pandemic. Face-to-face consultations experienced a significant and immediate decline following the introduction of restrictions. However, they gradually increased and returned to pre-pandemic levels after restrictions were lifted, indicating that most healthcare needs still require in-person contact. Telephone consultations rose sharply during the pandemic. Although their use declined after restrictions eased in July 2021, they remained above pre-pandemic levels.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic profoundly changed how general practice consultations are delivered in England, prompting a rapid shift to remote consultation methods. While telephone consultations surged when face-to-face contact was restricted, this increase was not sustained in the long term. Although remote consultations remained above pre-pandemic levels, they did not fully replace in-person visits. This suggests a dual use of resources rather than a substitution. Policy efforts should focus on balancing and supporting both remote and face-to-face consultation models.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105502"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679632","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}