Health Policy最新文献_第3页

The challenge of access to healthcare services as a condition for territorial equity. A methodological approach for sparsely populated rural areas 将获得保健服务作为领土平等条件的挑战。人口稀少的农村地区的方法方法

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-02 DOI: 10.1016/j.healthpol.2025.105310

Héctor Martínez Sánchez-Mateos, Ángel Raúl Ruiz Pulpón

{"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, 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 >90 % of rural population living within 15 min of a basic healthcare facility, while hospitals are less accessible for the rural population, with >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}

引用次数: 0

The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada 注册政策对病人从属于家庭医生的影响：加拿大的准实验评估

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-02 DOI: 10.1016/j.healthpol.2025.105313

Caroline King , M. Ruth Lavergne , Kimberlyn McGrail , Erin Strumpf , QC-BC Patient Enrolment Project Team

{"title":"The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada","authors":"Caroline King , M. Ruth Lavergne , Kimberlyn McGrail , Erin Strumpf , 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}

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Twenty years evaluating the health impact of urban policies in the city of Barcelona 二十年来评估巴塞罗那城市政策对健康的影响

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-30 DOI: 10.1016/j.healthpol.2025.105306

María-José López , Katherine Pérez , Xavier Continente , Carme Borrell

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Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption 面对Covid-19的法国医院弹性：以往执业质量对癌症手术恢复影响的多层次分析

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-28 DOI: 10.1016/j.healthpol.2025.105309

Noémie Malléjac , Zeynep Or

{"title":"Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption","authors":"Noémie Malléjac , Zeynep Or","doi":"10.1016/j.healthpol.2025.105309","DOIUrl":"10.1016/j.healthpol.2025.105309","url":null,"abstract":"<div><div>The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated.</div><div>Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105309"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785659","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}

引用次数: 0

Global health and care worker migration requires a global response 全球卫生和保健工作者移徙需要全球应对

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-28 DOI: 10.1016/j.healthpol.2025.105305

Ellen Kuhlmann , Michelle Falkenbach , Tiago Correia , Niamh Humphries , Eleanor Hutchinson , Gareth H Rees , Marius-Ionut Ungureanu , Tomas Zapata , Julia Lohmann

{"title":"Global health and care worker migration requires a global response","authors":"Ellen Kuhlmann , Michelle Falkenbach , Tiago Correia , Niamh Humphries , Eleanor Hutchinson , Gareth H Rees , Marius-Ionut Ungureanu , Tomas Zapata , Julia Lohmann","doi":"10.1016/j.healthpol.2025.105305","DOIUrl":"10.1016/j.healthpol.2025.105305","url":null,"abstract":"<div><div>The global migration of the health and care workforce (HCWF) has intensified, leading to complex policy scenarios and diverse migration patterns. While the traditional narrative of individual health and care workers (HCWs) migrating from low- and middle-income countries to high-income countries in search of higher income, career prospects and working conditions remains relevant, it now coexists with many other drivers, incentives, and dynamics at individual and policy level. The evolving dynamics of HCW migration have profound implications extending far beyond health labour markets, influencing broader societal and political landscapes. Despite their significance, the qualitative shifts in HCWF migration patterns and the governance challenges they present are poorly understood and under-researched, and policies have thus been limited in their effectiveness. In this policy comment we argue for a global response and an enhanced focus on policy implementation, using selected case studies to illustrate the argument. The cases highlight complexities of HCW migration patterns and opportunities for strengthening implementation of the WHO Global Code of Practice to respond effectively to the diverse needs of health systems and individual HCWs.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105305"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760878","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}

引用次数: 0

From policy to practice: Rolling out the clinical nurse specialist role in Portugal 从政策到实践：在葡萄牙推出临床护士专家角色

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-26 DOI: 10.1016/j.healthpol.2025.105308

Mário Amorim-Lopes , Sofia Cruz-Gomes , Elisa Doldi , Bernardo Almada-Lobo

{"title":"From policy to practice: Rolling out the clinical nurse specialist role in Portugal","authors":"Mário Amorim-Lopes , Sofia Cruz-Gomes , Elisa Doldi , Bernardo Almada-Lobo","doi":"10.1016/j.healthpol.2025.105308","DOIUrl":"10.1016/j.healthpol.2025.105308","url":null,"abstract":"<div><div>The specialization of Health Human Resources (HHR) is increasingly recognized as essential for addressing evolving healthcare demands. This paper presents a comprehensive policy framework for assisting with the implementation of Clinical Nurse Specialist (CNS) roles at the national or regional level, integrating key dimensions including barriers and enablers, regulation and governance, education and training requirements, career development, workforce planning, and economic analysis. The framework was applied to the implementation of CNS roles in Portugal, resulting in the issuance of a decree-law by the government.</div><div>Our findings demonstrate that the economic analysis step was critical in addressing concerns from government authorities and health system funders regarding the potential budgetary impact of CNS implementation. By providing evidence-based projections of costs and benefits, the economic analysis facilitated smoother negotiations and consensus-building among stakeholders, including nursing unions. Furthermore, the integration of workforce planning ensured the alignment of educational capacity with workforce needs, thus avoiding potential implementation bottlenecks.</div><div>The application of the framework also revealed important feedback relationships between its dimensions, highlighting the interdependent nature of the implementation process. This dynamic approach, which adapts to real-time feedback and stakeholder input, underscores the necessity of a holistic and iterative strategy for successful CNS role integration. The insights gained from the Portuguese case underscore the utility of this policy framework in guiding the implementation of advanced nursing roles in diverse healthcare contexts.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105308"},"PeriodicalIF":3.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747154","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}

引用次数: 0

How does OTC drugs consumption relate to prescribed drugs and health care consultations in Europe? 在欧洲，非处方药的消费与处方药和医疗咨询有什么关系？

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-23 DOI: 10.1016/j.healthpol.2025.105307

Aida Isabel Tavares

引用次数: 0

Fostering integrated healthcare in rural Australia: A review of service models for older Australians with preventable chronic conditions. 促进澳大利亚农村综合保健：对患有可预防慢性病的澳大利亚老年人服务模式的审查。

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-22 DOI: 10.1016/j.healthpol.2025.105304

Mohammad Hamiduzzaman, Vanette McLennan, Harry Gaffney, Sarah Miles, Sarah Crook, Lewis Grove, Matthew Gray, Victoria Flood

{"title":"Fostering integrated healthcare in rural Australia: A review of service models for older Australians with preventable chronic conditions.","authors":"Mohammad Hamiduzzaman, Vanette McLennan, Harry Gaffney, Sarah Miles, Sarah Crook, Lewis Grove, Matthew Gray, Victoria Flood","doi":"10.1016/j.healthpol.2025.105304","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105304","url":null,"abstract":"<p><p>Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105304"},"PeriodicalIF":3.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744457","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}

引用次数: 0

Framing the loss: Preferences for vaccine hesitancy and gender effect in France and Italy 构建损失：法国和意大利对疫苗犹豫和性别影响的偏好

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-17 DOI: 10.1016/j.healthpol.2025.105301

Anna Rinaldi , Pierfrancesco Dellino , Massimo Paradiso

引用次数: 0

Commentary on “The learning rehabilitation system: Strengthening an intersectoral strategy to improve functioning of an ageing population” by Bickenbach et al. 对Bickenbach等人的“学习康复系统：加强部门间战略以改善老龄化人口的功能”的评论。

IF 3.6 3区医学

Health Policy Pub Date : 2025-03-12 DOI: 10.1016/j.healthpol.2025.105303

Nicola Manocchio , Concetta Ljoka , Valerio Ferdinandi , Lucia Cicchi , Calogero Foti

{"title":"Commentary on “The learning rehabilitation system: Strengthening an intersectoral strategy to improve functioning of an ageing population” by Bickenbach et al.","authors":"Nicola Manocchio , Concetta Ljoka , Valerio Ferdinandi , Lucia Cicchi , Calogero Foti","doi":"10.1016/j.healthpol.2025.105303","DOIUrl":"10.1016/j.healthpol.2025.105303","url":null,"abstract":"<div><div>Bickenbach et al. in their paper propose the transformation of the Learning Health System paradigm into a Learning Rehabilitation System. The shift towards Rehabilitation, as opposed to the traditional anatomical-physiological approach, holds paramount importance in healthcare since Rehabilitation, as defined by the World Health Organization, centers on the individual, emphasizing the optimization of functioning and reduction of disability. In this commentary we would like to add some concepts to the discussion. When establishing an Individual Rehabilitation Project, the environment in which patients live and healthcare workers operate should be considered, since the broad context could be very different. We believe that a smooth and successful transition through a Learning Rehabilitation System needs an ethical and not moralistic educational system, solid international political stability and an active prevention perspective by health organizations. A new “health pyramid” grounded in the concept of human functioning of the single individual, should be the compass guiding future health interventions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105303"},"PeriodicalIF":3.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629103","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}

引用次数: 0