Health Policy最新文献

{"title":"Employment models for general practitioners in england: evidence from repeated surveys","authors":"Jonathan Martin Gibson,&nbsp;Sean Urwin,&nbsp;Sharon Spooner,&nbsp;Kath Checkland,&nbsp;Matt Sutton","doi":"10.1016/j.healthpol.2025.105425","DOIUrl":"10.1016/j.healthpol.2025.105425","url":null,"abstract":"<div><h3>Background</h3><div>Recruitment and retention of General Practitioners (GPs) is a global challenge in primary care. Traditionally, GPs in the UK have worked as self-employed partners. However, policy changes in England have allowed for salaried GP positions within primary care partnerships. The effects of these different employment models on recruitment and retention remain unclear.</div></div><div><h3>Objective</h3><div>This study investigates the impact of partnership vs. salaried employment models on GP job satisfaction, job pressures, and intentions to reduce working hours in England.</div></div><div><h3>Methods</h3><div>Data from nine waves of the national GP Worklife Survey (2001–2019) were analysed using multivariate regression models. The analysis adjusted for several GP characteristics, including age, gender, ethnicity, marital status, and number of children.</div></div><div><h3>Results</h3><div>Salaried GPs reported higher satisfaction with working hours but lower satisfaction with income compared to partner GPs. Partner GPs experienced higher job pressures and were more likely to intend to reduce their working hours within five years.</div></div><div><h3>Conclusions</h3><div>Flexible working arrangements, such as salaried positions, may enhance job satisfaction and retention among GPs, helping to address workforce challenges in primary care. Targeted policies are needed to mitigate job pressures and improve satisfaction, particularly among partner GPs.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105425"},"PeriodicalIF":3.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093033","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":"Can de-budgeting save primary care in Germany? A turning point for general practice","authors":"Damon Mohebbi ,&nbsp;Rumeysa Yasar ,&nbsp;Altina Ademi ,&nbsp;Nazmiye Acar ,&nbsp;Shadan Rahimpour","doi":"10.1016/j.healthpol.2025.105426","DOIUrl":"10.1016/j.healthpol.2025.105426","url":null,"abstract":"<div><div>In its last healthcare act, Germany’s previous government abolished budget caps for general practitioners (GPs) in February 2025, exempting most primary care services from quantity limits and fee reductions. Originally introduced in 1993 to control healthcare costs, budgets have led to significant financial shortfalls for outpatient practices. Meanwhile, a worsening GP shortage - driven by high retirement rates, changing career preferences, and increasing healthcare demand - has made primary care reform urgent. The new law seeks to make general practice more attractive but does not cover all GP services. Critics warn of financial burdens, with health insurers estimating additional annual costs of €400 million for GPs. While de-budgeting is a key step, broader reforms - strengthening practice structures, medical education, and digital systems - are needed to secure the future of primary care.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105426"},"PeriodicalIF":3.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026406","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":"Comparing health outcomes and costs of home and community-based services (HCBS) versus institutional care (IC) for long-term care insurance beneficiaries in South Korea: Can the less severe benefit more?","authors":"Sunghun Yun ,&nbsp;Soonman Kwon","doi":"10.1016/j.healthpol.2025.105427","DOIUrl":"10.1016/j.healthpol.2025.105427","url":null,"abstract":"<div><div>It is often considered that home and community-based services (HCBS) are better than institutional care services (IC) in terms of person’s preferences and costs in long-term care (LTC) settings. However, this may not always be the case depending on the baseline health status of the person. Using nationally representative data from South Korea, we examined whether the effects of HCBS versus IC on health outcomes and costs differ according to the individual's baseline health status.</div><div>Entropy balancing weights were applied to achieve a good balance of baseline covariates. These covariates included variables derived from a comprehensive needs assessment, as well as historical health status and healthcare utilization trends obtained from claims-based administrative data, thereby supporting the parallel trend assumption between the treated and control groups.</div><div>Our results indicated that, in general, HCBS were associated with better health outcomes and lower formal care costs compared to IC (5.7 %p less death, 0.55 point less decline of activities of daily living, and USD 6242 less formal care costs during a 1-year follow-up). However, these differences diminished among individuals with severe functional limitations at the baseline.</div><div>To the best of our knowledge, this is the first study to investigate the heterogenous effects of choosing HCBS over IC on older adult’s health outcomes and costs due to baseline health status, using a nationally representative data from South Korea where universal access to LTC services is available.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105427"},"PeriodicalIF":3.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931574","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":"Strengthening innovation capacity in health and care workforce: A role-based framework for the procurement professionals","authors":"Klaas Stek,&nbsp;Luc Lefers,&nbsp;Carolina Belotti Pedroso","doi":"10.1016/j.healthpol.2025.105423","DOIUrl":"10.1016/j.healthpol.2025.105423","url":null,"abstract":"<div><h3>Background</h3><div>The procurement function in the health and care workforce is pivotal for enabling innovation, sustainability, and value-based resource allocation. Yet, its workforce development remains underexplored in public health and health policy research.</div></div><div><h3>Objective</h3><div>To develop a role-based model of innovation procurement capacity in health and care, identifying emerging roles and associated competencies needed within complex public health systems.</div></div><div><h3>Methods</h3><div>We conducted 21 semi-structured interviews with procurement professionals from five European countries (Belgium, Denmark, Germany, the Netherlands, Spain). Guided by the Dynamic Capabilities framework, thematic analysis identified role-based patterns in innovation procurement. Competency profiles were mapped against the European Commission’s ProcurComp^EU framework.</div></div><div><h3>Results</h3><div>Six emerging roles were identified: Strategic Business Partner, Digital/Automation Expert, Innovation Matchmaker, Sustainability Coordinator, Data Engineer, and Innovation Coordinator. These roles signal a shift from generalist procurement functions to specialised, distributed innovation capacities. The analysis extends the ProcurComp^EU framework with sector-specific, innovation-oriented competencies.</div></div><div><h3>Conclusions</h3><div>Building procurement competencies in the health and care workforce is essential for harnessing innovation in service delivery. This study offers a framework for competency development and highlights the institutional conditions required for effective application. Innovation procurement demands differentiated roles and capabilities aligned with system-wide goals for resilience, digital transformation, and sustainability. The proposed role-based model serves as a practical roadmap for policymakers, public institutions, and training providers to professionalise the procurement workforce and position it as a strategic enabler of health and care transformation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105423"},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988589","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":"Comparative analysis of tuberculosis management in Indigenous North Canada and Alaska, USA from 1950s to 2019","authors":"Hongyu Huang ,&nbsp;Raja Faisal Abbas ,&nbsp;Shishi Wu ,&nbsp;Jerome Song ,&nbsp;Yuchuan Ye ,&nbsp;Elizabeth Rea ,&nbsp;Christopher Rutty ,&nbsp;Ross Upshur ,&nbsp;Pamela Orr ,&nbsp;Xiaolin Wei","doi":"10.1016/j.healthpol.2025.105422","DOIUrl":"10.1016/j.healthpol.2025.105422","url":null,"abstract":"<div><h3>Background</h3><div>Both Alaska and Indigenous North Canada share similarities in geographic location, population, and a history of colonization. While both regions have seen a significant decline in tuberculosis (TB) prevalence over the last century, Nunavut, Canada, has reported a troubling resurgence of TB cases since the early 2000s.</div></div><div><h3>Objective</h3><div>To identify analogies and highlight dissimilarities between the two regions using a comparative health systems approach within the historical and sociopolitical contexts. We also aim to provide governments with insights on employing best practices and adopting effective policies for improved TB management to achieve the WHO END-TB target by 2035.</div></div><div><h3>Method</h3><div>This study applied a modified version of the WHO Health Systems Building Blocks Framework to assess TB programs in both regions through a contextual lens. A scoping review inspired review of academic literature, government reports, and open-source documents (1950–2019) informed the analysis.</div></div><div><h3>Results</h3><div>In Indigenous Northern Canada, TB control is hindered by limited healthcare investment, reliance on evacuation policies, and workforce shortages. Social determinants, such as overcrowded housing and food insecurity, exacerbate the issue. In contrast, Alaska's early infrastructure development led to the establishment of local healthcare services, workforce training, and community-based programs, resulting in more effective TB management.</div></div><div><h3>Conclusion</h3><div>The underdeveloped economy, inadequate primary healthcare, weak community health services, dependence on medical travel, and persistent social determinants hinder TB control in Nunavut. The comparison of TB responses in Alaska and Indigenous Northern Canada highlights the necessity for well-resourced local and regional healthcare that actively involves the community.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105422"},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922020","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 use of discrete choice experiments in evaluating telehealth: a systematic review","authors":"Feby Savira ,&nbsp;Madison Frith ,&nbsp;Dieu Nguyen ,&nbsp;Richard Norman ,&nbsp;Deniz Senyel ,&nbsp;James Boyd ,&nbsp;Suzanne Robinson","doi":"10.1016/j.healthpol.2025.105421","DOIUrl":"10.1016/j.healthpol.2025.105421","url":null,"abstract":"<div><h3>Background</h3><div>There is a growing body of evidence from discrete choice experiments related to telehealth. Discrete choice experiments offer valuable insights in informing the design and evaluation of telehealth services and supporting the telehealth implementation and policy.</div></div><div><h3>Objective</h3><div>This review aims to examine studies assessing consumer preferences for telehealth using discrete choice experiments.</div></div><div><h3>Methods</h3><div>A systematic review was conducted, searching five health and multidisciplinary databases from inception until 4 April 2024. Grey literature searches, hand-searching, and reference list checks were also performed.</div></div><div><h3>Results</h3><div>Of 2832 studies screened, 52 met the inclusion criteria. Most studies were conducted from the patient perspective (n=47/52, 90 %) and covered a wide range of populations and settings. Of the included studies eligible for quality assessment, 68 % (n=23/34) received high-quality ratings, while others were assessed as moderate. Studies comparing face-to-face consultations with telehealth generally found a preference for face-to-face appointments. Telehealth is viewed more favourably if it can be offered at a lower cost, reduces wait times, and is part of a comprehensive care plan. Telehealth tends to be preferred by younger patients and clinicians, those digitally literate, and those with less severe or more private and stigmatised health conditions.</div></div><div><h3>Conclusion</h3><div>While face-to-face consultations are generally preferred, telehealth is viewed as advantageous if it reduces costs, shortens wait times, and is integrated into comprehensive care. The findings highlight the importance of considering these attributes when designing telehealth preference studies and informing the adoption and design of telehealth services.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105421"},"PeriodicalIF":3.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931573","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 matters most to the population in case of chronic conditions? Results from a discrete choice experiment in Italy","authors":"Milena Vainieri ,&nbsp;Veronica Spataro ,&nbsp;Sabina De Rosis ,&nbsp;Filippo Quattrone ,&nbsp;Sabina Nuti","doi":"10.1016/j.healthpol.2025.105420","DOIUrl":"10.1016/j.healthpol.2025.105420","url":null,"abstract":"<div><div>Relational continuity, care coordination, and teamwork are widely recognized as key components of quality in primary care. This study investigates population preferences regarding organizational models of primary care, with a particular focus on the roles of general practitioners, specialists, and nurses. A Discrete Choice Experiment (DCE) was conducted through a nationwide online cross-sectional survey, employing a full factorial experimental design with 20 randomly selected choice sets to minimize cognitive burden. The attributes examined included coordination, relational continuity, and teamwork.</div><div>Data were collected from a representative sample of 2,553 respondents across Italy in early 2021. Results underscore the centrality of teamwork (OR=1.85 in mild and 2.31 in severe chronic conditions), followed by relational continuity (OR=1.60 in mild and 1.55 in severe conditions). Coordination ranks third (OR=1.31) for mild conditions but reaches parity with relational continuity in the context of severe chronic conditions. These findings offer robust evidence of differentiated preferences based on chronic disease severity and support the design of tailored primary care models.</div><div>In conclusion, this analysis highlights the importance of incorporating coordination, relational continuity, and teamwork in the configuration of primary care services, offering policy-relevant insights for adapting delivery models to the needs of patients with varying levels of chronicity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105420"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925178","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":"Reframing the evaluation of integrated care; examples from the NHS in England.","authors":"Tom Ling, Nick Fahy, Jessica Dawney","doi":"10.1016/j.healthpol.2025.105418","DOIUrl":"10.1016/j.healthpol.2025.105418","url":null,"abstract":"<p><p>There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to 'do' it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective. We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105418"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979504","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":"Evaluation of the implementation experiences of the Hungarian integrated care coordination pilot.","authors":"Peter Andras Gaal, Tamas Evetovits, Eszter Sinko, Krisztina Davidovics, Judit Lam","doi":"10.1016/j.healthpol.2025.105417","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105417","url":null,"abstract":"<p><strong>Background: </strong>Caring for patients with multiple chronic conditions requires integration, but more evidence is needed on what makes reform initiatives work. This study aims to identify and analyse the critical success factors of a Hungarian care coordination experiment (1999-2008).</p><p><strong>Methods: </strong>The Hungarian Care Coordination System is described and analysed based on three feasibility dimensions: conceptual (problem-based policymaking), technical, and political. Data are from documentary analysis, official statistics and implementation experiences of a care coordinator organisation.</p><p><strong>Results: </strong>The conceptual and technical feasibility of the pilot is characterised by innovative features: provider and financial incentive (functional integration) based implementation; virtual fundholding; design features, which counterbalance incentives to undertreat, eliminate bankruptcy risks, exclude risk selection practices and ensure easy upscalability; the utilisation of advanced provider payment information systems for monitoring. The conceptual flaw of calculating the virtual budget should have been corrected and the risk of cost increase due to better access and quality could have been addressed. The experiment failed in terms of political feasibility. Better communication, more transparency, systematic monitoring and more frequent evaluation would have been needed.</p><p><strong>Discussion: </strong>The model did not upset existing arrangements. Efficiency was ensured through a balance of decentralised and centralized functions: care coordination by providers and revenue-generation, pooling, and purchasing by central agencies.</p><p><strong>Conclusion: </strong>The Hungarian Care Coordination System is a unique health system innovation, still relevant in the current Hungarian context, and for other countries to learn from.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105417"},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979538","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":"Reducing mental health emergency department visits through community-based assessment services. A controlled time-series analysis in the city of Lyon, France","authors":"Guillaume Barbalat,&nbsp;Romane De Rozario,&nbsp;Nicolas Franck","doi":"10.1016/j.healthpol.2025.105419","DOIUrl":"10.1016/j.healthpol.2025.105419","url":null,"abstract":"<div><h3>Background</h3><div>The mental health burden on Emergency Departments (EDs) is significant. Community-based mental health services are key to lowering ED visits by addressing mental health needs proactively.</div></div><div><h3>Objective</h3><div>To examine the impact of CAdEO, a community-based patient assessment and triage service launched in 2020 in Lyon, France, on psychiatric ED visits among new patients at a local psychiatric hospital.</div></div><div><h3>Methods</h3><div>We first used a quasi-experimental interrupted time series design to compare populations exposed (new patients) vs. non-exposed (patients currently under care) to CAdEO from 2015 to 2023. Second, we investigated how the quality of service functioning, measured by delays between referrals and consultations, affected ED visits.</div></div><div><h3>Results</h3><div>Exposure to the CadEO service was associated with a 0.5% daily decrease in mental health-related ED visits (Risk ratio (RR): 0.995; 95% Confidence Interval (CI): 0.991, 0.999). Reducing the waiting times for triage from 12 days to 4.7 days over a six-week period was associated with a 26.5% decrease in ED presentations (RR: 0.735; 95% CI=0.548, 0.986). Our sex-stratified analysis revealed that the ongoing effects of CAdEO resulted in males having lower ED visit rates than females. However, reducing waiting times for triage was associated with a lower rate of female ED visits. Finally, shorter CAdEO waits were linked to lower ED visits for mood and personality disorder patients.</div></div><div><h3>Conclusions</h3><div>This study suggests that a community-based patient assessment and triage service may help reduce the overall demand for mental health care in ED. Our findings also highlight the necessity for tailored approaches that consider gender and specific mental health conditions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105419"},"PeriodicalIF":3.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886723","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}