Health Policy最新文献

{"title":"Urban NO2-pollution and health outcomes: Evidence from a natural experiment in Italy on the simulated benefits of the EU zero-emission-vehicles resolution","authors":"Daniele Bondonio ,&nbsp;Paolo Chirico ,&nbsp;Massimiliano Piacenza ,&nbsp;Simone Robbiano","doi":"10.1016/j.healthpol.2025.105376","DOIUrl":"10.1016/j.healthpol.2025.105376","url":null,"abstract":"<div><h3>Background</h3><div>The EU “Fit-For-55″ resolution provisions the banning of fossil-fuel-vehicle sales beyond 2035, sparking a heated debate due to its uncertain effectiveness in reducing CO₂ emissions globally. Nevertheless, the EU shift towards zero-emission vehicles has the potential to decrease urban nitrogen dioxide (NO₂) pollution that is closely linked to respiratory and cardiovascular diseases and to increased mortality.</div></div><div><h3>Objective</h3><div>This paper aims to simulate the impact that the EU zero-emission-mobility policy is expected to have, post-transitional period, on urban NO₂ and health outcomes.</div></div><div><h3>Methods</h3><div>The analysis exploits some unique features of Northern-Italy air-pollution data and the Italian Covid-19 lockdown that is leveraged as a natural experiment to mimic the fossil-fuel traffic abatement expected by the policy. Our estimates are obtained by developing a novel intertemporal-statistical-matching approach specifically suited for quasi-experimental evaluations in the context of air-pollution multivariate time series.</div></div><div><h3>Results</h3><div>We find that the lockdown led to a mean NO₂ reduction of 13.62 μg/m³ (53 % from a baseline of 25.8 μg/m³), translating into a simulated reduction in the relative risk of total, cardiovascular, and respiratory mortality by 8.3, 7.5 and 3.8 percentage points, respectively. We also estimate impact heterogeneity, with log-linearly larger reductions in NO₂ and mortality risk at higher baseline-pollution levels.</div></div><div><h3>Conclusions</h3><div>These results imply that the EU zero-emission mobility policy is expected to improve air-quality and public health in urban areas with high traffic density, though benefits may vary across regions due to differences in meteorological conditions and urban/orographic characteristics, supporting a spatially differentiated policy implementation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105376"},"PeriodicalIF":3.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330531","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 new integrative organizational health literacy framework for preventive action through intersectoral collaboration: Results of a landscape review","authors":"Francisco Javier Ferreira-Alfaya,&nbsp;Yasmin Cura,&nbsp;María José Zarzuelo-Romero","doi":"10.1016/j.healthpol.2025.105380","DOIUrl":"10.1016/j.healthpol.2025.105380","url":null,"abstract":"<div><h3>Background</h3><div>Organizational Health Literacy (OHL) refers to the extent to which organizations facilitate equitable access, comprehension, and use of health information and services for informed decision-making.</div></div><div><h3>Objective</h3><div>This study aimed to (1) review and map existing OHL frameworks and (2) propose an innovative OHL framework that addresses gaps identified in current models.</div></div><div><h3>Methods</h3><div>A systematic search of academic (Web of Science, Scopus, MEDLINE) and grey literature from the past 15 years was conducted to identify OHL frameworks. This scoping review followed the PRISMA-ScR guidelines and the Arksey and O’Malley model. A new OHL intervention framework was developed to address gaps in existing models, based on the principles of preventive medicine and the public health action cycle.</div></div><div><h3>Results</h3><div>A total of 19 records were included (10 from academic databases and 9 from grey literature), covering diverse approaches and contexts related to OHL. Four intervention levels were identified: integrating HL into formal education, implementing HL assessments, developing interventions for vulnerable populations, and enhancing accessibility to health resources. The proposed framework emphasizes intersectoral collaboration and communication pathways between education and healthcare sectors, facilitating information exchange to continuously adapt interventions to population needs.</div></div><div><h3>Conclusion</h3><div>OHL development requires intersectoral collaboration; however, interoperability between sectors remains unaddressed in existing frameworks. This study proposes an innovative model that fosters sectoral connections toward a shared goal, creating a truly collaborative framework.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105380"},"PeriodicalIF":3.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549607","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":"Shall we call for a doctor? How to build trust toward AI in healthcare: Insights from a Polish cross-sectional preference study","authors":"Katarzyna Kolasa ,&nbsp;Katarzyna Baliga-Nicholson ,&nbsp;Jaroslaw Wasniewski ,&nbsp;Nikola Laskowska ,&nbsp;Krystyna Milian ,&nbsp;Dominika Ciupek","doi":"10.1016/j.healthpol.2025.105379","DOIUrl":"10.1016/j.healthpol.2025.105379","url":null,"abstract":"<div><h3>Objectives</h3><div>This research aimed to investigate key success factors for the adoption of AI-driven health technologies, particularly in healthcare ecosystems of low digital literacy, such as Poland.</div></div><div><h3>Methods</h3><div>Conducted between January and August 2023, the \"AIValue4Health\" study engaged over 1,000 Polish nationals in a representative survey. The study revealed preferences with 15 general statements about AI and stated preferences, with two hypothetical trade-off experiments comparing traditional healthcare with AI-enhanced solutions.</div></div><div><h3>Results</h3><div>In addition to the strong support for AI demonstrated through direct questioning, 28% and 76% of participants shifted from their initial preference for standard care to favor AI solutions, given validation studies and positive feedback from doctors, as well as free access to AI tools. This left over 60% and 80% of participants favoring digital solutions in both experiments, respectively.</div></div><div><h3>Conclusions</h3><div>The results revealed how to ensure successful integration of AI in healthcare, emphasizing, however, the necessity of validation studies and targeted educational initiatives to enhance digital literacy and trust in AI. Most importantly, the findings underscore the essential role of medical professionals as leaders in the adoption of digital health solutions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105379"},"PeriodicalIF":3.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366039","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":"Private equity investment in long-term care: The case of Ireland","authors":"Nicholas O’Neill ,&nbsp;Julien Mercille","doi":"10.1016/j.healthpol.2025.105378","DOIUrl":"10.1016/j.healthpol.2025.105378","url":null,"abstract":"<div><h3>Background</h3><div>Private equity (PE) firms are key actors in the financialisation of health care systems. Yet, research rarely focuses directly on these firms and related private for-profit actors involved in financialisation. Moreover, existing work mostly concerns the United States, while several key health care sectors remain under-researched.</div></div><div><h3>Objective</h3><div>This study examines the factors driving PE investment in long-term care (LTC) and the strategies PE firms use to enter and expand within the sector.</div></div><div><h3>Methods</h3><div>We conduct a thematic analysis of 20 in-depth interviews with expert informants, including senior executives from PE firms, financial investors and private for-profit providers. These interviews shed light on the role of PE in Ireland’s LTC sector, specifically within nursing homes and home care.</div></div><div><h3>Results</h3><div>Five key factors attract PE investment in Irish LTC: demographic trends, market composition, risk diversification, and the characteristics of state funding and regulation. In nursing homes, PE uses the “OpCo/PropCo” (operating company/property company) model. In home care, PE enters via global investments in parent companies, direct acquisitions of Irish firms, and master franchise agreements.</div></div><div><h3>Conclusions</h3><div>Examining private for-profit actors through key officials central to PE growth in LTC provides valuable insights into the financialisation of health care systems. This approach enhances our understanding of business interests driving investment in European LTC.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105378"},"PeriodicalIF":3.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313349","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 opportunities and challenges of integrating health and social care in post-stroke patient journey: perceptions of Estonian professionals","authors":"Kadi Lubi ,&nbsp;Helin Pevkur ,&nbsp;Katrin Gross-Paju ,&nbsp;Maarja-Liis Elland ,&nbsp;Peeter Ross","doi":"10.1016/j.healthpol.2025.105377","DOIUrl":"10.1016/j.healthpol.2025.105377","url":null,"abstract":"<div><div>Although strokes are one of the leading causes of death worldwide, their mortality is declining and the demand for integrated care is increasing. Therefore, changes in current health policy approaches are needed. In 2019, the Estonian Health Insurance Fund initiated a pilot study to examine an integrated health and social care approach in the journey of post-stroke patients. West Tallinn Central Hospital piloted the early involvement of community-based social care professionals of the local government. This research was conducted to examine the perceptions regarding an integrated care approach for post-stroke patients of all eleven participants via semi-structured in-depth interviews. By using a qualitative content analysis, participants’ experience with the selected approach were analyzed. The findings highlighted the potential and appropriateness of involving community-based social care professionals in the early phase of post-stroke management as part of a multidisciplinary team to enable a holistic, person-centered integrated care approach. The main challenges are the lack of different resources (e.g., specific knowledge, human resource, time), interoperability between health and social care electronic systems, and perceived inappropriateness in addressing a potential change in processes and with involved stakeholders. Thus, a comprehensive health policy and social care policy should be used to tackle these challenges to successfully implement an integrated care model with a multidisciplinary approach.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105377"},"PeriodicalIF":3.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313348","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 a medical residents' walkout on mortality rates in South Korea, 2024","authors":"Jin-Hwan Kim ,&nbsp;Saerom Kim","doi":"10.1016/j.healthpol.2025.105375","DOIUrl":"10.1016/j.healthpol.2025.105375","url":null,"abstract":"<div><h3>Background</h3><div>At the end of February 2024, over 11,000 medical residents in South Korea collectively resigned in opposition to the government's policy to increase medical school admissions, raising widespread concerns about potential health consequences amid prolonged workforce shortages in acute hospitals.</div></div><div><h3>Objective</h3><div>To assess the impact of the medical residents' walkout on mortality rates in South Korea during 2024.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study using mortality data from Statistics Korea's Vital Statistics (2019–2023) and the Ministry of Interior and Safety's Registration Expiration Statistics (2024). Analyses included crude mortality rates by sex, age, and region; sex- and age-standardized mortality rates; and excess mortality estimations using three modeling approaches with and without COVID-19 fixed effects.</div></div><div><h3>Results</h3><div>We found no evidence of increased mortality in 2024. During the walkout period (March-December 2024), mortality rates (577.4 per 100,000) and age-standardized mortality rates (approximately 650 and 750 per 100,000 for females and males) showed no increase from pre-walkout levels. Excess mortality estimates were consistently negative or negligibly small (-11,989 to -2831 deaths, 95 % CI) after controlling for COVID-19 effects, with more pronounced negative values during the walkout period (-30,779 to -7767). This pattern persisted across demographic groups and regions.</div></div><div><h3>Conclusions</h3><div>During a year-long walkout, mortality patterns in South Korea remained stable, consistent with findings from shorter healthcare strikes. Policymakers should establish robust and democratic dialogue for healthcare reforms, while researchers should investigate non-mortality impacts, including healthcare quality, access, and patient experiences, to develop comprehensive workforce policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105375"},"PeriodicalIF":3.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312735","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":"Towards effective policy measures to reduce informal payments in healthcare: addressing sample selection bias and measurement error in surveys","authors":"Maria Felice Arezzo ,&nbsp;Giuseppina Guagnano ,&nbsp;Colin C. Williams ,&nbsp;Adrian V. Horodnic","doi":"10.1016/j.healthpol.2025.105367","DOIUrl":"10.1016/j.healthpol.2025.105367","url":null,"abstract":"<div><div>Previous research has primarily utilized surveys to assess the extent of informal payments, identify key drivers, and recommend policy interventions. However, reliance on surveys presents challenges, including representativeness issues and social desirability bias, which may result in underestimated prevalence and misinformed policy measures. The aim of this paper is to evaluate the influence of these biases on estimating the prevalence of informal payments and on the development of effective policies to reduce informal payments. Reporting data from the third wave of Life in Transition Survey conducted in 2016 across 34 countries, a significant misalignment between reported and (estimated) actual behaviours regarding informal payments was found. The results of a Probit model adjusted for sample selection and measurement error revealed that, among those who made informal payments, approximately 20 % of respondents declared the opposite while the global prevalence of individuals making informal payments in the analysed countries is approximately 18 %. The implications for policy measures towards informal payments in public healthcare are then discussed.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105367"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262377","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":"Education and fertility: Evidence from an instrumental variable approach using higher education expansions in Turkey","authors":"Badi H. Baltagi ,&nbsp;Haci M. Karatas","doi":"10.1016/j.healthpol.2025.105366","DOIUrl":"10.1016/j.healthpol.2025.105366","url":null,"abstract":"<div><div>This paper examines the impact of higher education on women’s fertility behavior in Turkey. To address the endogeneity of education we use the plausibly exogenous variation in college availability in Turkey between 1983 and 2000. We find that increased education of women in Turkey significantly reduced the number of children and increased the probability of childlessness at the end of the fecund period. The effect of education on fertility worked through a postponement in first births at ages following college graduation until the age of 35, an improvement in women’s labor market outcomes, better marriage market outcomes, and use of modern contraceptive methods. These findings suggest that education reduces fertility at the intensive and extensive margin through a combined incarceration and human capital effect and health knowledge in Turkey.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105366"},"PeriodicalIF":3.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290943","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":"Policy recommendations for healthcare authorities, organizations and professionals on vaccine hesitancy in Europe: From evidence to practice","authors":"Tiago Correia ,&nbsp;Ana Patrícia Hilário ,&nbsp;Cátia Guerreiro ,&nbsp;Joana Mendonça ,&nbsp;Rita Morais ,&nbsp;Fábio Rafael Augusto ,&nbsp;André Beja","doi":"10.1016/j.healthpol.2025.105361","DOIUrl":"10.1016/j.healthpol.2025.105361","url":null,"abstract":"<div><div>Vaccine hesitancy presents significant challenges to public health, exacerbated by a lack of cohesive policies in Europe. Recognized as a complex social phenomenon influenced by various factors, vaccine hesitancy threatens health systems and public trust. This paper analyses the political background and current gaps in policies addressing vaccine hesitancy, with a specific focus on the role of healthcare authorities, organizations and professionals in shaping effective responses. The VAX-TRUST project, funded by H2020 and conducted in seven European countries, provides a framework for translating social scientific research into actionable strategies within healthcare settings. Using methodologies such as the Delphi method, the project developed the ASTARE model, which encompasses six dimensions: Awareness, Support, Training, Agency, Recognition, and Engagement. These dimensions guide tailored recommendations to strengthen the capacity of healthcare professionals, organizations, and authorities in addressing vaccine hesitancy, enhancing public trust, and vaccine confidence and uptake. The paper highlights the necessity of evidence-based, collaborative, and adaptive policies that raise public awareness, counteract misinformation, and support healthcare professionals. Effective policymaking requires understanding legislative processes, leveraging scientific evidence, and fostering stakeholder participation. By emphasizing context-sensitive interventions and culturally informed strategies, this study provides a comprehensive approach for health systems to address vaccine hesitancy and improve public health outcomes across Europe.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105361"},"PeriodicalIF":3.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167518","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":"Do faster‑trained physicians fill the gaps? Geographic concentration of emergency medicine physicians with different postgraduate training in Ontario Canada","authors":"David Kanter-Eivin ,&nbsp;Calvin Armstrong ,&nbsp;Anil Esleben ,&nbsp;Grant Sweeny ,&nbsp;Michaela Dowling ,&nbsp;Asil El Galad ,&nbsp;Stephenson Strobel","doi":"10.1016/j.healthpol.2025.105360","DOIUrl":"10.1016/j.healthpol.2025.105360","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments in underserved areas face chronic staffing challenges. One possible solution is to use physicians who are quicker to train and more pervasive in lieu of more extensively trained physicians. Canada allows for emergency medicine specialization via a 3-year pathway (CCFP(EM)) and a 5-year pathway (FRCPC) which means different geographic areas are exposed to EM physicians with different training lengths.</div></div><div><h3>Methods</h3><div>We examine Ontario, Canada which has both widespread geographic diversity and emergency providers with these two lengths of postgraduate training. We scrape the College of Physicians and Surgeons of Ontario public registry in 2015 and 2024. We map the geographic distribution of physician types and estimate spatial autocorrelation measures using global and local Morans I to determine whether these physicians became more geographically concentrated.</div></div><div><h3>Results</h3><div>Between 2015 and 2024, the number of CCFP(EM) and FRCPC physicians increased in overall numbers but their unique locations remained stable. Mapping of these locations suggests clustering into urban or suburban areas in the province. CCFP(EM) physicians have become more concentrated over time (Morans I of 0.234 and 0.308 in 2015 and 2024) relative to FRCPC physicians (Morans I of 0.096 and 0.103).</div></div><div><h3>Conclusion</h3><div>We find that, from 2015 to 2024, emergency physicians have become more concentrated in the province of Ontario due to CCFP(EM) physicians concentrating around urban areas with academic medical centres. Policies relying on less extensively trained providers to plug staffing gaps may not necessarily be effective in improving equitable access to physicians.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105360"},"PeriodicalIF":3.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231386","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}