Health Policy最新文献

{"title":"Participatory policy processes in a black box? Stakeholder interviews about the development of Germany´s national nutrition strategy","authors":"Marike Andreas,&nbsp;Anna K. Kaiser ,&nbsp;Falko F. Sniehotta","doi":"10.1016/j.healthpol.2025.105298","DOIUrl":"10.1016/j.healthpol.2025.105298","url":null,"abstract":"<div><h3>Background</h3><div>Stakeholder participation in policy processes can make processes more effective, democratic, and foster consensus in complex policy fields – if managed well. However, little is known about the conditions driving meaningful stakeholder participation in national-level policymaking.</div></div><div><h3>Objective</h3><div>We investigated Germany's 2024 national nutrition strategy to understand conditions for meaningful stakeholder participation.</div></div><div><h3>Method</h3><div>We invited all organisations officially listed as stakeholders in Germany's national nutrition strategy (<em>N</em> = 123) to participate in 30-minute semi-structured interviews. In the interviews, we asked about their perceptions of the process. Interviews were transcribed and analysed with MAXQDA. Using Clarke and Brown's approach to thematic analysis, we inductively coded positive and negative perceptions of the strategy.</div></div><div><h3>Results</h3><div>A total of 55 experts from 54 organizations participated in the interviews. They represented industry associations (<em>n</em> = 15) and public-sector researchers (<em>n</em> = 14), followed by NGOs (<em>n</em> = 13). Stakeholders welcomed the participatory nature of the nutrition strategy development, seeing it as an opportunity to contribute their perspectives and drive political change in health and sustainability. Building networks with other stakeholders was also seen as a positive outcome. However, many expressed concerns about the lack of transparency in the process - in particular how their input would influence the final strategy. Some feared their participation would legitimize outcomes they could not support.</div></div><div><h3>Conclusion</h3><div>The participatory process to inform Germany's national nutrition strategy resembled a consultation. Our interviews suggest that transparent communication, especially clarity on how stakeholder input is used, is crucial to encourage genuine collaboration. These insights can help policymakers fully leverage stakeholder participation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105298"},"PeriodicalIF":3.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the experience of empowerment in Flemish (proxy) budget holders: A regression analysis","authors":"Eva Pattyn ,&nbsp;Paul Gemmel ,&nbsp;Ruben Willems ,&nbsp;Susan Lagaert ,&nbsp;Jeroen Trybou","doi":"10.1016/j.healthpol.2025.105295","DOIUrl":"10.1016/j.healthpol.2025.105295","url":null,"abstract":"<div><div>The Flemish government implemented a cash-for-care scheme in 2017, allocating a personal budget (PB) as a voucher or cash budget to persons with physical and intellectual disabilities to increase budget holders’ empowerment. However, the literature shows that personal (inherent to budget holders) and contextual factors (inherent to cash-for-care schemes) potentially have an impact. This study, therefore, reports on Flemish budget holders’ empowerment and its associated factors. A survey was developed, examining personal and contextual factors related to empowerment. A convenience sample with multiple recruitment sources (via policy, user-, and care organization support) was used to recruit participants. Data collection took place from April 4, 2022, to October 31, 2022, and data were analyzed using bivariate and linear regression analyses. The survey was completed by 224 budget holders. The complexity of administrative procedures, educational level, private financial resources, and presence of an (in)formal care network were not associated with Flemish budget holders’ empowerment. However, the regression analyses showed that knowledge of the care and well-being sector, PB allocation type (cash and combination versus vouchers), and respondent type (proxies representing the budget holder versus people with disabilities as respondents) predicted empowerment. Knowledge and flexibility in PB use are significantly associated with higher empowerment scores. Enhancing knowledge about the (disability) care sector is thus a key objective when implementing a cash-for-care scheme.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105295"},"PeriodicalIF":3.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610813","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":"Quantitative trend analysis of well-established use mutual recognition and decentralised products indicates codified disharmonisation in the European Economic Area","authors":"Péter Szabó","doi":"10.1016/j.healthpol.2025.105297","DOIUrl":"10.1016/j.healthpol.2025.105297","url":null,"abstract":"<div><div>The growing number of well-established use (WEU) applications was reported by the Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMD<em>h</em>). The procedures from the CMDh annual statistics and products from the Mutual Recognition Information Product Index were analysed between 2006 and 2023. Drop-out and CMDh referral rates were determined, and the Anatomical Therapeutic Chemical codes for WEU products were subjected to trend analysis. The Summaries of Product Characteristics (SmPC) of active substances with a growing interest were scored to determine the level of disharmonisation in the most commonly authorised strength and pharmaceutical forms. The rise in the relative number of WEU applications has been confirmed. The reasons for heightened interest in WEU applications could be explained by (i) the reliable legal basis it has transformed into, (ii) the flexibility, (iii) the incentive system awarding protection. Products containing 3 mg melatonin and 25,000 IU colecaliferol in solid oral forms were the most sought-after products in recent years. An analysis of the SmPCs revealed a significant degree of disharmonisation in the clinical particulars, and it also shed light on intra- and inter- Reference Member State (RMS) variance in the decision making. The current European medicine approval system is not suited to effectively handle this ever-increasing use of one of the most resource intensive legal bases due to the high level of disharmonisation that has been overlooked for years. Consequently, a change in the current application compilation and assessment practices might be beneficial to ensure patient safety and therapy success.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105297"},"PeriodicalIF":3.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578403","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":"Medicare austerity reforms and patient out-of-pocket costs: The experience from Australian cancer patients","authors":"Maryam Naghsh-Nejad ,&nbsp;Kees Van Gool ,&nbsp;Phil Haywood ,&nbsp;Jane Hall","doi":"10.1016/j.healthpol.2025.105296","DOIUrl":"10.1016/j.healthpol.2025.105296","url":null,"abstract":"<div><div>In this paper, we examine trends in provider fees charged, government expenditure on private out-of-hospital medical services, and out of pocket costs following policy changes intended to reduce government expenditure. We examine the experience of a high-need patient group: people diagnosed with cancer. The Australian system for these services is predominantly publicly funded under fee for service; with no government control on the fees charged by providers. We calculate out of pocket costs for patients in the 12 months following a cancer diagnosis and find a large variation in these costs according to the type of treatment received as well as the place of residence and presence of additional government protection. We find that volumes of services, provider fees, and out of pocket costs rose over time. These findings are especially important for a high-need patient group as out of pocket costs are considered a barrier to access to healthcare. Governments may respond to the long-term fiscal challenges by attempting to constrain benefits it pays; our results demonstrate that careful consideration of the full impact of such policies is needed.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105296"},"PeriodicalIF":3.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private equity expansion and impacts in united states healthcare","authors":"Lynn Unruh (Professor Emerita) ,&nbsp;Thomas Rice (Professor Emeritus)","doi":"10.1016/j.healthpol.2025.105266","DOIUrl":"10.1016/j.healthpol.2025.105266","url":null,"abstract":"<div><div>Over the past two decades, private equity (PE) firms–private investors that use large pools of money to buy into and restructure companies–have become increasingly involved in U.S. healthcare ownership and management. PE's goal of acquiring quick financial gains is typically accomplished by assigning debt to the facilities and practices it buys, cutting labor costs, changing services to the most lucrative, upcoding diagnostic codes to raise prices, and merging, shutting down, or selling practices. This study shows that private equity has expanded into nearly every corner of U.S. healthcare, and in some sectors, such as hospitals, nursing homes and physician specialties, quite significantly. The PE business model is theorized to be incompatible with high quality, efficient, accessible healthcare. Empirical research supports this framework to some extent. Few studies find evidence for better healthcare quality/patient outcomes or lower expenditures. A few studies find better access in profitable areas for PE, and three find lower operating costs and/or higher operating margins, which may have negative impacts in other healthcare system outcomes. A few studies show no difference in various healthcare system outcomes. Otherwise, the preponderance of studies indicates worse or mixed (mostly worse) outcomes with PE ownership. PE involvement in healthcare is greater in the U.S. than Europe, but there is potential for it to reach similar levels in Europe. Federal and state policy initiatives to regulate PE in U.S. healthcare are in the incipient stage and would benefit greatly by more research on PE's impacts.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105266"},"PeriodicalIF":3.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets","authors":"Kathleen A. Holloway ,&nbsp;David Henry","doi":"10.1016/j.healthpol.2025.105269","DOIUrl":"10.1016/j.healthpol.2025.105269","url":null,"abstract":"<div><h3>Background</h3><div>Policy implementation to reduce overuse of antibiotics remains weak in many low/middle-income countries (LMIC).</div></div><div><h3>Aim</h3><div>Identify the most effective policies for reducing inappropriate use of antibiotics.</div></div><div><h3>Methods</h3><div>Data on four standard indicators of antibiotic use (lower values indicating less inappropriate use) from surveys (2006–12) and implementation of 23 policies (2007–11) were analysed. Differences in indicator scores between countries implementing and not implementing policies were calculated. The impacts of multiple policies were assessed by regression analysis. Results were combined with two previous studies, one using global data 2003–7, the other South-East Asia data 2010–2015.</div></div><div><h3>Results</h3><div>Data were available for 44 countries. Beneficial effects were seen in several analyses showing more active policy implementation was associated with lower antibiotic use. The number of effective policies were negatively correlated with % patients prescribed antibiotics (r -0.5, <em>p</em> = 0.002) and % upper respiratory tract infections prescribed antibiotics (r -0.6, <em>p</em> = 0.002). Correlation of average policy ranking effectiveness between this study and the earlier global study was significant (r 0.69, <em>p</em> &lt; 0.001). The top six policies from average rankings across the three studies were: national body responsible for quality use of medicines; public education programs; undergraduate training of doctors on clinical guidelines; antibiotics unavailable without prescription; hospital drug and therapeutics committees; and medicines free at the point of care.</div></div><div><h3>Conclusion</h3><div>Essential medicines policies consistently found to be associated with lower antibiotic use should be implemented urgently.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105269"},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511060","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":"Multiple job holding and its influencing factors among Belgian nurses: A cross-sectional study","authors":"Senne Vleminckx ,&nbsp;Anke Sevenans ,&nbsp;Manal Bouchatta ,&nbsp;Ive Verbeeck ,&nbsp;Erik Franck ,&nbsp;Filip Haegdorens","doi":"10.1016/j.healthpol.2025.105288","DOIUrl":"10.1016/j.healthpol.2025.105288","url":null,"abstract":"<div><div>Multiple job holding (MJH), historically referred to as moonlighting, is increasingly recognized among healthcare workers, yet it remains underexplored among nurses. This study investigates the prevalence and motivations for MJH among nurses in Belgium. Using a cross-sectional survey, data were collected in 924 nurses between November 2022 and March 2023. The aim was to identify key influencing factors driving nurses to consider or engage in MJH, with motivations categorized into “push” and “pull” factors. Results show that 38.3 % of nurses hold multiple jobs, with financial necessity and job dissatisfaction (push factors) as the dominant drivers. Younger nurses, men, and those without children were more likely to engage in MJH. Pull factors, such as professional growth and job autonomy, also played a role but were deemed less important. Financial insecurity, particularly the inability to live comfortably on a single income, emerged as a strong predictor of MJH. Additionally, nurses with master's degrees were more likely to take on secondary jobs, possibly due to career development motivations. Despite the growing trend of MJH, the study highlights concerns about nurses working outside their primary profession during a nursing shortage. These findings suggest a need for policy interventions to address inadequate financial compensation and improve job satisfaction within nursing roles to reduce the reliance on secondary employment.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105288"},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563667","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 introduction of maximum reimbursement prices for digital health applications in Germany in 2022: Current developments","authors":"Hendrikje Rödiger ,&nbsp;Reinhard Busse ,&nbsp;Cornelia Henschke","doi":"10.1016/j.healthpol.2025.105284","DOIUrl":"10.1016/j.healthpol.2025.105284","url":null,"abstract":"<div><div>Germany serves as a pioneering example for the integration of digital health applications. Since October 2020, digital health applications that passed a benefit evaluation have been provisionally or permanently included in the benefit basket of the German statutory health insurance. However, free price setting by the manufacturers in the first year after the introduction in the benefit basket led to high prices. After several policy debates, maximum reimbursement prices were introduced.</div><div>This article provides an overview of the changing reimbursement and pricing landscape after implementing maximum reimbursement prices. Processes of setting reimbursement prices are described, first results of maximum reimbursement prices are presented and critically reflected by views of stakeholders affected. Results of the first 1.5 years show that only four digital health applications were assigned a product-specific maximum price. For three of these digital health applications, the manufacturer's price is below the statutory health insurance's maximum reimbursement price. Although there is relatively minor impact on costs so far, this may change over the years with a growing number of digital health applications. Nevertheless, a systematic and transparent adjustment of the pricing mechanism after one year of inclusion in the benefit basket is necessary to strike a balance between the benefits of new digital health applications, statutory health insurance expenditures and the promotion of novel digital health applications.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105284"},"PeriodicalIF":3.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting outpatient medication safety in Finland: A mid-term review of a national medication safety programme for community pharmacies (2021–2026)","authors":"Emilia Mäkinen ,&nbsp;Tiina Koskenkorva ,&nbsp;Anna-Riia Holmström ,&nbsp;Marja Airaksinen ,&nbsp;Marianne Kuusisto ,&nbsp;Henna Kyllönen ,&nbsp;Anna Schoultz ,&nbsp;Charlotta Sandler","doi":"10.1016/j.healthpol.2025.105285","DOIUrl":"10.1016/j.healthpol.2025.105285","url":null,"abstract":"<div><div>Pharmacotherapies are common therapeutic interventions in patient care. Despite most medications being self-managed by patients at home, little attention has been paid to medication risks in the outpatient medication management process. As community pharmacies dispense medicines to outpatients, they are well-positioned to decrease preventable harm by implementing systemic medication risk management practices. This article is a mid-term review of a national development programme to enhance community pharmacies’ involvement in outpatient medication risk management in Finland (Valo programme 2021–2026). The article comprises the programme description utilising the US Centers for Disease Control and Prevention's framework, and the programme's preliminary mid-term results.</div><div>Through the programme: 1) the same patient safety incident reporting and learning system used by most Finnish health- and social care (HSC) organisations was implemented in community pharmacies, 2) medication safety culture was promoted by enhancing community pharmacists’ competencies in medication safety, 3) regional collaboration between community pharmacies and HSC organisations was supported through networks, and 4) a national research strategy was created to support outpatient medication safety research.</div><div>Involving community pharmacies in outpatient medication risk management supports HSC systems. This article introduces nationwide actions that could be utilised in other countries to enhance community pharmacies’ involvement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105285"},"PeriodicalIF":3.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of minimum staff level policies on the ward nursing team: Insights from a qualitative research study conducted in Germany","authors":"Felix Miedaner ,&nbsp;Werner Barbara ,&nbsp;Bernhard Roth ,&nbsp;Linda Metzner","doi":"10.1016/j.healthpol.2025.105286","DOIUrl":"10.1016/j.healthpol.2025.105286","url":null,"abstract":"<div><h3>Background</h3><div>The implementation of legally mandated staffing levels for nurses has complex and wide-ranging effects on the organizational environment in which they operate.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate the perspectives of nursing staff on these consequences.</div></div><div><h3>Methods</h3><div>Nine guideline-based expert interviews were conducted with nursing staff at a hospital unit in Germany where minimum nurse-to-patient ratios have been mandated since 2017. The analysis was carried out according to the summarizing qualitative content analysis with the help of the inductive category formation according to Mayring (2015).</div></div><div><h3>Results</h3><div>The participants confirmed the intended effects, e.g. the gain in time for care, but also mentioned that strict nurse-to-patient ratio guidelines for different patient types may lack practical relevance. Furthermore, the staff policy had several unintended side-effects on the nursing team: Nurses reported the formation of subgroups within the team, and that new challenges had arisen due to the wider range of personal characteristics, qualifications and experience levels on the team.</div></div><div><h3>Conclusions</h3><div>Although the positive effects on patient care reflect the importance of minimum staff policies, the negative repercussions on the nursing team ward and its daily work processes need to be taken into account and actively managed.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105286"},"PeriodicalIF":3.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551030","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}