Health Policy最新文献

{"title":"Strengthening diagnostic services in Latin America requires regional leadership, sustainable funding, and enhanced data sharing","authors":"Andres Moreira-Soto ,&nbsp;Nils Gade ,&nbsp;Bert Hoffmann ,&nbsp;Jan Felix Drexler","doi":"10.1016/j.healthpol.2025.105287","DOIUrl":"10.1016/j.healthpol.2025.105287","url":null,"abstract":"<div><div>Diagnostic services played a key role in government responses to the COVID-19 pandemic. In our work to support diagnostics in over 20 countries of the Global South, with a focus on Latin America, we observed common problems in resource-limited settings. We identify common constraints of (i) affordability of reagents, (ii) access to reagents, (iii) poor infrastructure, and (iv) limited human resources. Enhancing diagnostic services in resource-limited settings cannot be sustained only by international cooperation and philanthropic missions. Success depends on domestic leadership and regional cooperation of which the existent influenza or dengue networks in Latin America are prime examples. A Latin American Center for Disease Control and Prevention (CDC), as proposed by some, can only be successful if reliable funding and a clear mandate are secured. A stronger inclusion of diagnostic tool development and data sharing will be imperative for dealing with emerging pathogens.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105287"},"PeriodicalIF":3.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674985","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":"Physicians’ responses to time pressure: Experimental evidence on treatment quality and documentation behaviour","authors":"Claudia Souček ,&nbsp;Tommaso Reggiani ,&nbsp;Nadja Kairies-Schwarz","doi":"10.1016/j.healthpol.2025.105302","DOIUrl":"10.1016/j.healthpol.2025.105302","url":null,"abstract":"<div><h3>Background</h3><div>In hospitals, decisions are often made under time pressure. There is, however, little evidence on how time pressure affects the quality of treatment and the documentation behaviour of physicians.</div></div><div><h3>Setting</h3><div>We implemented a controlled laboratory experiment with a healthcare framing in which international medical students in the Czech Republic treated patients in the role of hospital physicians. We varied the presence of time pressure and a documentation task.</div></div><div><h3>Results</h3><div>We observed worse treatment quality when individuals were faced with a combination of a documentation task and time pressure. In line with the concept of the speed-accuracy trade-off, we showed that quality changes are likely driven by less accuracy. Finally, we showed that while documentation quality was relatively high overall, time pressure significantly lowered the latter leading to a higher hypothetical profit loss for the hospital.</div></div><div><h3>Conclusions</h3><div>Our results suggest that policy reforms aimed at increasing staffing and promoting novel technologies that facilitate physicians' treatment decisions and support their documentation work in the hospital sector might be promising means of improving the treatment quality and reducing inefficiencies potentially caused by documentation errors.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105302"},"PeriodicalIF":3.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760879","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":"'Uncharted territory': The experiences of health and social care practitioners in a multi-agency collaboration to support integrated service provision for children and young people in a disadvantaged community.","authors":"Cris Townley, Rebekah Grace, Tuval Keidar","doi":"10.1016/j.healthpol.2025.105299","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105299","url":null,"abstract":"<p><p>This paper explores an Australian place-based collaboration of ten agencies to reform the delivery of integrated health and social care services to children and families with complex health and social challenges. Data comprises interview transcripts of semi-structured individual interviews with 17 employees across the six most-engaged agencies in late 2022. Employing thematic analysis, we found that whilst there was agreement on the vision of creative, trust-based collaboration to drive, implement and scale up service delivery reform, points of tension highlighted complexities that acted contrary to this vision. These tensions suggest the need to clarify the governance role of the collaboration, attend to project maturation processes, revise the strategic direction as collaborations evolve, maintain communication and agency involvement, and continue to listen to consumer and clinician voices. We conclude that, in a complex service system environment, it is crucial to maintain and review a shared vision, clear strategies and a healthy collaborative environment. These conclusions may inform other interagency collaborations and policies with the goal of integrating health and social care.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105299"},"PeriodicalIF":3.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626872","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":"Rapid evaluation of the NHS Recovery Support Programme (RSP) in England: Implementing intensive national improvement support for challenged healthcare providers and systems","authors":"Maartje Kletter,&nbsp;Stephanie Gillibrand,&nbsp;Elaine Harkness,&nbsp;Jo Dumville,&nbsp;Paul Wilson","doi":"10.1016/j.healthpol.2025.105300","DOIUrl":"10.1016/j.healthpol.2025.105300","url":null,"abstract":"<div><div>Launched in 2021, the Recovery Support Programme (RSP) provides mandated intensive improvement support to NHS healthcare providers and systems in England experiencing significant financial, quality or safety failings. The aim is to prevent further deterioration, embed improvement and to enable sustained stabilisation. We conducted a rapid multi-method study to evaluate the early implementation of the RSP to understand initial impact and identify further developments which could improve its delivery. We found that whilst the RSP is generally perceived as more supportive and less punitive than the special measures regime it replaced, there are areas where its delivery could be enhanced. There is variation in how the programme is delivered across regions and several core processes could be standardised to enable more structured assessment of system capability and development of capacity to support change. The presence of cross system collective leadership and external facilitation may be the core-enabling features necessary to embed improvement and enable sustained stabilisation in NHS organisations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105300"},"PeriodicalIF":3.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643771","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":"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}