Health PolicyPub Date : 2024-10-20DOI: 10.1016/j.healthpol.2024.105187
Livio Garattini , Antonio Clavenna
{"title":"RSV prevention options for infants and older adults: A specific expanding competitive arena","authors":"Livio Garattini , Antonio Clavenna","doi":"10.1016/j.healthpol.2024.105187","DOIUrl":"10.1016/j.healthpol.2024.105187","url":null,"abstract":"<div><div>Respiratory Syncytial Virus (RSV) is an ubiquitous respiratory virus, which spreads like seasonal influenza throughout winter time in temperate climate countries. RSV infections are usually mild in healthy children and adults, but may be severe in premature infants, young children with congenital heart disease or chronic lung disease, immunocompromised individuals and frail elderly people.</div><div>At present, the pharmaceutical options to prevent RSV negative effects can be divided into monoclonal antibodies (mABs) and vaccines (active immunization). The two mABs licensed so far are indicated only for infants, while the first vaccines approved are mainly recommended for older adults.</div><div>The pharmaceutical competitive arena of products to prevent RSV negative effects has recently become very crowded after more than two decades with only one mAB as the unique option. Here, we try to put order in the dramatically increasing mix of very different products which have been recently launched. The aim of our effort is to provide some suggestions for European policy makers in order to limit the potentially relevant financial impact of these new expensive options on public pharmaceutical expenditures. We hope the suggested strategies might help to avoid transforming RSV from an apparently underscored health issue into a clearly overestimated health risk for the whole population in European countries. This dramatic change could be driven by a bunch of powerful multinational companies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105187"},"PeriodicalIF":3.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513278","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}
Health PolicyPub Date : 2024-10-19DOI: 10.1016/j.healthpol.2024.105188
Francesca Costanza, Giada Li Calzi
{"title":"Social innovation management to support integrated care: Insights from an Italian revelatory case study.","authors":"Francesca Costanza, Giada Li Calzi","doi":"10.1016/j.healthpol.2024.105188","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105188","url":null,"abstract":"<p><p>This research deals with Social Innovation (SI) and integrated and connected care in the hospital care, presenting a successful experience of telemedicine's implementation within the Italian context. Nowadays integrated care and connected care are relevant concepts for delivering people-centered healthcare; though their operationalization is challenging and requires accounting for systems' complexity. In this regard, SI may be a catalyst, since it consists in a kind of innovation motivated by social needs. Extant research on SI in healthcare is scant and fragmentary, overlooking operational features and enabling conditions. Considering these gaps, the paper investigates the potential contribution of SI management to integrated and connected care. For the purpose, it offers a revelatory case study, concerning the pediatric research hospital Gaslini (Genoa, Italy), which is, to our knowledge, the first Italian public hospital to have hired a SI manager. By referring to a telemedicine pilot project, the study analyzes main features of the SI management process and its approach to promote integrated and connected care. Research data are analyzed by combining Gioia methodology and systems thinking. The resulting grounded theory model is causal loops-shaped and highlights virtuous mechanisms of SI unveiling generative voids and existing skills.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105188"},"PeriodicalIF":3.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549030","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}
Health PolicyPub Date : 2024-10-18DOI: 10.1016/j.healthpol.2024.105189
Thaksha Thavam , Michael Hong , Rose Anne Devlin , Kristin K Clemens , Sisira Sarma
{"title":"Does financial incentive for diabetes management in the primary care setting reduce avoidable hospitalizations and mortality in high-income countries? A systematic review","authors":"Thaksha Thavam , Michael Hong , Rose Anne Devlin , Kristin K Clemens , Sisira Sarma","doi":"10.1016/j.healthpol.2024.105189","DOIUrl":"10.1016/j.healthpol.2024.105189","url":null,"abstract":"<div><div>Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105189"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592568","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}
Health PolicyPub Date : 2024-10-08DOI: 10.1016/j.healthpol.2024.105177
Ines Marina Niehaus , Andreas Lehr , André Kaiser , Helena Sophie Müller , Ludwig Kuntz
{"title":"German centralization strategy during COVID-19: Continuing or interrupting a trend?","authors":"Ines Marina Niehaus , Andreas Lehr , André Kaiser , Helena Sophie Müller , Ludwig Kuntz","doi":"10.1016/j.healthpol.2024.105177","DOIUrl":"10.1016/j.healthpol.2024.105177","url":null,"abstract":"<div><div>In response to the COVID-19 pandemic, many countries applied centralization strategies to the distribution of power between national government and regional/local governments over responsibility for regulatory tasks. As a result, health-policy decision-making competences were shifted from the regional level to the national level (vertical shift of decision-making competences). This centralization trend for the purpose of infection control is evident in Germany. We conducted a quantitative and qualitative analysis of health-policy regulatory measures (March 2018 to March 2020) in order to investigate whether the vertical shift in decision-making competences was already a trend in Germany before the COVID-19 pandemic and beyond infection control. Our results show that the centralization strategy observed during COVID-19 does not continue a trend. Before the COVID-19 pandemic, what was most important was the distribution of power at national level between government and non-government institutions (horizontal allocation of decision-making competences). This long-term trend strengthens the decision-making competences of government institutions and weakens non-government institutions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105177"},"PeriodicalIF":3.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592564","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}
Health PolicyPub Date : 2024-10-06DOI: 10.1016/j.healthpol.2024.105179
Miguel Viegas , João Valente dos Santos , Manuel João Coelho e Silva
{"title":"Impact of local sports policies in the prevalence of cardiovascular disease: An assessment with spatial data analysis","authors":"Miguel Viegas , João Valente dos Santos , Manuel João Coelho e Silva","doi":"10.1016/j.healthpol.2024.105179","DOIUrl":"10.1016/j.healthpol.2024.105179","url":null,"abstract":"<div><div>According to the World Health Organization, 17 million people die every year of cardiovascular diseases (CVD), particularly heart attacks and strokes. More than half of all deaths across the Europe are caused by CVDs. 80 % of premature deaths from these causes could be avoided by controlling the main risk factors: tobacco, unhealthy diet and physical inactivity.</div><div>Local authorities provide sport and recreation facilities to their communities. They also have a central role in forging partnerships with public and private sector to enhance the local sport delivery system.</div><div>The present paper consists of an empirical exercise about the statistical relationship between the financial effort of Portuguese municipalities in the implementation of sports policies and the prevalence of CVDs. The estimation of a Spatial Autocorrelation Model confirms the strong spatial dependence between neighbouring municipalities and validates the existence of a positive impact of local sports policies on mortality rate from cardiovascular diseases. The results raise the need to reinforce local policies to promote active living based on holistic approaches to combating heart disease and promoting healthy lifestyles in partnerships with health professionals, educators, and community leaders.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105179"},"PeriodicalIF":3.6,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442278","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}
Health PolicyPub Date : 2024-09-30DOI: 10.1016/j.healthpol.2024.105174
Christina Mensger , Yang Jiao , Maximiliane Jansky , Christian Banse , Friedemann Nauck , Monika Nothacker , Henrikje Stanze
{"title":"Voluntarily stopping eating and drinking (VSED): A systematic mixed-methods review focusing on the carers’ experiences","authors":"Christina Mensger , Yang Jiao , Maximiliane Jansky , Christian Banse , Friedemann Nauck , Monika Nothacker , Henrikje Stanze","doi":"10.1016/j.healthpol.2024.105174","DOIUrl":"10.1016/j.healthpol.2024.105174","url":null,"abstract":"<div><h3>Background</h3><div>Voluntary stopping of eating and drinking (VSED) is a way to end one's life prematurely. We synthesized the empirical data on VSED.</div></div><div><h3>Methods</h3><div>In this systematic mixed-methods review, we searched MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT for English and German articles published between January 1, 2013 and November 12, 2021. We included quantitative and qualitative research examining the experiences, attitudes, and knowledge of people confronted with VSED. We inductively analyzed the data after quantitative data transformation. We assessed quality and confidence using the Mixed-Methods Appraisal Tool and GRADE-CERQual approach, respectively. This study was registered in PROSPERO (CRD42022283743).</div></div><div><h3>Findings</h3><div>We identified 22 eligible articles, comprising 16 studies. The participants were healthcare professionals and relatives, but not individuals undertaking VSED. We present here our findings on the challenges of accompanying VSED, positive experiences with VSED, and the identified needs. Support during VSED is needed at multiple levels (medical care, family relief, course planning), and the willingness to accompany VSED is very high among healthcare professionals. However, there are several problems, the most obvious being the lack of knowledge and expertise regarding VSED, placing a great burden on families and professionals. The confidence in the review findings ranged from moderate to low.</div></div><div><h3>Interpretation</h3><div>Evidence-based guidance, in-depth knowledge, and training of healthcare professionals can greatly reduce the burden and fear among individuals accompanying VSED.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105174"},"PeriodicalIF":3.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395429","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}
Health PolicyPub Date : 2024-09-30DOI: 10.1016/j.healthpol.2024.105168
Nikita Jacob, Rita Santos, Peter Sivey
{"title":"The long-run effect of COVID-19 on hospital emergency department attendances:evidence from statistical analysis of hospital data from England","authors":"Nikita Jacob, Rita Santos, Peter Sivey","doi":"10.1016/j.healthpol.2024.105168","DOIUrl":"10.1016/j.healthpol.2024.105168","url":null,"abstract":"<div><div>During the COVID-19 pandemic, hospital emergency departments worldwide experienced a pronounced fall in utilisation of emergency care, with a decrease of up to 40% in many countries. Evidence suggests the cause of these changes include both population fear of COVID-19 and the effects of lockdowns and the interaction of these two effects. We analyse a sub-sample of national data on Accident and Emergency (A&E) attendances in England over an extended period from April 2019 to March 2022 for different patient groups, including by age, mental/physical health status, acuity, and common clinical groupings. Our results showed that all patient groups experienced substantial declines in attendances during the first two waves of the pandemic, including high acuity and cardiovascular patients. Mental health patients were the only exception, with a smaller decline in attendances. Our findings suggest that policymakers should recognise the potential harmful effects of lockdowns, public messaging, and changes in health care provision on all patients during health emergencies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105168"},"PeriodicalIF":3.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434411","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":"How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering","authors":"Bérengère Davin-Casalena , Dimitri Scronias , Yann Videau , Pierre Verger","doi":"10.1016/j.healthpol.2024.105175","DOIUrl":"10.1016/j.healthpol.2024.105175","url":null,"abstract":"<div><h3>Background</h3><div>General practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages.</div></div><div><h3>Objectives</h3><div>To investigate how GPs cope with doctor shortage issues.</div></div><div><h3>Materials and methods</h3><div>Two cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics.</div></div><div><h3>Results</h3><div>87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas.</div></div><div><h3>Conclusion</h3><div>These results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"149 ","pages":"Article 105175"},"PeriodicalIF":3.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382518","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":"Understanding the evolution of competing institutional logics in the marketization of care: A stage model analysis of Australia's National Disability Insurance Scheme","authors":"Fanny Salignac , Ralf Barkemeyer , Elizabeth Franklin-Johnson , Tulin Dzhengiz","doi":"10.1016/j.healthpol.2024.105173","DOIUrl":"10.1016/j.healthpol.2024.105173","url":null,"abstract":"<div><div>This study explores the marketization of healthcare through a stage model analysis, focusing on Australia's National Disability Insurance Scheme (NDIS). By employing mixed methods, including sentiment and frequency analysis as well as qualitative content analysis of policy documents and media coverage, we trace the NDIS's evolution and the interplay of competing social welfare and market logics over time. Our findings underline that the evolution and interplay between competing institutional logics follow a stage model of institutional change, detailing pre-emergence, orientation, contestation, consolidation, and normalization phases. Additionally, we observe a shift in dominant institutional logics across different stages, demonstrating the critical role of media and public sentiment in shaping discourse about the marketization of care, which intertwines with policy decision-making. Our findings emphasize the importance of adaptive engagement and communication strategies by policymakers to avoid marginalizing vulnerable groups as institutional logics evolve, especially in the latter stages of the process when a dominant logic has emerged. The study highlights the complex dynamics of institutional change and offers insights for both researchers and practitioners in the healthcare sector, shedding light on the coevolution of competing logics in the policy development and implementation process.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"149 ","pages":"Article 105173"},"PeriodicalIF":3.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378638","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}
Health PolicyPub Date : 2024-09-26DOI: 10.1016/j.healthpol.2024.105176
Jean Pierre Uwitonze , Lize Duminy , Carl Rudolf Blankart
{"title":"Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework","authors":"Jean Pierre Uwitonze , Lize Duminy , Carl Rudolf Blankart","doi":"10.1016/j.healthpol.2024.105176","DOIUrl":"10.1016/j.healthpol.2024.105176","url":null,"abstract":"<div><div>Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an <em>Ethical Spectrum and Resource Allocation Framework</em>, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"149 ","pages":"Article 105176"},"PeriodicalIF":3.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332746","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}