Health Policy最新文献

{"title":"Understanding the intention–action gap in physician migration during crises: Interrupted time-series evidence from Turkey","authors":"Jebağı Canberk Aydın,&nbsp;Emre Atilgan,&nbsp;Aysu Zekioğlu,&nbsp;Işıl Usta Kara","doi":"10.1016/j.healthpol.2025.105504","DOIUrl":"10.1016/j.healthpol.2025.105504","url":null,"abstract":"<div><h3>Background</h3><div>Health workforce migration is a global phenomenon with far-reaching implications for health systems. Turkey has experienced an unprecedented rise in physician emigration over the past decade, yet the relationship between migration intentions and realised mobility remains insufficiently explored, particularly under overlapping economic, political, and health system crises.</div></div><div><h3>Objective</h3><div>To examine the divergence between physician emigration intentions and realised migration from Turkey to OECD countries (2012–2022), and to assess how the 2017–2018 structural crisis coincided with shifts in migration dynamics.</div></div><div><h3>Methods</h3><div>Data on Good Standing Certificate applications from the Turkish Medical Association (intentions) were combined with OECD Health Workforce Migration data (realised flows). An interrupted time-series design and structural break analysis were applied to detect significant changes associated with the crisis period.</div></div><div><h3>Results</h3><div>The intention–action ratio increased from 0.77:1 in 2012 to 4.16:1 in 2022, with a notable structural break at 2017–2018. The interrupted time-series estimate indicated a crisis-related rise of +1.6 ratio points (<em>p</em> &lt; 0.001). Certificate applications grew from 59 to 2685, while OECD inflows rose from 77 to 645, illustrating intensifying migration friction.</div></div><div><h3>Conclusions</h3><div>Periods of crisis appear to amplify emigration intentions while constraining their realisation, widening the intention–action gap. This pattern has implications beyond Turkey, highlighting the need for friction-sensitive forecasting, evidence-based retention strategies in source countries, and ethically balanced recruitment in destination countries.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105504"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688749","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":"Beyond income: The overlooked role of institutional trust and digital access in vaccine equity","authors":"Iman Nurjaman S.Kep., Ners., M.Kep., CWCCA., CSI","doi":"10.1016/j.healthpol.2025.105509","DOIUrl":"10.1016/j.healthpol.2025.105509","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105509"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694433","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":"An inventory of policy levers to reduce low value care: Results of a rapid scoping review","authors":"Lindsey M Warkentin,&nbsp;Lisa Tjosvold,&nbsp;Ken Bond","doi":"10.1016/j.healthpol.2025.105508","DOIUrl":"10.1016/j.healthpol.2025.105508","url":null,"abstract":"<div><h3>Background</h3><div>The continued use of low-value health care consumes system resources and creates unnecessary risk. There are numerous policy levers available to improve appropriateness of care, but a supporting tool is needed to allow for characteristic and evidence comparison.</div></div><div><h3>Objective</h3><div>Develop an inventory which catalogues policy levers which support the reduction of low-value care, alongside their effectiveness evidence and implementation factors.</div></div><div><h3>Methods</h3><div>Information on relevant levers was identified through searches in Medline, Cochrane Library, and Google Scholar, with additional targeted searches. An Excel-based inventory was developed with a list of levers, their descriptions, effectiveness outcomes, and implementation considerations. Filters were developed to help identify levers based on key characteristics. The inventory was refined through presentations to and feedback from key stakeholders.</div></div><div><h3>Results</h3><div>The inventory includes 53 levers which may influence clinician or patient behaviour, service provision, fiscal policies, and populations or organizations. Levers were often used across a variety of settings, care providers, and clinical indications, though some levers addressed specific low-value care contexts. Fiscal policy levers or those influencing service provision were more restrictive, while clinician and patient behaviour levers and those aimed at populations or organizations were less restrictive. Evidence was identified for 40 levers, with 9 levers considered high impact (&gt; 5 % change to behaviour, utilization, or cost) or consistently supported (&gt; 10 studies, the majority reporting desired effects).</div></div><div><h3>Conclusion</h3><div>This inventory can support health systems in addressing low-value care, through the ability to compare policy levers and select those applicable to the particular context.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105508"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670979","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":"Facemask and respirator use for bushfire smoke protection: A cross-country comparison of public health policies in Australia, Canada, India, and the United States","authors":"Abrar Ahmad Chughtai ,&nbsp;Elizabeth Kpozehouen ,&nbsp;Holly Seale ,&nbsp;Smita Shah ,&nbsp;Guy B. Marks ,&nbsp;C Raina MacIntyre","doi":"10.1016/j.healthpol.2025.105510","DOIUrl":"10.1016/j.healthpol.2025.105510","url":null,"abstract":"<div><h3>Background</h3><div>As climate change intensifies the frequency and severity of bushfires, exposure to bushfire smoke is emerging as a significant public health concern, associated with numerous adverse health outcomes, including exacerbation of chronic obstructive pulmonary disease, asthma, cardiovascular diseases, and respiratory infections.</div></div><div><h3>Objective</h3><div>This study examined policies related to the use of masks and respirators as protective measures against smoke exposure.</div></div><div><h3>Methods</h3><div>Policies and guidelines of health departments, emergency and fire services, and other relevant organisations of selected countries were reviewed. Guidelines were sourced from organizational websites, PubMed, and Google Scholar using specific keywords.</div></div><div><h3>Result</h3><div>There is variability in policies regarding mask and respirator use during bushfires. Health departments generally recommend using P2/ N95 respirators to protect the public from particulate exposure arising bushfire smoke, while emergency and fire services generally recommend surgical or cloth masks. Few guidelines provided detailed instructions on the proper use of respirators, including fit testing, or fit checking procedures. Most guidelines emphasised monitoring air quality and avoiding bushfire smoke, particularly for high-risk groups. There is no guidance provided on the length of time a mask should be used in any guideline.</div></div><div><h3>Conclusion</h3><div>The inconsistent recommendations from health organisations and countries regarding mask and respirator use during bushfires highlights the lack of high-quality evidence in this area. Health, emergency and fire services, and other relevant organisations should provide clear guidance around types of facemasks, the length of time a facemask should be used and on proper use of respirators use, including training and fit checking.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105510"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694431","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 role of EU funds in capital investment for health-care: a case study of Estonia's approach to provider network transformation 2004-2024","authors":"Triin Habicht ,&nbsp;Kaija Kasekamp ,&nbsp;Yulia Litvinova ,&nbsp;Mark Hellowell","doi":"10.1016/j.healthpol.2025.105506","DOIUrl":"10.1016/j.healthpol.2025.105506","url":null,"abstract":"<div><h3>Background</h3><div>Many health systems need substantial capital investment to advance people-centred, integrated care, but public capital budgets are often constrained. Estonia strategically leveraged EU grants to enable provider-network transformation alongside broader service-delivery reforms.</div></div><div><h3>Reform content</h3><div>After EU accession, Estonia leveraged EU grants to finance coordinated programmes of investment aligned with national strategies. Across 121 projects, €652.8 million was invested, of which €463.8 million came from EU funds. Investments supported optimisation of the acute hospital network, expansion of nursing/long-term care, establishment of multidisciplinary primary health-care (PHC) centres, and upgrades to digital infrastructure and emergency preparedness. Project selection was determined by functional development plans, reform-related eligibility criteria and co-financing rules, with the Estonian Health Insurance Fund (EHIF) engaged to assess long-term budget impact.</div></div><div><h3>Expected results</h3><div>Overall, this multi-phase investment programme was designed to modernise infrastructure, rationalise acute capacity, expand PHC scope and strengthen continuity of care and preparedness. Observed system changes include: fewer acute beds and more nursing beds; modernised regional hospitals; and substantial PHC and digital upgrades. However, uptake of extended PHC services was limited in practice, highlighting the need to combine capital and organisational change.</div></div><div><h3>Conclusions</h3><div>Estonia’s experience shows that EU grant funds - though modest relative to total health spending - can spur reconfiguration when embedded in clear strategies, conditional access to capital, inclusive stakeholder engagement, and purchaser alignment. Future sustainability will depend on securing predictable domestic capital and ensuring that infrastructure investments are matched by service-delivery and workforce changes to realise intended benefits.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105506"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694434","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":"Pricing matters: A retrospective national study of pricing reform impact on hip fracture procedures in Israel","authors":"Gideon Leibner ,&nbsp;Meir Liebergall ,&nbsp;Shuli Brammli-Greenberg","doi":"10.1016/j.healthpol.2025.105503","DOIUrl":"10.1016/j.healthpol.2025.105503","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the effects of a 2015 national reform in the Israeli healthcare system in the pricing structure for hip fracture procedures, where hospitals are reimbursed at a fixed rate based on the relevant Procedure-Related Group (PRG). The reform increased reimbursement rates for urgent hip-replacements, shifting the relative financial incentives between procedures.</div></div><div><h3>Objective</h3><div>To estimate the impact of the PRG tariff change on procedure mix and patients’ likelihood of undergoing hip replacement.</div></div><div><h3>Methods</h3><div>Utilizing a longitudinal retrospective case study approach, this national, multicenter, population-based study analyzed data from all 88,585 publicly funded urgent hip surgical procedures carried out in Israel from 2007 to 2018. The empirical strategy included a descriptive analysis of trends, Interrupted Time Series (ITS) and Projection-Based Adaptation of DID (Projected-DID).</div></div><div><h3>Results</h3><div>Among 88,585 urgent hip surgeries, 68.2% occurred before and 31.8% after the reform. Internal hip fixation (86.5%) remained most common, but total hip arthroplasty (THA) rose from 10.5% in 2007 to 32.2% in 2018, accompanied by a corresponding decline in hemiarthroplasty (HA). ITS analysis showed accelerated THA adoption post-reform (slope-change OR 1.06/quarter), with immediate declines in HA and IHF. The projected-DID estimates indicated the reform more than doubled the probability of THA, while moderating trends in HA and IHF. Overall, higher reimbursement increased likelihood of joint replacement, shifting from HA to THA.</div></div><div><h3>Conclusions</h3><div>Our study joins the extensive literature showing that compensation mechanisms are powerful tools for policymakers and payers to influence clinical decisions and shift practice at both hospital and departmental levels.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105503"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625404","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":"Associations between residents’ experience and compliance, staffing and clinical quality Star Ratings for Australian residential long-term care homes","authors":"Nicole Sutton ,&nbsp;Nelson Ma ,&nbsp;Jin Sug Yang ,&nbsp;Michael Woods ,&nbsp;Rachael L. Lewis ,&nbsp;Deborah Parker","doi":"10.1016/j.healthpol.2025.105521","DOIUrl":"10.1016/j.healthpol.2025.105521","url":null,"abstract":"<div><h3>Background</h3><div>Public reporting systems are increasingly used to promote transparency and accountability in the delivery and quality of long-term care (LTC). Australia’s Star Ratings system includes resident experience measures, offering an opportunity to assess their added informational value relative to more commonly used quality indicators.</div></div><div><h3>Objective</h3><div>To examine whether resident experience ratings capture distinct aspects of quality in residential LTC homes, this study investigates their association with regulatory compliance, staffing, and clinical quality ratings.</div></div><div><h3>Methods</h3><div>A pooled panel with a two-period change analysis was used, drawing on 2023–2024 Star Ratings data from 4,957 home-quarter observations across 2,642 unique Australian residential LTC homes. Multivariate analyses assessed associations between resident experience ratings and ratings for compliance, staffing, and clinical quality, adjusting for home-specific characteristics.</div></div><div><h3>Results</h3><div>After controlling for home-specific characteristics, the residents’ experience rating exhibits a positive but modest association with compliance and clinical quality ratings, but no significant association with staffing ratings. However, annual changes in residents’ experience ratings were not significantly associated with corresponding changes in other rating categories.</div></div><div><h3>Conclusions</h3><div>Resident experience ratings provide distinct insights into care quality that are not strongly reflected in ratings for compliance, clinical or staffing. Their inclusion in national quality frameworks strengthens the person-centredness and comprehensiveness of LTC quality measurement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105521"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702823","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":"Does pay for performance affect socioeconomic inequalities in access? Evidence from hospital specialised care in England","authors":"Alberto Núñez-Elvira ,&nbsp;Yan Feng ,&nbsp;Søren Rud Kristensen ,&nbsp;Paula Lorgelly ,&nbsp;Rachel Meacock ,&nbsp;Luigi Siciliani ,&nbsp;Matt Sutton","doi":"10.1016/j.healthpol.2025.105365","DOIUrl":"10.1016/j.healthpol.2025.105365","url":null,"abstract":"<div><div>Pay for performance aims to improve quality and efficiency in the health sector but may widen inequalities. We investigate how pay for performance for specialised hospital care in England affected socioeconomic inequalities in access. We focus on two clinical areas: trauma care aimed at reducing delayed discharges from adult critical care; and internal medicine aimed at reducing in-hospital waiting time and length of stay for patients requiring urgent coronary bypass grafting. Both were part of the Prescribed Specialised Services Commissioning for Quality and Innovation. Using patient-level administrative data from Hospital Episodes Statistics in 2012/13–2016/17, we employ difference-in-difference models to estimate the impact of these schemes across socioeconomic status. Our treatment group comprises hospitals that adopted the scheme, and our control group the remaining eligible hospitals. For trauma care, we measure the impact of the scheme on discharge delays and the probability of an overnight discharge. For urgent coronary bypass, we measure pre-surgery inpatient waiting time, length of stay, 30-day and one-year mortality, and hospital-acquired infections. For trauma care we find the scheme widened inequalities by reducing delays that favoured more patients in the least income-deprived quintile (by 2.4 h or 30.4 % at the sample mean) than in the most income-deprived quintile (by 1.3 h). We find no effect or socioeconomic differences across outcomes for patients requiring an urgent coronary bypass.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105365"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644188","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 pre-admission care on hospital mortality: Results of an instrumental variable analysis from Italy","authors":"Francesco Moscone ,&nbsp;Elisa Tosetti ,&nbsp;Giorgio Vittadini","doi":"10.1016/j.healthpol.2025.105483","DOIUrl":"10.1016/j.healthpol.2025.105483","url":null,"abstract":"<div><h3>Background</h3><div>With healthcare spending projected to increase in the coming decades, the relationship between expenditure and health outcomes demands urgent attention.</div></div><div><h3>Objective</h3><div>This paper investigates the impact of health care spending on hospital mortality. We use data on 96,778 patients admitted for acute myocardial infarction (AMI) in the Lombardy region, Italy, in the years from 2007 to 2022 and combine them with information on expenditure on pharmaceuticals and outpatient visits made in the 12 months prior to hospital admission.</div></div><div><h3>Methods</h3><div>We adopt an instrumental variables approach to evaluate the causal impact of the total cost for pre-admission prescriptions and outpatient visits on hospital patient’s mortality.</div></div><div><h3>Results</h3><div>We find that pre-admission healthcare, particularly pharmaceutical spending, has a significant impact on reducing mortality rates within hospitals, with a 10 % increase in pharmaceutical spending leading to a reduction in mortality by around 3.0 percentage points, although this result varies depending on the age group and the type of infarction.</div></div><div><h3>Conclusions</h3><div>The findings suggest that prioritizing pharmaceutical management can significantly reduce hospital mortality, highlighting a key area for healthcare optimization.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105483"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745681","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":"Multi-Sector collaboration to promote healthy ageing: A comparative case study of national policy responses in the Western Pacific Region","authors":"Tao Yang ,&nbsp;Aaron Hagedorn ,&nbsp;Wenqian Xu ,&nbsp;Siwon Lee ,&nbsp;Mikiko Kanda ,&nbsp;Sunghun Yun ,&nbsp;Honglin Chen","doi":"10.1016/j.healthpol.2025.105501","DOIUrl":"10.1016/j.healthpol.2025.105501","url":null,"abstract":"<div><div>This study investigates how national policies in nine Western Pacific countries—China, Japan, South Korea, Australia, New Zealand, Singapore, Malaysia, Vietnam, and Cambodia—promote healthy ageing through multi-sector collaboration. The objective is to identify common patterns and country-specific features in the governance and organization of collaborative efforts.</div><div>Using comparative case study analysis based on government documents, official reports, academic literature, and authoritative websites, the analysis reveals a growing policy emphasis on cross-sector collaboration in healthy ageing. Three distinct models of collaborative governance were identified, each characterized by different sectoral roles and coordination mechanisms.</div><div>These findings contribute to a better understanding of how multi-sector approaches are structured and implemented in diverse policy contexts to support healthy ageing. The study offers practical insights for policymakers aiming to strengthen intersectoral collaboration and align national strategies with international frameworks such as the UN Decade of Healthy Ageing (2021–2030) and the WHO Regional Action Plan for Healthy Ageing in the Western Pacific Region.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105501"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694432","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}