Health Policy最新文献

{"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}

{"title":"Barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs: A scoping review.","authors":"L Fischer, R G M Smeets, M Rijken, A M J Elissen","doi":"10.1016/j.healthpol.2025.105283","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105283","url":null,"abstract":"<p><strong>Background: </strong>Integrated care attempts to address multiple care needs, but barriers to implementation remain. The service user perspective can guide policy and practice to advance implementation.</p><p><strong>Objective: </strong>To map barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs.</p><p><strong>Methods: </strong>A scoping review was conducted by searching PubMed, Embase, Web of Science, CINAHL, and grey literature. Eligible studies were analysed by categorising barriers and facilitators at the micro, meso, and macro levels of the healthcare system. They were further mapped by the components retrieved from the SELFIE framework for integrated care for multimorbidity.</p><p><strong>Results: </strong>Across the 34 included studies, people with multiple care needs identified more barriers and facilitators at the micro level than at the meso and macro levels. Mapped under 'the individual and their environment', social and personal barriers (e.g. socioeconomic disadvantages, lack of social support) hindered integrated care. Mapped under 'service delivery' and 'workforce', a trusting relationship with a key care provider as part of a multidisciplinary care team was identified to facilitate integrated care.</p><p><strong>Conclusions: </strong>Our findings show that 'soft' relational and social factors are critical to integrated care. These 'soft' factors are primarily created at the micro level, but seem actionable at meso and macro levels. The unique perspective of people with multiple care needs suggests that more rigorous involvement of service users at higher levels is needed to inform policymakers and care providers on how to shape enabling conditions for the implementation of integrated care.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105283"},"PeriodicalIF":3.6,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588362","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":"Long-term public healthcare burden associated with intimate partner violence among Canadian women: A cohort study","authors":"Gabriel John Dusing ,&nbsp;Beverley M. Essue ,&nbsp;Patricia O'Campo ,&nbsp;Nicholas Metheny","doi":"10.1016/j.healthpol.2025.105282","DOIUrl":"10.1016/j.healthpol.2025.105282","url":null,"abstract":"<div><div>Intimate partner violence (IPV) is a major global health issue, yet few studies explore its long-term public healthcare burden in countries with universal healthcare systems. This study analyzes this burden among Canadian women using data from the Neighborhood Effects on Health and Wellbeing survey and Ontario Health Insurance Plan (OHIP) records from 2009 to 2020. We employed inverse probability weighting with regression adjustment to estimate differences in cumulative costs and OHIP billings between those reporting exposure to IPV during the survey and those who did not. Our sample included 1,094 women, with 38.12 % reporting IPV exposure via the Hurt, Insult, Threaten, Scream scale. Findings show a significant public healthcare burden due to IPV: women reporting IPV in 2009 had an average of 17 % higher healthcare costs and 41 additional OHIP billings (0.1732;95 % CI: 0.0578–0.2886; 41.23;95 % CI: 12.63–69.82). Policies prioritizing primary prevention and integration of trauma-informed care among healthcare providers are vital to alleviate the long-term burden on public health systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105282"},"PeriodicalIF":3.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551031","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":"Immigrants’ self-perceived barriers to healthcare: A systematic review of quantitative evidence in European countries","authors":"Chiara Allegri,&nbsp;Elisa Barbiano di Belgiojoso,&nbsp;Stefania Maria Lorenza Rimoldi","doi":"10.1016/j.healthpol.2025.105268","DOIUrl":"10.1016/j.healthpol.2025.105268","url":null,"abstract":"<div><h3>Background</h3><div>with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing.</div></div><div><h3>Methods</h3><div>we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential).</div></div><div><h3>Results</h3><div>linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned.</div></div><div><h3>Discussion</h3><div>policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants’ needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results’ robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105268"},"PeriodicalIF":3.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454841","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":"Forgone Care of doctor's visits in Germany – Results from three cross-sectional surveys","authors":"Christine Haeger ,&nbsp;Raphael Kohl ,&nbsp;Julie L. O'Sullivan ,&nbsp;Susanne Schnitzer","doi":"10.1016/j.healthpol.2025.105273","DOIUrl":"10.1016/j.healthpol.2025.105273","url":null,"abstract":"<div><h3>Background</h3><div>Forgone care, defined as not using health care despite needing it, leads to adverse outcomes such as increased emergency care use. Our study uses data from German representative surveys (2016, 2021, 2022) to examine the frequency, demographics, and reasons for forgone care.</div></div><div><h3>Methods</h3><div>Multiple logistic regression models of individual cohorts and pooled data were used to assess the likelihood of forgoing a doctor's visit. Reasons for forgone care were analyzed descriptively and further clustered in different types of barriers.</div></div><div><h3>Results</h3><div>Of 10,122 participants, 21 % reported forgone care in the past year: 22 % in 2016, 18 % in 2021, and 20 % in 2022. The likelihood of forgone care is highest among women (OR: 1.22 [1.09; 1.37]) and younger adults aged 18–44 years (OR: 1.19 [1.05; 1.34]), whereas participants in partnerships were less likely to forgo care (OR: 0.77 [0.69; 0.87]). Barriers were categorized as systemic (e.g. waiting time; 39 %), psychological (e.g. fear of diagnosis; 22 %), and physical (e.g. difficulty reaching the doctor; 19 %). Younger adults and members of the workforce cited systemic barriers most often, whereas older adults (65+) cited psychological and physical barriers.</div></div><div><h3>Discussion</h3><div>Targeted interventions for vulnerable groups are needed that reduce barriers for forgone care. Recommendations include more accessible doctor's offices, improved appointment systems, expanded telemedicine, and flexible hours.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105273"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509169","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":"The impact of eliminating out-of-pocket payments for medicines on low-income households: a controlled interrupted time series analysis using linked administrative data from British Columbia","authors":"Kartik Sharma ,&nbsp;Lucy Cheng ,&nbsp;Colin R. Dormuth ,&nbsp;Kimberlyn M. McGrail ,&nbsp;Mary A. De Vera ,&nbsp;Fiona Clement ,&nbsp;Rita K. McCracken ,&nbsp;Muhammed Mamdani ,&nbsp;Michael R. Law","doi":"10.1016/j.healthpol.2025.105270","DOIUrl":"10.1016/j.healthpol.2025.105270","url":null,"abstract":"<div><h3>Background</h3><div>There is interest in reducing out-of-pocket payments for prescription medicines, but the effects of such interventions remain unclear.</div></div><div><h3>Objective</h3><div>To study the impact of changes to the public prescription drug insurance program in British Columbia (BC), Canada that eliminated copayments for low-income households.</div></div><div><h3>Methods</h3><div>We used administrative data from 2017 to 2021 from Population Data BC and a controlled interrupted time-series design to examine a 2019 policy that eliminated copayments for households with incomes below $13,750. Households with incomes over $45,000—who experienced no changes in public coverage—served as a control. Our primary outcomes were prescription drug expenditures and the number of prescriptions dispensed. We also conducted a pre-post analysis to study impacts on dispensing and expenditures across therapeutic classes.</div></div><div><h3>Results</h3><div>The intervention cohort included 9,095 patients representing 8,011 households with an average age of 48.4. The control cohort included 820,395 patients representing 471,778 households with an average age of 51.1. Copayment elimination led to a level increase of $3.85 (95 % CI: $1.13 - $7.03) in monthly drug expenditures and had no impact on the trend. The mean number of prescriptions dispensed had a level increase of 0.07 (95 % CI: 0.04 – 0.09) and the rate of dispensing increased by 0.006 prescriptions monthly (95 % CI: 0.002 – 0.010). Copayment elimination was associated with increased expenditures and dispensing across most therapeutic classes.</div></div><div><h3>Interpretation</h3><div>Copayment elimination for low-income households in BC led to significant increases in prescription drug expenditures and dispensing across drug classes. Eliminating copayments appears to be effective at improving access to medicines for lower-income families.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105270"},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518917","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":"Determinants and associated costs of unmet healthcare need and their association with resource allocation. Insights from Finland","authors":"Lien Nguyen,&nbsp;Unto Häkkinen","doi":"10.1016/j.healthpol.2025.105272","DOIUrl":"10.1016/j.healthpol.2025.105272","url":null,"abstract":"<div><div>The Finnish counties’ allocation formulae for welfare services are based on utilisation collected from national registers and do not account for unmet needs. We investigated factors associated with self-reported unmet healthcare need and associated costs of primary and total healthcare, as well as the association between regional variation in unmet needs and utilisation-based need. The 2017–2018 FinSote survey data were matched with 2017 register data (n = 13,800). Costs of healthcare visits were used as a proxy for utilisation. We applied three logit regressions to explore factors related to self-reported unmet need and eight two-part models to analyse cost data. Analysis weights were developed and used. Those reporting unmet need were female, unemployed and foreign-born, and had multiple morbidities and poor self-assessed health. The highest income quintile and good self-rated quality of life were negatively associated with self-reported unmet need. A person with unmet needs spent an additional €32.2–183.9 and €269.7–963.7 yearly on primary and total healthcare, respectively. Regional differences in self-reported unmet need were not fully correlated with the need indices used in the regional resource allocation. To account for unmet need in budget allocations, self-reported unmet need and quality of life data should be collected more extensively and routinely. Addressing unmet need should be viewed as a long-term investment in primary care to reduce avoidable health inequalities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105272"},"PeriodicalIF":3.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508385","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}