Health Policy最新文献

{"title":"Operationalising public trust for health policymakers - A qualitative study in the EU, France, Italy, and Switzerland","authors":"Federica Zavattaro ,&nbsp;Viktor von Wyl ,&nbsp;Felix Gille","doi":"10.1016/j.healthpol.2025.105393","DOIUrl":"10.1016/j.healthpol.2025.105393","url":null,"abstract":"<div><h3>Background</h3><div>Public trust is crucial for the success of health data-sharing initiatives (HDSIs), as it influences public participation. Although the potential for policies to actively foster trust is widely acknowledged, recent policy analyses suggest that this opportunity is often overlooked in practice.</div></div><div><h3>Objective</h3><div>To investigate if and how health policymakers at the European Union level and in France, Italy, and Switzerland prioritise and integrate public trust into their policy work, identifying key gaps and providing preliminary guidance to bridge them.</div></div><div><h3>Methods</h3><div>We conducted 57 semi-structured online interviews with policymakers involved in HDSIs at different stages of the policy process: 20 at the European level, 11 in France, 13 in Italy, and 13 in Switzerland. An inductive thematic approach was employed to identify emerging themes.</div></div><div><h3>Results</h3><div>Policymakers recognise public trust as crucial for public participation in HDSIs, yet no shared definition of trust in health data-sharing emerged. In France, trust-building is treated as a policy priority and embedded in stakeholder and public engagement processes prior to legislation. At the European, Italian, and Swiss levels, trust remains a vague concept, addressed implicitly without clear strategies. Policymakers highlighted the absence of specific guidance on trust-building and called for its development.</div></div><div><h3>Conclusions</h3><div>We identified a lack of harmonisation among policymakers regarding the definition of public trust and its translation into policy. In response, we propose a working definition of public trust in health data-sharing and highlight the urgent need for concrete, actionable tools to support policymakers in integrating trust-building principles into health data-sharing policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105393"},"PeriodicalIF":3.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604805","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":"Developing recommendations and actions for integrated services delivery through primary health care teams in Canada: a deliberative dialogue approach for a national knowledge translation event.","authors":"Nelly D Oelke, Ashmita Rai, Peter Hirschkorn, Breton Mylaine, Catherine Donnelly, Stephanie Montesanti, Gaboury Isabelle, Karin Maiwald, Paul Wankah","doi":"10.1016/j.healthpol.2025.105391","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105391","url":null,"abstract":"<p><p>Primary health care teams are a key strategy in providing integrated care, particularly for patients with multiple chronic conditions. Despite a strong commitment to improving primary health care through team-based care globally, challenges to its implementation remain. A comparative policy analysis was conducted in four Canadian provinces (British Columbia, Alberta, Ontario, and Quebec) to examine the policies and structures supporting service integration for patients with two or more chronic conditions through primary health care teams. Results are reported on Phase 3 of the project, including a national knowledge translation event to refine recommendations and develop actions for implementing recommendations related to team-based primary health care in policy and practice. Our virtual knowledge translation event took place in June 2022; with 25 participants including policymakers, decision-makers, providers, patients and researchers. Eight key recommendations were discussed and revised with feedback and strategies for implementation developed. Five themes were identified from the discussions: 1) composition of the team and access; 2) communication and electronic health records; 3) remuneration; 4) patient engagement; and performance measurement. Recommendations for policy and practice are outlined and compared to existing Canadian and international literature.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105391"},"PeriodicalIF":3.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621151","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 private equity in the German outpatient sector","authors":"Beate Jochimsen ,&nbsp;Bernhard Gibis","doi":"10.1016/j.healthpol.2025.105389","DOIUrl":"10.1016/j.healthpol.2025.105389","url":null,"abstract":"<div><div>Outpatient medical care in Germany has traditionally been delivered by self-employed physicians, primarily in solo or small group practices. A 2004 reform allowed corporate private investors, to finance outpatient care for the first time. Since then, the establishment of so-called medical care centres (MCCs) has become a staple of public healthcare. From the outset, concerns have been raised that economic interests could conflict with the values of a public health system. However, there is a notable lack of empirical evidence to support this potential conflict. This study seeks to narrow the empirical gap using three methodological approaches: a scoping review, identification of relevant data sources, and a brief case study. Our findings indicate that, to date, there is no empirical evidence suggesting a decline in the quality or scope of healthcare services when MCCs are financed by private equity investors. Nonetheless, the potential emergence of oligopolistic structures and a lack of transparency in provider ownership and structure call for careful regulatory oversight. Policy recommendations include strengthening the data infrastructure with respect to medical outcomes, costs, and provider characteristics (e.g. ownership or affiliations), and safeguarding medical decision-making from profit-driven influence by owners. As rising private investment, including private-equity, in outpatient care is observed across nearly all healthcare systems, an internationally comparative approach is essential.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"Article 105389"},"PeriodicalIF":3.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654452","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 burden of disease estimates in European Union Health policymaking: A systematic analysis of EU legislation","authors":"José Chen-Xu ,&nbsp;Diana Grad ,&nbsp;Nour Mahrouseh ,&nbsp;João Vasco Santos ,&nbsp;Silvia Riva ,&nbsp;Federica Gazzelloni ,&nbsp;Brigid Unim ,&nbsp;Periklis Charalampous ,&nbsp;Enkeleint A. Mechili ,&nbsp;Sarah Cuschieri ,&nbsp;Vanessa Gorasso ,&nbsp;Henk Hilderink ,&nbsp;Orsolya Varga ,&nbsp;Susana Viegas","doi":"10.1016/j.healthpol.2025.105387","DOIUrl":"10.1016/j.healthpol.2025.105387","url":null,"abstract":"<div><h3>Background</h3><div>The use of burden of disease (BoD) metrics in policymaking is crucial for evidence-based decision-making. However, there is currently no information available regarding their utilisation in policies at the European level.</div></div><div><h3>Objective</h3><div>This study aimed to analyse the use of BoD metrics within the European legislation.</div></div><div><h3>Methods</h3><div>Systematic searches on EUR-Lex were conducted for documents published between 2004 and 2023, to account for European Union-25 (EU-25). Network and qualitative analyses of documents were conducted to assess the legislation content.</div></div><div><h3>Results</h3><div>In total, 2615 documents were found, of which 191 included BoD metrics. Among the selected documents, 131 (69 %) were published after 2018. Ten were legally binding documents. The most prevalent EuroVoc (EU’s multilingual and multidisciplinary thesaurus) domains were social questions and environment. The most frequent EuroVoc terms were climate change policy (<em>n</em> = 45), EU environmental policy (<em>n</em> = 32) and pollution control measures (<em>n</em> = 32). The most common EU institution responsible for the retrieved documents was the European Commission (<em>n</em> = 152). As for the purposes of usage, argument (<em>n</em> = 93) and impact assessment (<em>n</em> = 50) were most common. Most BoD metrics were localized in the main text (<em>n</em> = 122).</div></div><div><h3>Conclusion</h3><div>Despite growing recognition of BoD metrics in supporting policymaking, their use remains focused on environmental health topics. Further efforts in training policymakers, knowledge dissemination and policy-oriented research could enhance the uptake of BoD studies in EU policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105387"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581091","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":"Policy makers must adopt agile signal detection tools to strengthen epidemiological surveillance and improve pandemic preparedness","authors":"Cédric Mahé ,&nbsp;Aimo Kannt ,&nbsp;AIOLOS consortium","doi":"10.1016/j.healthpol.2025.105386","DOIUrl":"10.1016/j.healthpol.2025.105386","url":null,"abstract":"<div><div>The SARS-COV2 pandemic has highlighted the urgent need for agile and responsive disease surveillance systems. To strengthen epidemiological surveillance and improve pandemic preparedness, policymakers must adopt real-time signal detection tools that integrate multisource data, including non-traditional health data, advanced analytics, and artificial intelligence (AI). Such approaches enable more efficient monitoring and decision-making through collaborative networks. Expanding these agile tools across Europe under a supranational mandate would enhance public health outcomes, support healthcare system efficiency, and increase business resilience. Leveraging private sector data and ensuring modularity for gradual scale-up are essential to maintaining adaptability and responsiveness.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105386"},"PeriodicalIF":3.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522220","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":"Exploring differences in performance management across public and private providers in primary care: Evidence from Finland and Sweden","authors":"Anna Häger Glenngård ,&nbsp;Teemu Malmi","doi":"10.1016/j.healthpol.2025.105383","DOIUrl":"10.1016/j.healthpol.2025.105383","url":null,"abstract":"<div><div>We employ a qualitative approach to explore whether and how the use of performance measurement systems differs between public and private providers in Swedish and Finnish primary care, from the perspective of primary care centre managers. The two settings are similar in terms of decentralised healthcare systems but differ in terms of organisation of primary care and governance principles for public and private providers. Our findings highlight the importance of considering contextual factors when interpreting results on differences between public and private providers. We observe a) increased goal clarity and an increased use of management controls when payment is separated from provision, b) a similar use of control practices between public and private providers when they operate under the same governance principles, and c) differences in control practices when the “rules of the game” differ. We identify two actions that can facilitate performance management at the provider level. One is for purchasers or owners to clearly communicate the scope of services for which providers are responsible for to improve their goal clarity. The other is for an actor at the national level to facilitate access to reliable data to enhance appropriate performance management and the sharing of experiences among providers.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105383"},"PeriodicalIF":3.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549425","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":"Impact of territorial case management on hospital admissions for complex chronic patients in Catalonia (Spain)","authors":"Jesús Antonio Vaquero Cruzado ,&nbsp;Nuria Gutiérrez Jiménez ,&nbsp;Laura Carrillo Ciércoles ,&nbsp;Eva García Tarrida ,&nbsp;María Jesús Megido Badía ,&nbsp;Nuria Fabrellas Padrés","doi":"10.1016/j.healthpol.2025.105384","DOIUrl":"10.1016/j.healthpol.2025.105384","url":null,"abstract":"<div><h3>Background</h3><div>Chronic diseases are the most frequent health problem in the population. The development of case management, as an advanced care practice, is a basic strategy in the care of complex chronicity. The Catalan Health Plan establishes general guidelines for chronic care, linked to the role of the nurse case management.</div></div><div><h3>Objective</h3><div>The objective is to analyse the impact on the health system of shared monitoring, by the chronicity care team and its primary care reference team, in patients identified as complex chronic diseases (CCP) or with advanced disease (MACA), in regarding hospital admissions.</div></div><div><h3>Methods</h3><div>Retrospective quasi-experimental intervention study, with pre-post analysis, comparing each patient one year before and one year after being incorporated into the case management portfolio of a team made up of 14 nurses, 2 family medicine specialists and one social worker, with attention 365 days a year, 24 h a day.</div></div><div><h3>Results</h3><div>Regarding the decrease in hospital admissions, an average decrease (2013–2021) of 56 % was observed for MACA and 53 % in CCP. Statistical analysis based on a Poisson regression model with offset demonstrates that the intervention program had a significant effect on reducing hospital admissions, from a team formed from primary care itself.</div></div><div><h3>Conclusions</h3><div>The organization and structure of a chronic care team such as the one described, in an integrated manner with other levels of care, allows for a significant reduction in hospital admissions<strong>.</strong></div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105384"},"PeriodicalIF":3.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510981","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, Yan Feng, Søren Rud Kristensen, Paula Lorgelly, Rachel Meacock, Luigi Siciliani, Matt Sutton","doi":"10.1016/j.healthpol.2025.105365","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105365","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105365"},"PeriodicalIF":3.6,"publicationDate":"2025-06-23","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":"Implications of multiprofessional collaboration in primary care – benefits for all? A quantitative study of effects on resource utilization of a team-based primary care practice in Sweden","authors":"Anna H Glenngård,&nbsp;Mattias Haraldsson","doi":"10.1016/j.healthpol.2025.105382","DOIUrl":"10.1016/j.healthpol.2025.105382","url":null,"abstract":"<div><div>We investigate differences in resource utilization between a multiprofessional team-based primary care practice and standard care for elderly patients with complex needs, from the perspective of different actors involved in healthcare delivery. The study is based on a mobile care team reform in a Swedish region, that spans across both organisational boundaries and different legislation. Our findings suggest that a shift towards a more proactive approach to outpatient care initially may lead to higher resource utilization and prevent hospital care and contribute to a more effective use of resources in the long run. The pattern observed is consistent the intentions behind the implementation of interventions aimed at shifting care closer to patients. Therefore, when implementing such interventions, it is important for decision-makers to be prepared to accept increased resource use initially in order to potentially benefit in the future. Our study highlights the challenges of measuring and comparing resource utilization across different actors. When implementing healthcare reforms that span across organisational borders, it is crucial to systematically collect and compile comparable data. Reliable information on the costs and patient outcomes associated with new ways of providing care, is important from both a management and a policy perspective.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105382"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491879","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 progressivity of health care revenue financing in 29 countries: A comparison","authors":"Andres Võrk ,&nbsp;Peter Pažitný ,&nbsp;Ruth Waitzberg ,&nbsp;Sara Allin ,&nbsp;Daiga Behmane ,&nbsp;Nicolas Bouckaert ,&nbsp;Damien Bricard ,&nbsp;Lucie Bryndová ,&nbsp;Antoniya Dimova ,&nbsp;Fidelia Cascini ,&nbsp;Péter Gaál ,&nbsp;Katharina Habimana ,&nbsp;Marios Kantaris ,&nbsp;Ewa Kocot ,&nbsp;Madelon Kroneman ,&nbsp;Liubovė Murauskienė ,&nbsp;Zeynep Or ,&nbsp;Carlo de Pietro ,&nbsp;Ingrid S. Saunes ,&nbsp;Steve Thomas ,&nbsp;Thomas Rice","doi":"10.1016/j.healthpol.2025.105381","DOIUrl":"10.1016/j.healthpol.2025.105381","url":null,"abstract":"<div><h3>Background</h3><div>This study assesses progressivity in public and private health care revenue collection among 29 high-income countries by combining the results of two previous articles comprising this special section of <em>Health Policy</em>. In those studies, we developed qualitatively based scores regarding revenue collection policies for three public revenue sources (income taxes, social insurance contributions, consumption taxes) and two private revenue sources (voluntary health insurance, out-of-pocket payments).</div></div><div><h3>Objective</h3><div>The current study sums these scores, weighted by the shares of each revenue source in each country, to calculate an overall progressivity score for each country.</div></div><div><h3>Methods</h3><div>We derived weights for each revenue source using publicly available OECD and Eurostat macrolevel data on the structure of health care financing and government revenues.</div></div><div><h3>Results</h3><div>France was the country that had the most progressive system, and Latvia, Hungary, and Bulgaria, the least progressive.</div></div><div><h3>Conclusions</h3><div>Countries relying more on out-of-pocket payments tend to be more regressive overall, suggesting that, from an equity perspective, their role should remain limited. Tax-based systems do not inherently ensure progressivity, especially when relying heavily on regressive consumption taxes. While wealthier countries and those with less income inequality tend to be more progressive, in contrast, Switzerland and Germany both scored among the more regressive countries. Our study shows that policy matters in promoting progressivity in health system revenue collection. Both public and private sources can be regressive if nothing is done. Yet, there are policy instruments that can mitigate regressivity, and even private sources of funds can be made less regressive.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105381"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581228","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}