Health Policy最新文献

{"title":"Equal access to primary care – A reference for spatial allocation in Germany","authors":"Alexander Haering ,&nbsp;Matthias Kaeding ,&nbsp;Anna Werbeck","doi":"10.1016/j.healthpol.2025.105364","DOIUrl":"10.1016/j.healthpol.2025.105364","url":null,"abstract":"<div><h3>Background</h3><div>Equal access to primary care is essential for a reliable health-care system, as it influences health outcomes, reduces follow-up visits, and lowers overall healthcare costs. However, inequalities in access, often driven by the uneven geographical distribution of primary care physicians, remain an issue in Germany.</div></div><div><h3>Objective</h3><div>We investigate the regional distribution of primary care physicians in Germany and analyze to what extent regional disparities can be explained by observable infrastructural and environmental characteristics.</div></div><div><h3>Methods</h3><div>To investigate our research question, we apply a greedy capacitated algorithm on very fine spatial data. We compare our reference allocation of primary care physicians to the status quo using OLS regressions and a Oaxaca-Blinder decomposition.</div></div><div><h3>Results</h3><div>Our findings indicate a shortage of primary care physicians in Germany of approximately 6%, with rural areas being particularly affected. While some disparities can be partially explained by factors such as purchasing power and the number of schools, significant portions of the variation remain unexplained.</div></div><div><h3>Conclusion</h3><div>We offer ideas on how to improve primary care location planning and reduce regional disparities based on an algorithmic reference allocation and the analyzes of infrastructural and environmental factors’ impact on regional disparities. While being limited by the exclusion of other determinants of health, we provide a foundation for developing more targeted policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105364"},"PeriodicalIF":3.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205197","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":"Addressing workforce gaps in public health medicine subspecialties in Turkiye: A call to action","authors":"Eray Ontas","doi":"10.1016/j.healthpol.2025.105363","DOIUrl":"10.1016/j.healthpol.2025.105363","url":null,"abstract":"<div><div>Preventive health functions are essential to system resilience, yet remain chronically underprioritized across many European and neighbouring countries. The value of preventive public health professionals becomes visible during acute crises—pandemics, environmental emergencies, occupational health incidents—when surveillance, rapid response, system-wide coordination hinge on specialists trained in epidemiology, occupational medicine, and environmental medicine. However, the difficulty of quantifying the routine impact contributes to persistent political and financial neglect of this workforce. In Turkiye, as in other middle-income countries, these subspecialists are severely underrepresented. Despite formal recognition of public health subspecialties, the Ministry of Health has not fully integrate these roles into workforce planning or service delivery. In 2024, only 3 of 1035 subspecialty training positions were allocated to public health— underscoring institutional deprioritization. Without defined staffing models or programmatic roles, even well-trained specialists remain underutilized. On the demand side, preventive medicine is an unattractive career path for physicians. Extended training durations, additional compulsory service, uncertain career trajectories deter recruitment and retention. Addressing these gaps requires more than technical reform: financial, academic incentives must be complemented by defined career pathways, leadership opportunities, integration into national health strategies. These gaps are not merely administrative—they reflect a deeper failure to position public health as a strategic pillar of system resilience and national health security. Turkiye’s experience reflects a broader regional challenge: preventive public health subspecialties remain undervalued and poorly integrated across many middle-income countries. Without structural reforms, countries may face the next crisis with insufficient capacity to detect, respond to, and prevent public health threats.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105363"},"PeriodicalIF":3.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213058","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":"Overseas general practitioners (GPs) and opioid prescriptions in England","authors":"Joan E. Madia ,&nbsp;Catia Nicodemo ,&nbsp;Cristina E. Orso ,&nbsp;Cristina Tealdi","doi":"10.1016/j.healthpol.2025.105362","DOIUrl":"10.1016/j.healthpol.2025.105362","url":null,"abstract":"<div><div>The substantial recent rise in opioid prescription rates, along with increasing evidence of misuse and associated morbidity and mortality, raises serious concerns about the appropri- ateness of these drugs for pain management. This study investigates prescription behaviour differences across opioid drug categories between UK-trained and overseas-trained GPs. Us- ing panel data covering all English practices from 2018 to 2021, we find a strong association between practices with more overseas GPs and opioid prescription patterns. Regional dif- ferences emerge, with GPs from North America prescribing more opioids and those from Africa and Asia prescribing less, relative to the UK-trained counterparts. Heterogeneous cultural norms, different training environments, and varying epidemiological patterns might explain these different prescribing behaviours. Comprehensive cross-country assessments of GP competencies could identify areas for targeted training, helping to align the practices of foreign-trained GPs with UK standards while supporting the attraction of global talent.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"159 ","pages":"Article 105362"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184802","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":"Initiatives to increase childhood vaccination coverage: an international comparison","authors":"Madelon Kroneman ,&nbsp;Alfons Fermin ,&nbsp;Bernd Rechel ,&nbsp;Sara Allin ,&nbsp;Anders Anell ,&nbsp;Daiga Behmane ,&nbsp;Theresa Bengough ,&nbsp;Miriam Blümel ,&nbsp;Lucie Bryndová ,&nbsp;Krisztina Davidovics ,&nbsp;Antonio Giulio De Belvis ,&nbsp;Chrystala Charalambous ,&nbsp;Charalambos Economou ,&nbsp;Shaza Fadel ,&nbsp;Inês Fronteira ,&nbsp;Petér Gaál ,&nbsp;Michel Grignon ,&nbsp;Iwona Kowalska-Bobko ,&nbsp;Iva Lukačević Lovrenčić ,&nbsp;Sarah Mantwill ,&nbsp;Judith D. de Jong","doi":"10.1016/j.healthpol.2025.105351","DOIUrl":"10.1016/j.healthpol.2025.105351","url":null,"abstract":"<div><div>Background Childhood vaccination rates fluctuate over time and do not always meet the levels recommended by the WHO.</div><div>Objective This study aims to provide an overview of measures countries have introduced to increase vaccination rates.</div><div>Methods We developed a structured data collection template that was completed by country experts from Europe, Israel, the USA, and Canada. Experts were identified using the European Observatory on Health Systems and Policies’ HSPM (Health Systems and Policy Monitor) network. We approached experts from 32 countries and received responses from 22 countries. In the template we asked for measures introduced between 2014 and 2019. The experts were asked to indicate the type of intervention, the target population, possible positive and negative effects, and evidence on effectiveness. The information was collected between September 2019 and January 2020.</div><div>Results We identified four main types of interventions: restrictive measures for the unvaccinated, financial incentives, measures supporting the logistics of vaccination, and vaccination promotion campaigns. Restrictive measures often involved expanding existing mandatory vaccination policies or limiting access to pre-school activities for unvaccinated children. Financial incentives for healthcare providers showed some positive effects. Regarding logistical support, several countries used schools as alternative vaccination sites, though this presented organisational challenges. Many countries invested in improving knowledge among both healthcare professionals and parents to encourage vaccine uptake.</div><div>Conclusions Most initiatives implemented in the countries covered focussed on communication and knowledge enhancement. However, there is limited evidence on the impact of these measures on vaccination coverage.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105351"},"PeriodicalIF":3.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167514","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":"Lived experience of out-of-pocket costs of health care and medicines by people with chronic conditions and their families in Australia: a systematic review of the qualitative literature","authors":"Jane Desborough ,&nbsp;Charles Maskell-Knight ,&nbsp;Shelley Wang ,&nbsp;Anne Parkinson ,&nbsp;Danielle Butler ,&nbsp;Hsei-Di Law ,&nbsp;Kamania Butler ,&nbsp;Leanne Watts ,&nbsp;Elisabeth Huynh ,&nbsp;Fiona Hodson ,&nbsp;Samar Ibrahim ,&nbsp;Julie Veitch ,&nbsp;Jillian Kingsford-Smith ,&nbsp;Michael Kidd ,&nbsp;Cam Donaldson","doi":"10.1016/j.healthpol.2025.105359","DOIUrl":"10.1016/j.healthpol.2025.105359","url":null,"abstract":"<div><h3>Background</h3><div>Despite Australia’s universal health insurance scheme, Medicare, out-of-pocket costs (OOPC) for health care comprises 14 % of total health expenditure. People with chronic conditions spend a greater proportion of their incomes on health care than people without a chronic condition.</div></div><div><h3>Objective</h3><div>To review the qualitative literature examining experiences of OOPC of out-of-hospital care by people with chronic conditions and to discuss this in relation to current Australian health policy.</div></div><div><h3>Methods</h3><div>Systematic review and narrative synthesis of the qualitative literature examining OOPC for people with chronic conditions in Australia. Search: Pubmed, CINAHL Complete, Cochrane Library, PsycINFO and EconLit databases from 1999 to 10^th April 2025.</div></div><div><h3>Results</h3><div>37 studies met the inclusion criteria. Reduced or lost employment due to ill-health led to income loss, aggravating the financial burden of health management. While many people were able to access bulk-billing general practitioners, challenges in affording upfront and copayments for medical and allied health consultations, and medication costs were reported. Cost was the greatest barrier to accessing dental care. Trade-offs were described between health management and meeting basic living needs, particularly for people who earned too much to qualify for government welfare payments.</div></div><div><h3>Conclusion</h3><div>While Australian health policies effectively reduce the financial burden of health care for many people, distinct challenges exist for groups ineligible for concessional thresholds. Future research to identify the priorities and preferences of people with chronic conditions can further inform policy to improve the equity of health financing in Australia.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105359"},"PeriodicalIF":3.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116536","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 second Trump administration: A policy analysis of challenges and opportunities for European health policymakers","authors":"Scott L. Greer ,&nbsp;Holly Jarman ,&nbsp;Rachel Kulikoff ,&nbsp;Dimitra Panteli ,&nbsp;Ewout van Ginneken ,&nbsp;Matthias Wismar","doi":"10.1016/j.healthpol.2025.105350","DOIUrl":"10.1016/j.healthpol.2025.105350","url":null,"abstract":"<div><h3>Background</h3><div>The second Trump administration has already made major changes in US policies that affect health and health systems worldwide.</div></div><div><h3>Methods</h3><div>We use the Health System Performance Assessment categories developed by the European Observatory on Health Systems and Policies to identify areas in which US actions affect the health systems and policies of European states and the EU, and presidential Executive Orders supplemented by campaign statements to understand US actions.</div></div><div><h3>Results</h3><div>We identify relevant US policies in the areas of finance, resource generation (regulation, vaccines, artificial intelligence, supply chain resilience, workforce, research, education) and governance (geopolitical turbulence, climate change, US departure from the World Health Organization, and foreign aid). We then identify opportunities for states or the EU to strengthen their health systems, potential threats to their health systems that might arise from US actions, and serious confirmed threats.</div></div><div><h3>Conclusion</h3><div>The second Trump administration is creating heavy demands on European governments in many areas, which might undermine their fiscal capacity and willingness to fund health systems or new ventures, but diminished US investment in areas such as multilateralism, pandemic response, research, education, and aid (especially in areas such as gender and reproductive health) all create opportunities for European policymakers to strengthen their health systems, health-related economic sectors, and influence in global health governance.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105350"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124681","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":"Private provision of health services in Ukraine: A qualitative exploration of current policy challenges, and considerations for reform","authors":"Mark Hellowell ,&nbsp;Olga Demeshko ,&nbsp;Radmyla Hrevtsova ,&nbsp;Tomas Roubal ,&nbsp;Kateryna Fishchuk ,&nbsp;Solomiya Kasyanchuk ,&nbsp;Jarno Habicht","doi":"10.1016/j.healthpol.2025.105349","DOIUrl":"10.1016/j.healthpol.2025.105349","url":null,"abstract":"<div><h3>Background</h3><div>The role of private healthcare providers (PHPs) in Ukraine has increased, despite the ongoing war. As the Government of Ukraine (GoU) continues health reforms, governance mechanisms for PHPs need further examination.</div></div><div><h3>Objective</h3><div>This study assesses the policy responses to the growth of PHPs in Ukraine, focusing on four key state functions: information generation, regulation, purchasing, and policy-making.</div></div><div><h3>Methods</h3><div>A qualitative approach was used, including interviews and document analysis, to explore the effectiveness of governance frameworks in managing the private healthcare sector.</div></div><div><h3>Results</h3><div>Regulations for PHPs are comprehensive but outdated and require stronger enforcement. The National Health Service of Ukraine (NHSU) has extensive purchasing agreements with PHPs but lacks policies to address equity and efficiency concerns. Many PHPs are not enrolled in the national health information system, limiting the GoU’s ability to make evidence-based policy decisions. Strengthening the requirement for PHPs to enrol in the e-health system is needed, along with improved licensing and contractual specifications. Additionally, policy-making processes are vulnerable to influence by PHPs’ commercial interests, highlighting the need for greater transparency and broader stakeholder engagement.</div></div><div><h3>Conclusions</h3><div>Enhancing regulatory enforcement, expanding e-health system participation, and improving policy processes are essential for the GoU to address challenges posed by private sector growth. Strengthening these governance mechanisms will support Ukraine’s goals of equity, financial protection, and high-quality care, enhancing resilience to the multiple impacts of the war.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"158 ","pages":"Article 105349"},"PeriodicalIF":3.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071746","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":"Munich goes viral: Measuring the impact of the Oktoberfest on COVID-19 infection rates using difference-in-differences","authors":"Daniel Herold ,&nbsp;Phil-Adrian Klotz ,&nbsp;Jan Thomas Schäfer","doi":"10.1016/j.healthpol.2025.105332","DOIUrl":"10.1016/j.healthpol.2025.105332","url":null,"abstract":"<div><div>With about 6 million visitors, the <em>2022 Oktoberfest</em> in Germany has been one of the largest in-person social events following the COVID-19 pandemic. Despite high vaccination rates in Germany at that time, health authorities pointed out the high risk of getting infected at such events. Using a unique dataset, we estimate the causal impact of the <em>Oktoberfest</em> on the spread of infection by applying an event study design. Our results imply a significant increase in the infection rates during and after <em>Oktoberfest</em>, especially in the age cohorts 15–34 and 35–59. However, the case rate drops relatively quickly after <em>Oktoberfest</em>. We also find little to no effect of the fair on the infection rates of the remaining age cohorts below 15 and above 60 years of age. A robustness check using the hospitalization rate as dependent variable confirms those results. Our findings have important implications for regulations of large social events in times of COVID-19, when the share of vaccinated people in the population is already high.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105332"},"PeriodicalIF":3.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947390","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":"From clicks to care: Exploring the digital strategies of Italian health authorities in communicating ‘General Practitioner Selection’ service","authors":"Alessandro Vinci ,&nbsp;Luca Pirrotta ,&nbsp;Giulia Venturi ,&nbsp;Milena Vainieri","doi":"10.1016/j.healthpol.2025.105347","DOIUrl":"10.1016/j.healthpol.2025.105347","url":null,"abstract":"<div><div>The prioritization of digitalization is crucial to the agendas of nations worldwide. While substantial funds have been allocated to foster it, there remains a scarcity of tools dedicated to systematically monitoring the performance of the digital transformation. This work describes the level of digitalization and information of a fundamental primary care service: the “General Practitioner (GP) selection”. The analysis was conducted by consulting websites of Italian Local Health Authorities (LHAs). First, we explored the digitalization levels of 105 websites through the Primary Care Digital Information (PCDI) composite index. It comprises four dimensions: informativeness, accessibility, inclusiveness, and adaptability, scoring on a five-point scale (low-high digitalization). Second, we conducted a readability analysis, employing three validated measures. We found an average level of digitalization and information, although dimensions perform differently. The best-performing dimension was adaptability, while the worst was inclusiveness. Half of the LHAs provided several digital alternatives to GP selection, while the remaining provided limited or no options. Regarding readability, just 29% of the LHA's websites were found easy to read. Overall, our findings depict that Italian LHAs have different approaches. This study highlights that, despite best practices, several areas require monitoring and intervention. Moreover, some barriers characterize Italian health communication strategies, notably the variability of information across and within regions and on average low website readability.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105347"},"PeriodicalIF":3.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068388","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":"Price regulation and competition among on-patent anticancer drugs in Italy","authors":"Michele Caimmi ,&nbsp;Beatrice Canali ,&nbsp;Laura Candelora ,&nbsp;Alessandra Di Costanzo ,&nbsp;Francesca Fiorentino ,&nbsp;Chiara Vassallo ,&nbsp;Maria Luisa Mancusi","doi":"10.1016/j.healthpol.2025.105348","DOIUrl":"10.1016/j.healthpol.2025.105348","url":null,"abstract":"<div><div>In recent years, the Italian Medicines Agency has adopted several measures aimed at curbing public pharmaceutical expenditure, including temporary and confidential price reductions, and Managed Entry Agreements. Besides, the Agency plays a pivotal role in price negotiations, serving as a tool for cost containment and financial sustainability for the Italian NHS. Our study aims at testing one potentially relevant channel for pursuing this objective and analyze if the Agency anchors the treatment cost of on-patent market entrants with those of on-patent therapeutic alternatives that previously obtained reimbursement in a given market. Our sample includes 86 anticancer indications which obtained reimbursement in Italy between March 2017 and May 2022, whose marketing authorization was granted under the centralized procedure at European level. Gathering data from multiple sources (drugs Summary of Product Characteristics, their pivotal clinical trials, and an IQVIA database on Italian negotiation dynamics), we identify competing indications within cancer site and treatment line, and then evaluate treatment costs based on median exposure to treatment in pivotal clinical trials. We retrieve prices from hospital expenditure data, which reflect discount negotiated with the regulator, tender, and commercial discounts. Our findings suggest that both the market average and the last reimbursed treatment cost significantly correlate with newly negotiated treatment costs, indicating that earlier negotiation outcomes serve as benchmarks for new ones.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105348"},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068302","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}