Health Policy最新文献_第9页

Examining COVID-19 mortality inequalities across 169 countries: Insights from the COVID-19 mortality inequality curve (CMIC) and Theil index analysis 审视169个国家的COVID-19死亡率不平等：来自COVID-19死亡率不平等曲线（CMIC）和Theil指数分析的见解

IF 3.6 3区医学

Health Policy Pub Date : 2025-05-08 DOI: 10.1016/j.healthpol.2025.105345

Emiliano Lopez Barrera , Kristina Miljkovic , Kodjo Barnor , Dragan Miljkovic

{"title":"Examining COVID-19 mortality inequalities across 169 countries: Insights from the COVID-19 mortality inequality curve (CMIC) and Theil index analysis","authors":"Emiliano Lopez Barrera , Kristina Miljkovic , Kodjo Barnor , Dragan Miljkovic","doi":"10.1016/j.healthpol.2025.105345","DOIUrl":"10.1016/j.healthpol.2025.105345","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has highlighted global disparities in health outcomes, with mortality driven by pre-existing comorbidities, demographic vulnerabilities, and systemic socioeconomic inequalities. These factors underscore the need for evidence-based policies to address health inequities and strengthen system resilience.</div></div><div><h3>Objective</h3><div>This study quantifies COVID-19 mortality disparities across 169 countries, focusing on obesity, age, and income dimensions, to inform equitable and effective policy interventions.</div></div><div><h3>Methods</h3><div>Using publicly available datasets, the COVID-19 Mortality Inequality Curve (CMIC) and Index (CMII) were applied to measure disparities, while the Theil Index decomposed them into within- and between-group components. Mortality data were analyzed at three time points—December 2020, August 2021, and February 2022—to capture the effects of vaccination campaigns.</div></div><div><h3>Results</h3><div>The Theil Index revealed significant reductions in mortality inequality among countries with lower obesity rates (from 1.43 to 0.80) and older populations (from 0.95 to 0.54), reflecting the impact of targeted vaccination efforts. However, income-based disparities showed limited improvement (Theil Index: 0.61 to 0.54), emphasizing persistent inequities in healthcare access. High-income countries achieved the most significant reductions in inequality due to early and widespread vaccination.</div></div><div><h3>Conclusions</h3><div>Tailored health policies prioritizing equitable vaccine distribution, data harmonization, and targeted interventions for obesity and age-related vulnerabilities are critical for reducing disparities and strengthening health system resilience during global crises.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105345"},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942255","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}

引用次数: 0

The impact of C-level positions on hospital performance: A scoping review of top management team outcomes c级职位对医院绩效的影响：对最高管理团队成果的范围审查

IF 3.6 3区医学

Health Policy Pub Date : 2025-05-07 DOI: 10.1016/j.healthpol.2025.105346

Matthias Lukas Zuchowski , Dennis Henzler , Mark Dominik Alscher , Eckhard Nagel

{"title":"The impact of C-level positions on hospital performance: A scoping review of top management team outcomes","authors":"Matthias Lukas Zuchowski , Dennis Henzler , Mark Dominik Alscher , Eckhard Nagel","doi":"10.1016/j.healthpol.2025.105346","DOIUrl":"10.1016/j.healthpol.2025.105346","url":null,"abstract":"<div><h3>Background</h3><div>As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges.</div></div><div><h3>Objective</h3><div>This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory.</div></div><div><h3>Methods</h3><div>The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect.</div></div><div><h3>Results</h3><div>Out of 5430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency.</div></div><div><h3>Conclusions</h3><div>The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer’s influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105346"},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068304","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}

引用次数: 0

Understanding the influence of leadership, organisation, and policy on delivering an integrated child health and social care service in community settings: A qualitative exploration using the SELFIE framework. 了解领导力、组织和政策对在社区环境中提供综合儿童健康和社会护理服务的影响：使用自拍框架的定性探索。

IF 3.6 3区医学

Health Policy Pub Date : 2025-05-03 DOI: 10.1016/j.healthpol.2025.105335

I Litchfield, L Harper, M Syed, F Dutton, M Melyda, C Wolhuter, C Bird

{"title":"Understanding the influence of leadership, organisation, and policy on delivering an integrated child health and social care service in community settings: A qualitative exploration using the SELFIE framework.","authors":"I Litchfield, L Harper, M Syed, F Dutton, M Melyda, C Wolhuter, C Bird","doi":"10.1016/j.healthpol.2025.105335","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105335","url":null,"abstract":"<p><strong>Background: </strong>The Sparkbrook Children's Zone is an example of a place-based integrated health and social care service developed to support children and young people living in marginalized populations in the United Kingdom. This model of care is expected to address both clinical need and the social determinants of health but evidence of the practical support needed is lacking.</p><p><strong>Objective: </strong>To understand the infrastructural challenges of providing a service combining clinical and non-clinical staff from a range of organisations and settings.</p><p><strong>Methods: </strong>A qualitative exploration of the experiences of staff delivering the service and used a directed content analysis to present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework.</p><p><strong>Results: </strong>A total of 14 staff were interviewed including clinicians, social care providers, local voluntary groups, and school-based family mentors. Participants described the gap between system-level integration and the lack of practical support for delivering a unified service on the ground; the training opportunities afforded by collocation; the complexity of securing staff from multiple employers using various funding sources; and the need for lengthier evaluations that extend beyond early instability.</p><p><strong>Conclusions: </strong>Despite decades of structural reform aimed at integrating the health and social care system in the UK, there was a surprising lack of practicable support for delivering a place-based integrated health and social care service. Their delivery is also hindered by short-term funding cycles limiting the reliability of evidence gathered from complex and evolving services.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105335"},"PeriodicalIF":3.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052457","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}

引用次数: 0

How do policy supports enable the implementation, scale, and sustainability of integrated care programs in England, Germany, and The Netherlands? Lessons for Canada. 在英国、德国和荷兰，政策支持如何促进综合护理项目的实施、规模和可持续性？给加拿大的教训。

IF 3.6 3区医学

Health Policy Pub Date : 2025-05-03 DOI: 10.1016/j.healthpol.2025.105334

Stefanie Tan, Julie Farmer, Walter P Wodchis, Sara Allin

{"title":"How do policy supports enable the implementation, scale, and sustainability of integrated care programs in England, Germany, and The Netherlands? Lessons for Canada.","authors":"Stefanie Tan, Julie Farmer, Walter P Wodchis, Sara Allin","doi":"10.1016/j.healthpol.2025.105334","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105334","url":null,"abstract":"<p><strong>Background: </strong>Integrated care aims to coordinate the care needs of a population, particularly individuals requiring complex care, across community, primary and secondary care settings. This study explores policy supports for integrated models of care in England, Germany, and The Netherlands to consider the implications for policy transfer for Canada.</p><p><strong>Methods: </strong>We reviewed academic and grey literature about integrated models of care across three comparator countries and conducted in-depth qualitative interviews with 14 expert informants in Autumn 2023. Results were mapped against a framework for analysis about policy supports and transfer.</p><p><strong>Results: </strong>Integrated care initiatives varied in scale and scope with local population initiatives (Germany), devolved decision-making initiatives (England), or by addressing population subgroups (Netherlands). There are power and relative funding imbalances between the health and social services sectors that impede collaboration. Voluntary approaches to organisational governance reforms and partnerships with primary care providers promote uptake but policy entrepreneurs are crucial to facilitating implementation. Workforce adaptations and upskilling initiatives can enable interprofessional collaboration and intersectoral knowledge to address implementation gaps. There remain practical challenges with data infrastructure and sharing.</p><p><strong>Conclusions: </strong>Legislation is an important enabling factor for supporting governance. New financing streams can reward collaborative working for interdisciplinary teams. Policymakers at the macro- and meso‑level must support policy from intention to implementation.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105334"},"PeriodicalIF":3.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060400","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}

引用次数: 0

Early access to medicines with added therapeutic value: Measuring and comparing time to medicines access in England, France, Germany, Italy and Spain 早期获得具有附加治疗价值的药物：衡量和比较英国、法国、德国、意大利和西班牙的药物获取时间

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-28 DOI: 10.1016/j.healthpol.2025.105317

Sophie Delcroix-Lopes , Nadia Amer , Christophe Chaignot , Charlotte Pelletan

{"title":"Early access to medicines with added therapeutic value: Measuring and comparing time to medicines access in England, France, Germany, Italy and Spain","authors":"Sophie Delcroix-Lopes , Nadia Amer , Christophe Chaignot , Charlotte Pelletan","doi":"10.1016/j.healthpol.2025.105317","DOIUrl":"10.1016/j.healthpol.2025.105317","url":null,"abstract":"<div><div>The scientific breakthroughs over the past few decades have opened up new therapeutic possibilities, transforming the treatment of critical illnesses like cancer and rare diseases. However, delayed access to these innovations can lead to a loss of valuable life years for patients.</div><div>The annual European medicines access times Monitor, launched by the French Statutory Health Insurance (CNAM) with the support of the French National Authority for Health (HAS), analysed time to patient access across five countries between 2017 and 2023 (England, France, Germany, Italy and Spain) for a sample of 50 molecules that demonstrate therapeutic improvement.</div><div>The results underscore the crucial role of Early Access Schemes-EAS in accelerating patient access to medicines. These schemes are particularly prevalent in countries where national reimbursement is contingent on Health Technology Assessment-HTA assessments and price negotiations—notably France, Italy, and Spain.</div><div>These findings indicate that early access schemes, rather than being restricted to compassionate use for patients with no alternative treatment options, can also serve as a strategy to expedite access to essential therapies, particularly cancer drugs, prior to their formal reimbursement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105317"},"PeriodicalIF":3.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882893","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}

引用次数: 0

The role of community pharmacists in natural disasters: Experiences from the 2023 Türkiye earthquakes 社区药师在自然灾害中的作用：来自2023年台湾地震的经验

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-28 DOI: 10.1016/j.healthpol.2025.105333

Samet Dinçer , Fatma Gündüz , Ezgi Atalay , Galip Usta , Sare Peçe Göktaş

{"title":"The role of community pharmacists in natural disasters: Experiences from the 2023 Türkiye earthquakes","authors":"Samet Dinçer , Fatma Gündüz , Ezgi Atalay , Galip Usta , Sare Peçe Göktaş","doi":"10.1016/j.healthpol.2025.105333","DOIUrl":"10.1016/j.healthpol.2025.105333","url":null,"abstract":"<div><h3>Objective</h3><div>On 6 February 2023, a series of earthquakes struck the south-eastern region of Türkiye. The aim of this research is to identify the challenges and experiences of community pharmacists who were first-degree victims of the earthquake during and after the earthquake in providing health services.</div></div><div><h3>Methods</h3><div>Phenomenological design, one of the qualitative research methods, was used in the study. In-depth interviews were conducted with 15 individuals who were both first-degree earthquake victims and community pharmacists.</div></div><div><h3>Results</h3><div>Qualitative data were analyzed with the MAXQDA 2020 program and three main themes were created. It was determined that community pharmacists did not prepare despite knowing about seismic hazards. Following the disaster, a number of difficulties arose, such as drug safety issues, risky behaviors, and the physical destruction of pharmacies. It was noted that some community pharmacists could not return to normal processes on the date of the research.</div></div><div><h3>Conclusions</h3><div>Continuing pharmacy services without interruption during disasters is of global importance. Before the disaster, training should be organized for community pharmacists on their roles in disasters, medication management, and providing health care. Community pharmacists should take part in crisis management committees and contribute to drug supply chain planning. The roles of community pharmacists in risk reduction, preparedness, response, and recovery phases should be determined, and strategic actions should be developed for pre- and post-disaster periods.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105333"},"PeriodicalIF":3.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899889","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}

引用次数: 0

“That’s a tricky question”: perceptions of mandatory vaccination among parents and paediatricians in Austria “这是一个棘手的问题”：奥地利父母和儿科医生对强制性疫苗接种的看法

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-25 DOI: 10.1016/j.healthpol.2025.105331

Nora Hansl, Katharina T. Paul

{"title":"“That’s a tricky question”: perceptions of mandatory vaccination among parents and paediatricians in Austria","authors":"Nora Hansl, Katharina T. Paul","doi":"10.1016/j.healthpol.2025.105331","DOIUrl":"10.1016/j.healthpol.2025.105331","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic and recurrent outbreaks of vaccine-preventable diseases highlight the need to improve vaccine uptake. Vaccine mandates constitute prominent policy instruments that promise a quick increase in coverage. Yet mandates are difficult to implement and bear the potential to increase resistance and polarisation, while diminishing trust. Against this background, studying perceptions towards mandates of groups directly affected by mandates is key to sustainable vaccination governance</div></div><div><h3>Objective</h3><div>In this paper, we study parents as decision-makers for childhood immunisation and paediatricians who administer vaccination and mitigate reactance. We explore how these two groups perceive vaccine mandates</div></div><div><h3>Methods</h3><div>Our study builds on 42 qualitative interviews with parents and paediatricians. We draw on the case of Austria, which is characterised by a fragmented vaccination system and recent experiences with mandates</div></div><div><h3>Results</h3><div>Perceptions overall are ambivalent, with both cohorts weighing positive and negative aspects. We find four lines of reasoning that relate to perceptions of vaccine mandates: <em>political and societal impact, epidemiological reasoning, ethical considerations,</em> and <em>impact on vaccine uptake</em>. Both cohorts show considerable alignment in their perceptions. Crucially, we find that perceptions of mandates are formed in contextual, concrete experiences with the healthcare system</div></div><div><h3>Conclusions</h3><div>Our findings have critical implications for vaccination policy in Austria and beyond, especially concerning the distribution of responsibility in vaccination systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105331"},"PeriodicalIF":3.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895668","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}

引用次数: 0

Availability of primary care and avoidable attendance at English emergency departments: A regression analysis 英国急诊科初级保健的可获得性和可避免的出勤率：回归分析

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-24 DOI: 10.1016/j.healthpol.2025.105330

Timothy Jamieson , Hugh Gravelle , Rita Santos

{"title":"Availability of primary care and avoidable attendance at English emergency departments: A regression analysis","authors":"Timothy Jamieson , Hugh Gravelle , Rita Santos","doi":"10.1016/j.healthpol.2025.105330","DOIUrl":"10.1016/j.healthpol.2025.105330","url":null,"abstract":"<div><div>Attendances at emergency departments (EDs) by patients who could have been treated in primary care increase waiting times and costs in EDs and may reduce quality of care. This study examines whether the probability that a patient’s ED attendance is avoidable is associated with their characteristics and the quality, staffing, and availability of their general practice, particularly its extended hours provision. We estimate ED attendance level linear probability and logistic regressions using data on 10.16 M attendances at 144 major EDs by patients aged 16 or over from 6668 English practices. We use two definitions of avoidable ED attendance: the NHS definition (non-urgent) and a new wider definition (clinically inappropriate).</div><div>9.3 % of attendances were avoidable according to the NHS definition and 21.8 % with our definition. The probability of avoidable attendance was lower for older, female patients, those living in more socioeconomically deprived or sparsely populated areas, or those closer to their practice than to the ED attended. Attendances from practices where a higher proportion of patients get same-day GP appointments, or were aware of early morning extended hours, were less likely to be avoidable. The probability that an ED attendance was clinically inappropriate was about 0.5 % smaller during weekends or evenings when the practice had extended hours but was not associated with the overall provision of extended hours by the practice.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105330"},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901978","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}

引用次数: 0

Planning the scale-up of integrated care programs: A qualitative multiple-case study of case management for adults with complex needs in Quebec, Canada. 规划综合护理方案的规模：一个定性的多案例研究的案例管理在加拿大魁北克省成人复杂的需求。

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-18 DOI: 10.1016/j.healthpol.2025.105321

Catherine Hudon, Alexandra Lemay-Compagnat, Mathieu Bisson, Maud-Christine Chouinard, Gregory Moullec, Lourdes Rodriguez Del Barrio, Émilie Angrignon-Girouard, Marie-Dominique Poirier, Marie-Mychèle Pratte

{"title":"Planning the scale-up of integrated care programs: A qualitative multiple-case study of case management for adults with complex needs in Quebec, Canada.","authors":"Catherine Hudon, Alexandra Lemay-Compagnat, Mathieu Bisson, Maud-Christine Chouinard, Gregory Moullec, Lourdes Rodriguez Del Barrio, Émilie Angrignon-Girouard, Marie-Dominique Poirier, Marie-Mychèle Pratte","doi":"10.1016/j.healthpol.2025.105321","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105321","url":null,"abstract":"<p><strong>Background: </strong>Adults with complex needs require health and social services from a variety of providers. Appropriate care for these people calls for integrated care. However, few studies have assessed the organizational conditions conducive to implementing integrated care programs in preparation for scale-up.</p><p><strong>Objective: </strong>This study aimed to 1) implement a case management program as part of an integrated care program initiative for adults with complex needs in health and social services organizations and primary care clinics, 2) evaluate the organizational factors influencing implementation, and 3) share recommendations from key stakeholders to facilitate scale-up.</p><p><strong>Methods: </strong>A qualitative multiple-case study was conducted in two health and social services organizations and five primary care clinics in Quebec, Canada. We collected data through participant observation, semi-structured interviews, and focus groups with stakeholders. The data were analyzed using deductive (RE-AIM framework) and inductive thematic analysis. Case stories were developed and then compared.</p><p><strong>Results: </strong>Identifying patients targeted by the program was challenging. Better access to health information technology for case-finding was strongly recommended. Remuneration methods compatible with family physicians' expected levels of commitment to the program were needed to promote their engagement. Appropriate change management was also important to promote implementation and ensure sustainability of the program over time.</p><p><strong>Conclusion: </strong>This study may inform stakeholders interested in scaling up integrated care programs for adults with complex needs.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105321"},"PeriodicalIF":3.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176017","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}

引用次数: 0

Common institutional ownership and the erosion of competition in the American health insurance market: A quantitative analysis 共同机构所有权与美国健康保险市场竞争的侵蚀：一个定量分析

IF 3.6 3区医学

Health Policy Pub Date : 2025-04-13 DOI: 10.1016/j.healthpol.2025.105316

Kevin Smith

{"title":"Common institutional ownership and the erosion of competition in the American health insurance market: A quantitative analysis","authors":"Kevin Smith","doi":"10.1016/j.healthpol.2025.105316","DOIUrl":"10.1016/j.healthpol.2025.105316","url":null,"abstract":"<div><h3>Background</h3><div>Empirical studies have shown that when large institutional investors and private equity funds own a significant stake in multiple publicly traded firms within an industry, this common ownership may lead to anti-competitive behavior. In 2010, the Affordable Care Act (ACA) was passed. This law created health insurance exchanges that allowed for Americans to purchase health insurance plans directly on a marketplace. The insurers on this marketplace have common institutional owners, that could influence the level of competition in these markets.</div></div><div><h3>Objective</h3><div>To assess the causal effects of common ownership on competition in the US health insurance market.</div></div><div><h3>Methods</h3><div>To identify the causal impact of common ownership, I use two empirical strategies: the Arellano-Bond Dynamic Panel Model and Bartik-style Instruments. Data on firm ownership came the paper, “Common Ownership Data: Scraped SEC form 13F filings for 1999-2017” by Matthew Backus, Christopher Conlon, and Michael Sinkinson.</div></div><div><h3>Results</h3><div>The results show that a one standard deviation increase in common ownership leads to a 7.7 % increase in monthly premiums charged for certain health insurance plans. This finding is robust to different model specifications and suggests that common ownership reduces competition in the health insurance exchanges.</div></div><div><h3>Conclusions</h3><div>The results from this paper indicate that policymakers and regulators need to formulate policies that limit the amount that institutional investors and private equity funds can own of companies in the health insurance industry in the US. Additionally, policymakers need to make more data on firm ownership available, as the data that is available has quality issues.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105316"},"PeriodicalIF":3.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824152","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}

引用次数: 0