Health PolicyPub Date : 2025-01-22DOI: 10.1016/j.healthpol.2025.105251
Zachary DV Abel , Laurence SJ Roope , Raymond Duch , Sophie Cole , Philip M Clarke
{"title":"Inequality in COVID-19 vaccine acceptance and uptake: A repeated cross-sectional analysis of COVID vaccine acceptance and uptake in 13 countries","authors":"Zachary DV Abel , Laurence SJ Roope , Raymond Duch , Sophie Cole , Philip M Clarke","doi":"10.1016/j.healthpol.2025.105251","DOIUrl":"10.1016/j.healthpol.2025.105251","url":null,"abstract":"<div><div>Background COVID-19 vaccine hesitancy was a key barrier to ending the pandemic via mass immunisation.</div><div>Objectives Assess magnitudes and differences in socioeconomic inequality in stated COVID-19 vaccine acceptance (hesitancy) and uptake.</div><div>Methods Online surveys were conducted in 13 countries, collecting data from 15,337 and 18,189 respondents respectively. The investigation compares socioeconomic inequality in reported vaccine acceptance, measured in 2020–21 and subsequent uptake of vaccination in 2022. Inequalities are quantified using differences, ratios and the Erreygers adjusted concentration index. A regression decomposition approach is used to identify factors associated with inequality.</div><div>Results Mean uptake levels were 87 %, while acceptance was lower at 77 %. The difference between the richest and the poorest quintile was as large as 23 percentage points in acceptance and 30 p.p. in uptake, both observed in France. Acceptance and uptake were pro-rich (regressive) in most countries. Nine countries reported pro-rich inequality in acceptance, and eight in uptake. Uptake was significantly less regressive than acceptance in Australia, China, India, and USA. Australia and Colombia were the only countries where vaccination uptake was pro-poor (progressive). Age, marital status and political ideology were correlated with socioeconomic inequalities in several countries in both waves, while gender and education were associated with acceptance, and health levels with uptake.</div><div>Conclusion We found significant inequalities in vaccination acceptance and uptake across countries but inequality was generally lower in vaccine uptake than in acceptance. This suggests that inequalities can be reduced over time if adequate policies are in place to overcome hesitancy and reduce inequalities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105251"},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042531","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}
Health PolicyPub Date : 2025-01-22DOI: 10.1016/j.healthpol.2025.105250
Mohammad Ishtiaque Rahman
{"title":"Understanding private equity-owned HHAs in the U.S.: A performance comparison between pe-owned and non-pe-owned agencies","authors":"Mohammad Ishtiaque Rahman","doi":"10.1016/j.healthpol.2025.105250","DOIUrl":"10.1016/j.healthpol.2025.105250","url":null,"abstract":"<div><h3>Background</h3><div>Private equity (PE) ownership in the healthcare sector has increased, raising concerns about its impact on care quality and patient outcomes. In the U.S., private equity-owned home health agencies (HHAs) make up a growing share of the market. This study aims to compare the performance of PE-owned HHAs with non-PE-owned agencies across several quality measures.</div></div><div><h3>Objective</h3><div>To assess the impact of PE ownership on care quality, patient outcomes, and operational efficiency in HHAs by comparing PE-owned and non-PE-owned agencies using data from Medicare-certified HHAs.</div></div><div><h3>Methods</h3><div>The study utilized data from the Centers for Medicare & Medicaid Services (CMS) Home Health Compare dataset, spanning 2017 to 2023. Fourteen quality and outcome measures were analyzed. Non-parametric tests, including the Mann-Whitney U test and Cliff's Delta, were used to identify significant differences between PE-owned and non-PE-owned HHAs.</div></div><div><h3>Results</h3><div>PE-owned HHAs generally outperformed non-PE-owned agencies in metrics such as timely care initiation and patient improvement in mobility and self-care. However, they underperformed in areas related to long-term outcomes, such as timely physician-recommended medication actions, preventable readmission rates, and discharge to the community.</div></div><div><h3>Conclusions</h3><div>PE-owned HHAs demonstrate greater efficiency and improvement in certain areas of patient care, but underperformance in critical long-term care outcomes raises concerns about the sustainability of care quality. Policymakers must carefully monitor the influence of PE ownership to ensure that improvements do not come at the expense of patient well-being.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105250"},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030425","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}
Health PolicyPub Date : 2025-01-19DOI: 10.1016/j.healthpol.2025.105247
Tevfik Bulut
{"title":"Classifying the WHO European countries by noncommunicable diseases and risk factors","authors":"Tevfik Bulut","doi":"10.1016/j.healthpol.2025.105247","DOIUrl":"10.1016/j.healthpol.2025.105247","url":null,"abstract":"<div><h3>Background</h3><div>In the twenty-first century, noncommunicable diseases (NCDs) are a major obstacle to global development and the accomplishment of the Sustainable Development Goals set forth by the United Nations. The WHO (World Health Organization) European Region lacks comprehensive understanding of NCD risk factors, the NCDs they trigger, and the more disadvantaged countries.</div></div><div><h3>Objective</h3><div>This study aims to classify the countries in the European Region at the country level based on NCDs and their key risk factors.</div></div><div><h3>Methods</h3><div>The Ward method, a hierarchical clustering technique based on Manhattan and Euclidean distance measures, was used. The study's dataset comes from the WHO's publicly available NCDs and key risk factors dataset.</div></div><div><h3>Results</h3><div>The European region's countries have been categorized into two clusters based on key NCD risk factors. The second cluster consists of countries with high income levels. On the other hand, in the European Region, countries fall into three clusters based on NCDs. Countries in the third cluster, which consists of low- and upper-middle-income countries, have lower average values in four variables compared to other countries, resulting in lower overall disease prevalence.</div></div><div><h3>Counclusions</h3><div>The prevalence of NCDs varies among clusters, with high-income countries having lower disease prevalence, particularly in diabetes and hypertension. Addressing risk factors and improving healthcare access and infrastructure are crucial in reducing the burden of NCDs in the European region.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105247"},"PeriodicalIF":3.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025677","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}
Health PolicyPub Date : 2025-01-15DOI: 10.1016/j.healthpol.2025.105245
James Nind , Carlo A. Marra , Shane Scahill , Damien Mather , Alesha Smith
{"title":"The development of a discrete choice experiment: Investigating pharmacy selection in New Zealand","authors":"James Nind , Carlo A. Marra , Shane Scahill , Damien Mather , Alesha Smith","doi":"10.1016/j.healthpol.2025.105245","DOIUrl":"10.1016/j.healthpol.2025.105245","url":null,"abstract":"<div><h3>Introduction</h3><div>Discrete choice experiments (DCEs) provide a method for understanding preferences for service provision and there have been limited applications to the selection of community pharmacies. The validity and accuracy of DCEs rely upon the attributes and levels used. This paper aims to describe the development of a DCE investigating New Zealanders preferences for community pharmacies.</div></div><div><h3>Methods</h3><div>Five focus groups were conducted between August 2022 and April 2023, each representing a different demographic group. The transcripts underwent thematic analysis to develop themes and to write attributes that were important and realistic to participants. A complete survey combined choice tasks, generated through a partial factorial design, with demographic questions. It was pilot-tested using a ‘think aloud’ approach to ensure it was feasible and interpreted as intended.</div></div><div><h3>Results</h3><div>Thirty three codes were collated and refined into six attributes; location, wait time, customer service, prescription co-payments, nearby businesses, and car parking. Participants were asked to imagine they were in a new area, hence, attributes were presented as information available online.</div></div><div><h3>Discussion</h3><div>This in-depth reporting of DCE attribute development allows for robust evaluation of the validity of the processes used and identifies several differences.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105245"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030423","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}
Health PolicyPub Date : 2025-01-13DOI: 10.1016/j.healthpol.2025.105248
Paul Leavy , Sophie Mulcahy Symmons , David Mockler , Pádraic Fleming , Blánaid Daly , John Ford , Sara Burke
{"title":"How and why do health system factors influence general dentists’ participation in publicly funded, contracted primary dental care services: A realist review","authors":"Paul Leavy , Sophie Mulcahy Symmons , David Mockler , Pádraic Fleming , Blánaid Daly , John Ford , Sara Burke","doi":"10.1016/j.healthpol.2025.105248","DOIUrl":"10.1016/j.healthpol.2025.105248","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify health system contexts and mechanisms influencing general dental practitioners’ (GDPs) participation in state funded, contracted primary oral healthcare.</div></div><div><h3>Methods</h3><div>Peer-reviewed articles and other sources were identified via EMBASE, Medline (OVID), Web of Science and Google Scholar databases, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour, relevance and richness, and coded to identify data relating to contexts, mechanisms and outcomes. Inductive and deductive coding was used to generate context–mechanism–outcome configurations (CMOCs) and develop the final programme theory.</div></div><div><h3>Results</h3><div>Database searching identified 1,844 articles of which 29 were included. A further 33 sources were identified through adjunctive searches. Analysis identified key systems contexts influencing GDP participation. These include system emphasis on treatment over prevention, low priority for oral healthcare, funding constraints, and change implementation with minimal clinician consensus. At operational level, contracts can restrict GDP decision-making and ability to deliver high quality and holistic patient care. Key underlying mechanisms were feelings of ceded clinical and entrepreneurial control, stress and demoralisation, mistrust of the system and feeling undervalued.</div></div><div><h3>Conclusions</h3><div>The factors influencing GDP participation in state-funded, contracted dental care over private dental care are complex. The findings presented in this review have the potential to act as a good place to start leveraging health system change including better GDP engagement and increase participation in publicly funded systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105248"},"PeriodicalIF":3.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025683","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":"How COVID-19 illness perceptions and individual shocks are associated with trust during the COVID-19 pandemic in Australia, France, Germany, and South Africa","authors":"Marie-Hélène Broihanne , Daria Plotkina , Stefanie Kleimeier , Anja S. Göritz , Arvid O.I. Hoffmann","doi":"10.1016/j.healthpol.2024.105178","DOIUrl":"10.1016/j.healthpol.2024.105178","url":null,"abstract":"<div><div>The COVID-19 pandemic jeopardized individuals’ health and economic stability, and the associated shocks might have decreased individuals’ trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals’ institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105178"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395428","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}
Health PolicyPub Date : 2024-12-22DOI: 10.1016/j.healthpol.2024.105243
Josefien van Olmen, Katrien Danhieux, Edwin Wouters, Veerle Buffel, Roy Remmen, Monika Martens
{"title":"Scaling up integrated care for chronic diseases in belgium: A process evaluation.","authors":"Josefien van Olmen, Katrien Danhieux, Edwin Wouters, Veerle Buffel, Roy Remmen, Monika Martens","doi":"10.1016/j.healthpol.2024.105243","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105243","url":null,"abstract":"<p><strong>Introduction: </strong>Few integrated care studies elaborate how interventions are brought to wider scale. The SCUBY project developed interventions for scale-up of an Integrated Care Package (ICP) for two common diseases - type 2 diabetes and hypertension-, comprising evidence-based roadmaps and policy dialogues. This paper's aim is to report on the process evaluation of the ICP scale-up in Belgium. Specific objectives are: to describe the development of scale-up interventions; to assess the actual process outcomes; and to assess progress on three scale-up dimensions coverage, expansion and institutionalisation.</p><p><strong>Methods: </strong>A case study design, with data collection including project diaries, stakeholder surveys and interviews. 11 Key informant interviews were held with five research team members and six external people. Tools were developed to visualise progress for coverage, institutionalisation and expansion.</p><p><strong>Results: </strong>The roadmap included three themes: primary care practice organization, data and monitoring, and healthcare financing. 99 policy dialogues of varying size and type were held. Stakeholders rated all themes relevant. For scale-up outcomes, progress was most on the institutionalization axis.</p><p><strong>Discussion: </strong>Scale-up of ICP demands a collaborative, networking approach to build trust and buy-in. Protagonists need to strike a balance between relevance and feasibility of scale-up strategies, being aware of context elasticity. A roadmap can be a living document serving change teams in communication, planning and monitoring, while allowing intervention plasticity.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105243"},"PeriodicalIF":3.6,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959274","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}
Health PolicyPub Date : 2024-12-13DOI: 10.1016/j.healthpol.2024.105237
Andrey Elizondo, Robin Williams, Stuart Anderson, Kathrin Cresswell
{"title":"Implementing integrated care infrastructure: A longitudinal study on the interplay of policies, interorganizational arrangements and interoperability in NHS England.","authors":"Andrey Elizondo, Robin Williams, Stuart Anderson, Kathrin Cresswell","doi":"10.1016/j.healthpol.2024.105237","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105237","url":null,"abstract":"<p><strong>Background: </strong>New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms.</p><p><strong>Method: </strong>This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure. We undertook a longitudinal qualitative investigation -encompassing interviews and documentary analysis- of the implementation of interorganizational and digital interoperability infrastructures intended to support integrated care policies.</p><p><strong>Findings: </strong>Our findings underscore the long-term symbiotic relationship between institutional interorganizational frameworks and the construction of interoperability infrastructures, emphasizing how they mutually reinforce each other to support their ongoing evolution. Iterative, flexible, and experimental approaches to implementation provide opportunities to adapt to local realities while learning in the making.</p><p><strong>Conclusion: </strong>This study underlines the importance of adaptable, locally-informed implementation strategies in supporting the vision of integrated care, and the need to understand such development as a long-term, ongoing process of construction and learning.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105237"},"PeriodicalIF":3.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873548","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}
Health PolicyPub Date : 2024-12-10DOI: 10.1016/j.healthpol.2024.105234
Eleonora Gheduzzi, Silvia Mitidieri, Maria Picco, Federica Segato
{"title":"What mechanisms lead to the endurance of health and social care integration? A multiple case study in Italy.","authors":"Eleonora Gheduzzi, Silvia Mitidieri, Maria Picco, Federica Segato","doi":"10.1016/j.healthpol.2024.105234","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105234","url":null,"abstract":"<p><strong>Background: </strong>The rising complexity of the population's needs has made health and social care integration a priority for the future. Despite the presence of supporting policies and funding, the number of successful experiences that endure over time is limited.</p><p><strong>Objective: </strong>This work aims to investigate how health and social care integration occur and identify factors facilitating its endurance.</p><p><strong>Methods: </strong>We conducted a multiple case study on four long-lasting health and social care integration cases in Italy, where a new policy for enhancing integration was introduced. 20 senior managers employed in the four cases were interviewed and 33 official documents and websites were collected. The interviews' transcripts and documents were coded using an abductive approach.</p><p><strong>Results: </strong>The modalities of health and social care integration can vary according to the level of integration, type of network governance, and level of customization. There is no one predominant solution as the modalities depend on the specific context. To support policy-makers and health and social care providers in designing and implementing a sustainable health and social care integration in their contexts, this study provides six possible macro factors that clarify the priorities for integration.</p><p><strong>Conclusions: </strong>This paper clarifies the modalities of integration and provides macro factors for enduring health and social care integration over time, providing avenues for future supporting policies.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105234"},"PeriodicalIF":3.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824920","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}
Health PolicyPub Date : 2024-11-30DOI: 10.1016/j.healthpol.2024.105217
Nikita Jacob, Rita Santos, Peter Sivey
{"title":"Erratum to “The long-run effect of COVID-19 on hospital emergency department attendances:evidence from statistical analysis of hospital data from England” [Health Policy 150 (2024) 105168]","authors":"Nikita Jacob, Rita Santos, Peter Sivey","doi":"10.1016/j.healthpol.2024.105217","DOIUrl":"10.1016/j.healthpol.2024.105217","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105217"},"PeriodicalIF":3.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756814","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}