Health PolicyPub Date : 2024-11-08DOI: 10.1016/j.healthpol.2024.105198
Ivana Gusar , Dragan Šijan , Tomislav Sorić , Sonja Šare , Mediana Županović , Marija Ljubičić
{"title":"Predictors of Croatian nurses' turnover intention: A cross-sectional study","authors":"Ivana Gusar , Dragan Šijan , Tomislav Sorić , Sonja Šare , Mediana Županović , Marija Ljubičić","doi":"10.1016/j.healthpol.2024.105198","DOIUrl":"10.1016/j.healthpol.2024.105198","url":null,"abstract":"<div><div>The turnover intention rate among nurses is very high both worldwide, and in Europe. It is related to personal and professional factors that contribute to the decision to leave or stay. This descriptive cross-sectional study aimed to identify the personal and professional predictors that contribute to nurses’ turnover intention in Croatia. A convenient sample of 448 nurses employed in public general hospitals was used. The Practice Environment Scale of the Nursing Work Index questionnaire and the Turnover Intention Scale were applied. A logistic regression model was used to determine the associations between nurses' turnover intention and their personal and professional factors. The results indicate that both types of factors can influence nurses’ turnover intention. The associations between turnover intention and personal factors such as age (<em>p</em> = 0.033), gender (<em>p</em> = 0.023), job satisfaction (<em>p</em> < 0.001), and social satisfaction (<em>p</em> = 0.006), were recorded. Nurse participation in hospital affairs (<em>p</em> = 0.026), and the nurse manager ability, leadership, and support of nurses (<em>p</em> = 0.002), which are professional factors were also associated with turnover intention. In order to prevent turnover intention, continuous measures need to be planned and implemented to increase nurses' satisfaction and improve their working environment.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105198"},"PeriodicalIF":3.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640323","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 : 2024-11-08DOI: 10.1016/j.healthpol.2024.105200
Stephen Whiting , Karim Abu-Omar , Peter Gelius , João Firmino-Machado , Ivo Rakovac , Romeu Mendes
{"title":"Physical activity policy implementation and physical activity levels in the European Union: Are we on track to close the gap between policy and practice?","authors":"Stephen Whiting , Karim Abu-Omar , Peter Gelius , João Firmino-Machado , Ivo Rakovac , Romeu Mendes","doi":"10.1016/j.healthpol.2024.105200","DOIUrl":"10.1016/j.healthpol.2024.105200","url":null,"abstract":"<div><div>National policies are a key starting point to achieve changes in population health. This study aimed to provide an overview of the relationship between physical activity policy implementation and the levels of sufficient physical activity across the European Union over the last decade.</div><div>Data from the 23 indicators of the European Union Health-Enhancing Physical Activity Monitoring Framework established to monitor country implementation of the European Union Physical Activity Guidelines from 2015, 2018 and 2021, and physical activity prevalence data from the Special Eurobarometer on Sport and Physical Activity in 2013, 2017 and 2022 were analysed.</div><div>European Union Member States significantly increased their physical activity policy implementation from 2015 to 2021 by 13.2 % (63.30 ± 18.89 versus 76.51 ± 14.94 %, <em>p</em> < 0.001, 95 % CI [-19.97, -6.45]). However, no significant change in levels of sufficient physical activity was found between 2013 and 2022 (60.59 ± 15.67 versus 61.70 ± 17.67 %, <em>p</em> = 0.360, 95 % CI [-3.61, 1.39]). Additionally, most European Union countries are not on track to meet the targeted 10 % relative reduction in levels of insufficient physical activity by 2025.</div><div>Physical activity policies in the European Union do not appear to be related with the intended goal of increasing levels of physical activity. Policies may need to be reviewed and policy monitoring expanded, strengthened, and better integrated.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105200"},"PeriodicalIF":3.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649876","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 : 2024-11-08DOI: 10.1016/j.healthpol.2024.105199
Bernd Rechel , Béatrice Durvy , Gonçalo Figueiredo Augusto , Isabelle Aujoulat , Daiga Behmane , Anne-Carole Bensadon , Sara Burke , Melissa D'Agostino , Krisztina Davidovics , Mark Dayan , Antonio Giulio De Belvis , Judith de Jong , Katarzyna Dubas-Jakóbczyk , Inês Fronteira , Elena Gabriel , Giuseppe Greco , Peter Groenewegen , Signe Smith Jervelund , Marios Kantaris , Madelon Kroneman , Tuija Ylitörmänen
{"title":"Primary prevention in hospitals in 20 high-income countries in Europe – A case of not “Making Every Contact Count”?","authors":"Bernd Rechel , Béatrice Durvy , Gonçalo Figueiredo Augusto , Isabelle Aujoulat , Daiga Behmane , Anne-Carole Bensadon , Sara Burke , Melissa D'Agostino , Krisztina Davidovics , Mark Dayan , Antonio Giulio De Belvis , Judith de Jong , Katarzyna Dubas-Jakóbczyk , Inês Fronteira , Elena Gabriel , Giuseppe Greco , Peter Groenewegen , Signe Smith Jervelund , Marios Kantaris , Madelon Kroneman , Tuija Ylitörmänen","doi":"10.1016/j.healthpol.2024.105199","DOIUrl":"10.1016/j.healthpol.2024.105199","url":null,"abstract":"<div><div>This article provides a snapshot of primary prevention activities in hospitals in 20 European high-income countries, based on inputs from experts of the Observatory's Health Systems and Policies Monitor (HSPM) network using a structured questionnaire. We found that in the vast majority of countries (15), there are no systematic national policies on primary prevention in hospitals. Five countries (Cyprus, Finland, Ireland, Romania and the United Kingdom) reported systematic primary prevention activities in hospitals, although in one of them (Cyprus) this was due to the fact that small hospitals in rural areas or less populated districts host providers of primary care. In two of the five countries with systematic national policies on primary prevention, there are no incentives (financial or otherwise) to provide these interventions. The remaining three countries (Finland, Romania and the United Kingdom) report the existence of incentives, but only two of them (Romania and the United Kingdom) provide financial incentives in the form of additional funding. Only two of the 20 countries (Ireland and the United Kingdom) make explicit use of the Making Every Contact Count (MECC) approach. Overall, it can be concluded that there is little focus on primary prevention in hospitals in Europe, which may be seen as a missed opportunity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105199"},"PeriodicalIF":3.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649878","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 : 2024-11-02DOI: 10.1016/j.healthpol.2024.105194
Phoebe Dunn, Lucinda Allen, Luisa Buzelli, Leo Ewbank, Hugh Alderwick
{"title":"NHS action on social and economic development in England: Vague national policy expectations","authors":"Phoebe Dunn, Lucinda Allen, Luisa Buzelli, Leo Ewbank, Hugh Alderwick","doi":"10.1016/j.healthpol.2024.105194","DOIUrl":"10.1016/j.healthpol.2024.105194","url":null,"abstract":"<div><div>Under recent reforms to the National Health Service (NHS) in England, NHS organizations have been given new objectives to contribute to social and economic development. Health systems in other high-income countries are pursuing related approaches. This paper analyses national policy documents to understand the framing of the NHS's new policy priorities on social and economic development. We focus on the role of NHS integrated care systems—area-based planning bodies responsible for managing NHS resources and coordinating local services. National policy is vague about what social and economic development means in practice. There is limited guidance on which approaches local organizations should prioritize, and which organisations are responsible for implementation. Greater clarity from national policymakers and an overarching framework to guide local action is needed to reduce the risk of inaction, poorly targeted interventions, and missed opportunities for learning and evaluation. Policymakers and health system leaders also need to be realistic about the limits of local action given the importance of national public policy choices in shaping the social determinants of health. Coordinated policy action and investment across government is needed to address underlying social and economic conditions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105194"},"PeriodicalIF":3.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632337","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 : 2024-11-01DOI: 10.1016/j.healthpol.2024.105192
Francesca Meda, Michela Bobini, Michela Meregaglia, Giovanni Fattore
{"title":"Scaling up integrated care: Can community hospitals be an answer? A multiple-case study from the Emilia-Romagna region in Italy.","authors":"Francesca Meda, Michela Bobini, Michela Meregaglia, Giovanni Fattore","doi":"10.1016/j.healthpol.2024.105192","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105192","url":null,"abstract":"<p><p>Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105192"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592333","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 : 2024-11-01DOI: 10.1016/j.healthpol.2024.105197
Eyal Katvan , Orly Korin , Israel Issi Doron , Eytan Mor , Boaz Shnoor , Daniel Gelman , Tamar Ashkenazi
{"title":"Abolishing age criterion to determine organ transplant recipients in Israel: A qualitative study of medical staff perceptions","authors":"Eyal Katvan , Orly Korin , Israel Issi Doron , Eytan Mor , Boaz Shnoor , Daniel Gelman , Tamar Ashkenazi","doi":"10.1016/j.healthpol.2024.105197","DOIUrl":"10.1016/j.healthpol.2024.105197","url":null,"abstract":"<div><h3>Introduction</h3><div>Since April 2014 the age limitation on candidates listed for organ transplantation in Israel was abolished following the recommendations of a Public Committee. In this research the new policy was examined in light of scarce medical resources and the increased rate of aging in Israel.</div></div><div><h3>Methods</h3><div>The opinions of twelve medical staff regarding the policy change were analyzed by a qualitative methodology, using semi-structured interviews.</div></div><div><h3>Results</h3><div>Interviews with medical staff members revealed three main themes: 1. positive acceptance of the new policy; 2. concerns and problems regarding the change; and 3. the influence of the policy change on the organ transplant allocation system and patient-doctor relationships.</div></div><div><h3>Discussion and Conclusions</h3><div>The medical staff expressed positive views towards the new policy, based on age-free, individually determined admission to transplant waiting lists. However, some concerns were raised regarding the medical implications of this policy, thus potentially hindering its full application.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105197"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607506","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 : 2024-10-31DOI: 10.1016/j.healthpol.2024.105195
Pushkar Silwal , Tim Tenbensel , Daniel Exeter , Arier Lee
{"title":"Using outcome measures in sub-national level performance management: When and under what circumstances?","authors":"Pushkar Silwal , Tim Tenbensel , Daniel Exeter , Arier Lee","doi":"10.1016/j.healthpol.2024.105195","DOIUrl":"10.1016/j.healthpol.2024.105195","url":null,"abstract":"<div><div>There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105195"},"PeriodicalIF":3.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632293","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":"Implementation of socio-economic variables in risk adjustment systems: A quantitative analysis using the example of Germany","authors":"Gerald Lux , Theresa Hüer , Florian Buchner , Jürgen Wasem","doi":"10.1016/j.healthpol.2024.105196","DOIUrl":"10.1016/j.healthpol.2024.105196","url":null,"abstract":"<div><div>At least in Western Europe, competitive social health insurance systems have implemented systems of morbidity-based risk adjustment to establish a level playing field for insurers. However, insured persons with specific socio-economic characteristics are still underfunded, leaving incentives for risk selection. In Germany, there is an ongoing debate about (re)implementing socio-economic variables to reduce this undercompensation. This study analyses whether the following four socio-economic groups are systematically under- or over‐compensated under the present risk equalization system in Germany: insured persons with co‐payment exemption (1), recipients of basic income support for unemployment (2), of benefits of social long-term care-insurance (3) and insured persons with reduced earning capacity (4). On this basis, several attempts of incorporating these variables into the German risk adjustment system, allowing a better fit for the socio-economically disadvantaged groups, are examined. With a data set of about 9.2 million insured persons, the performance of the modifications is demonstrated for the German system. The disparate outcomes of the various models in different dimensions necessitate the consideration of trade-offs and their incorporation into the implementation of a model designed to mitigate the undercompensation of the affected insured groups.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105196"},"PeriodicalIF":3.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632092","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 : 2024-10-29DOI: 10.1016/j.healthpol.2024.105191
Stefano Gandolfi , Nicola Bellè , Sabina Nuti
{"title":"Please mind the gap between guidelines & behavior change: A systematic review and a consideration on effectiveness in healthcare","authors":"Stefano Gandolfi , Nicola Bellè , Sabina Nuti","doi":"10.1016/j.healthpol.2024.105191","DOIUrl":"10.1016/j.healthpol.2024.105191","url":null,"abstract":"<div><h3>Background & Objective</h3><div>This systematic review evaluates the impact of guidelines on healthcare professionals’ behavior and explores the resulting outcomes.</div></div><div><h3>Methods</h3><div>Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis.</div></div><div><h3>Results</h3><div>The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %).</div></div><div><h3>Conclusions</h3><div>The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105191"},"PeriodicalIF":3.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693781","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 : 2024-10-28DOI: 10.1016/j.healthpol.2024.105190
Loup Beduchaud , Enoa Celingant , Clara Faure , Mathilda Meunier , Iñaki Blanco-Cazeaux
{"title":"Do international medical graduates’ recruitment policies help to overcome healthcare shortage areas in developed countries? A systematic review","authors":"Loup Beduchaud , Enoa Celingant , Clara Faure , Mathilda Meunier , Iñaki Blanco-Cazeaux","doi":"10.1016/j.healthpol.2024.105190","DOIUrl":"10.1016/j.healthpol.2024.105190","url":null,"abstract":"<div><div>This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians’ retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105190"},"PeriodicalIF":3.6,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513277","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}