Frontiers in health services最新文献

{"title":"Financing the transition: a roadmap for sustaining disease control in low- and middle-income countries after the 2025 contraction in development assistance for health.","authors":"Shyamkumar Sriram","doi":"10.3389/frhs.2026.1902705","DOIUrl":"10.3389/frhs.2026.1902705","url":null,"abstract":"<p><p>In 2025, development assistance for health fell by about 21% in a single year, driven largely by a 67% reduction in United States financing, disrupting HIV, tuberculosis, malaria, immunization and maternal health programs across low- and middle-income countries. Modelling indicates millions of avoidable deaths by 2030 if the resulting gap is not filled, yet most recipient governments have not reprioritized budgets or raised domestic revenue in response. This brief argues that the contraction is structural rather than cyclical and sets out a sequenced transition-financing roadmap. It proposes phased, country-led actions: protect frontline services immediately; mobilize domestic revenue through progressive as well as consumption taxes and restructure debt over the medium term; and embed efficiency and pooled procurement under the Lusaka Agenda, without allowing efficiency to substitute for adequate public financing.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1902705"},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From data collection to action: environmental health information management practices in eleven municipalities in the east coast of South Africa.","authors":"Siphesihle Siyamukela Masimula, Mpinane Flory Senekane, Nisha Naicker","doi":"10.3389/frhs.2026.1890673","DOIUrl":"10.3389/frhs.2026.1890673","url":null,"abstract":"<p><strong>Background: </strong>The availability of reliable information in the delivery of environmental health services (EHS) is crucial to identifying environmental health threats in communities and deploying targeted interventions. This requires environmental health information management practices and systems to be evaluated from time-to-time to bring efficiency and enable continuous improvement for improved public health outcomes. As a result, this study assesses environmental health information management in municipalities that provide EHS in the east coast of South Africa.</p><p><strong>Methods: </strong>A descriptive quantitative cross-sectional study design was employed, combining an online survey of 105 environmental health practitioners (EHPs) and document reviews across 11 municipalities. Descriptive and inferential statistical analyses were conducted through IBM SPSS Statistics.</p><p><strong>Results: </strong>Findings highlight over-reliance on paper-based data management processes, resulting to data duplication (88.6%) and increased workload (90.5%) for EHPs (<i>p</i> = 0.004). Inadequate training, lack of adequate digital tools (17.1%), inconsistent support (61.9%) and poor feedback (46.6%) impeded effective information utilisation for public health action. The study further underscored the need for improved quality assurance, feedback mechanisms and technical support. Governance, organisational capacity, limited digital infrastructure, and insufficient training emerged as key barriers.</p><p><strong>Conclusion: </strong>Substantial environmental health information management strengthening through digitalisation, improved governance, capacity-building, and stronger quality assurance systems are required. A comprehensive and integrated digital EHIS is needed to improve data quality, information utilisation, and evidence-based environmental health decision-making in South Africa.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1890673"},"PeriodicalIF":2.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal bleeding care across hospital and EMS settings in the Almaty region: a cross-sectional survey of organization, practice, and service capacity.","authors":"Sungat Otegen, Mohammad Khoshraftar, Lyudmila S Yermukhanova, Abylai Baimakhanov/Baimahanov, Aruzhan Otegenova Muratkyzy, Altynay Abdu Muratqyzy, Murat Jakanov, Aizat Seidakhmetova, Alireza Afshar","doi":"10.3389/frhs.2026.1918526","DOIUrl":"10.3389/frhs.2026.1918526","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal bleeding (GIB), particularly upper gastrointestinal bleeding (UGIB), requires rapid coordination between emergency medical services (EMS) and hospital teams, yet evidence on how service organization affects timeliness and practice is limited in Kazakhstan.</p><p><strong>Aim: </strong>To evaluate the organization of GIB care in Almaty region, with emphasis on clinician knowledge and practice, EMS performance, and organizational features of hospital care.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey between March and October 2024 involving two broad respondent groups and three distinct samples: a hospital-based group comprising 99 inpatient clinicians and 99 hospital representatives, and an EMS group comprising 120 personnel. The three samples completed different questionnaires and were analyzed separately. Descriptive analyses, chi-square or Fisher's exact tests, and exploratory Spearman correlations were used.</p><p><strong>Results: </strong>Inpatient clinicians showed near-universal agreement with guideline-based UGIB management principles, but self-reported adherence was inconsistent. Only 1.0% reported always using validated risk scores, and 99.0% reported only sometimes protecting the airway before endoscopy in patients with active hematemesis and altered mental status. In unadjusted respondent-level analyses, clinicians with ≥5 years of experience more frequently reported adequate training and perceived risk scores as useful (both <i>p</i> < 0.001). In the EMS group, all six respondents reporting arrival within 10 min were in the ≥16-team category (6/58, 10.3%; Fisher's exact <i>p</i> = 0.047). Reported ambulance-team availability showed a modest inverse correlation with continuous arrival time (<i>ρ</i>=-0.277, <i>p</i> = 0.002), while completion of selected examinations and vital-sign assessments differed across team-availability categories (all <i>p</i> < 0.001). All hospital representatives reported 24-hour endoscopist availability, but important elements of written protocol content were reported less consistently.</p><p><strong>Conclusions: </strong>UGIB care in the Almaty region showed consistently described structural endoscopy availability but incomplete protocol content, together with selected inpatient-practice and prehospital differences. The EMS findings were exploratory and require confirmation using operational and patient-level data.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1918526"},"PeriodicalIF":2.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Breaks that benefit: international evidence to support innovation in research, policy, and practice around unpaid carer short breaks.","authors":"Diane Seddon, Gillian Toms, Emma Miller, Elizabeth Hanson, Don Williamson, Kate Hogarth, Kim Whitmore","doi":"10.3389/frhs.2026.1932038","DOIUrl":"10.3389/frhs.2026.1932038","url":null,"abstract":"","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1932038"},"PeriodicalIF":2.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare utilization patterns and medication burden in post-COVID syndrome: a cross-sectional analysis reveals four phenotypes.","authors":"Jens Hamberger, Linda Kraus, Karin Meissner, Thilo Hinterberger, Thomas Loew, Oliver Schoeffski, Harald Gündel, Steffen Walter, Marc N Jarczok, Katja Weimer","doi":"10.3389/frhs.2026.1838358","DOIUrl":"10.3389/frhs.2026.1838358","url":null,"abstract":"<p><p>Post-COVID syndrome has emerged as a major public health challenge, yet comprehensive characterization of healthcare utilization patterns and medication burden within single cohorts remains limited. This cross-sectional analysis examined baseline data from 76 patients (49 ± 12 years, 62% female) enrolled in a randomized trial of psychosomatic treatment interventions for functional post-COVID syndrome. Participants completed the Health Care Utilization Questionnaire (HCU) assessing physician visits, hospitalizations, alternative healing methods, and other healthcare services over the preceding 12 months. Medication and other preparation (MOP) use was systematically documented and classified using the Anatomical Therapeutic Chemical (ATC) classification system. K-means clustering identified distinct patient phenotypes, and correlations between MOP count and healthcare utilization were examined using Spearman correlation coefficients. Healthcare utilization was universal, with 100% of participants engaging with healthcare services and a mean of 43.5 contacts per year. Medication burden was substantial, with 85.5% taking at least one medication, a mean of 4.57 medications per patient, and polypharmacy (≥5 MOP, all types) present in 39.5% of the cohort (46.1% of patients with any MOP). K-means clustering identified four distinct patient phenotypes: Low Utilizers (64.5%, <i>n</i> = 49), Moderate-High Utilizers (27.6%, <i>n</i> = 21), High-Intensity Users (6.6%), and one outlier. High-Intensity Users demonstrated the most striking profile with 9.60 mean medications, 75.0 total healthcare contacts annually, and mean out-of-pocket costs of €2,881. MOP count showed significant positive correlations with total doctor visits (<i>ρ</i> = 0.471, <i>p</i> < 0.001), total healthcare contacts (<i>ρ</i> = 0.344, <i>p</i> = 0.002), and out-of-pocket costs (<i>ρ</i> = 0.375, <i>p</i> = 0.001). Post-COVID syndrome patients demonstrate high healthcare engagement, substantial medication burden, and meaningful heterogeneity in utilization patterns. The identification of distinct patient clusters and strong correlations between medication burden and healthcare utilization provide insights for developing targeted clinical management strategies. This study is based on a selected clinical cohort, and findings should be interpreted with caution regarding generalizability to the broader post-COVID population. These findings may inform clinical management strategies and health system planning for post-COVID patients.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1838358"},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and healthcare systems-level interventions for postpartum hemorrhage prevention and management in Nigeria: a systematic review of effectiveness and implementation outcomes.","authors":"Melody Ucho, Princess Okelu, Sarim Faheem, Iretioluwa Adeola, Adwoa Ansong, Dorice Vieira, Nessa Ryan, Joyce Gyamfi, Emmanuel Peprah","doi":"10.3389/frhs.2026.1886853","DOIUrl":"10.3389/frhs.2026.1886853","url":null,"abstract":"<p><strong>Background: </strong>Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally and in Nigeria. Although clinical interventions may address PPH, less is known about their implementation within routine health systems. The objective of this systematic review was to synthesize the implementation research outcomes of interventions for PPH prevention and management in Nigeria for healthcare providers and patients.</p><p><strong>Methods: </strong>This systematic review of interventions for PPH in Nigeria searched seven electronic databases (i.e., Embase, Web of Science, MEDLINE, Global Health, Cochrane Library, PubMed, and PAIS) without date restrictions. Peer-reviewed studies reporting implementation and service outcomes, including adoption, sustainability, fidelity, and effectiveness, were included. Data were extracted on intervention type, setting, implementation, service and client outcomes. Risk of bias was assessed and visualized (via ROBVIS tool).</p><p><strong>Results: </strong>Of the 1,255 articles retrieved, 31 met the inclusion criteria, including 20 randomized controlled trials, eight observational, two mixed-methods, and one qualitative study. Most were conducted in tertiary facilities; none exclusively focused on primary-level care. Clinical interventions were mostly reported (<i>n</i> = 25). Evidence suggested comparable effectiveness between misoprostol and oxytocin for low-risk women. Device-based interventions, including the non-pneumatic anti-shock garment, were associated with improved stabilization and reduced mortality. Healthcare Systems-level interventions that include standardized care protocols in clinical management of PPH, particularly multicomponent bundled interventions such as the E-MOTIVE bundle and AMTSL, demonstrated high adoption and were associated with reductions in severe PPH. Implementation outcomes were infrequently reported (5 of 31 articles). Overall risk of bias was low-to-moderate.</p><p><strong>Conclusions: </strong>There was a notable gap in the evaluation and reporting of IS outcomes as well as the assessment of the patient's perspective from the receipt of interventions. Translation of effective PPH interventions may be constrained by limited implementation evaluation in Nigeria, particularly in primary-level care settings. Substantial lack of evidence exists in regions that bear a disproportionately high burden of PPH mortality.</p><p><strong>Systematic review registration: </strong>Open Science Framework (DOI 10.17605/OSF.IO/CYS2M).</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1886853"},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers encountered and implementation strategies deployed to facilitate real-world remote symptom monitoring in patients receiving active cancer treatment.","authors":"Gabrielle B Rocque, Nicole L Henderson, D'Ambra N Dent, Tanvi V Padalkar, Emma Hendrix, Catherine S Smith, J Nicholas Odom, Tara Kaufmann, Chao-Hui Sylvia Huang, Chelsea McGowan, Jennifer Young Pierce, Ethan M Basch, Justin D Smith, Angela M Stover","doi":"10.3389/frhs.2026.1875180","DOIUrl":"10.3389/frhs.2026.1875180","url":null,"abstract":"<p><strong>Background: </strong>Remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) impacts patient and health system outcomes, yet data is lacking on real-world barriers to RSM and implementation strategies employed to address barriers.</p><p><strong>Methods: </strong>Guided by the updated Consolidated Framework for Implementation Research 2.0 (CFIR), this two-site implementation evaluation of early RSM implementation and scale-up aimed to evaluate barriers, facilitators, and implementation strategies. Patients and clinical team members were interviewed. Transcripts were coded in NVivo using directed content analysis to categorize barriers and facilitators. The Longitudinal Implementation Strategy Tracking System (LISTS) method was used to track implementation strategies deployed. Incidences where a barrier was reported were linked to strategies employed, creating key barrier-strategy combinations. Kappa for agreement between coders (all >.80).</p><p><strong>Results: </strong>40 patients and 30 clinical team members (physicians, nurses, nurse practitioners, non-clinical navigators, administrators) completed interviews. Interviewees identified 47 barriers in the CFIR domains. Eight key barrier-strategy combinations were identified by both patients and clinic teams; 13 additional combinations were identified by both groups. Amongst these 21 barrier-strategy combinations, primary barriers addressed related to the innovation (19%), outer setting (10%), the inner setting (19%), individuals (10%), and implementation processes (43%). Unaddressed barriers persisted despite use of multiple implementation strategies.</p><p><strong>Conclusion: </strong>Implementing RSM is complex and requires combinations of implementation strategies to overcome barriers at multiple CFIR levels. Future work is needed to leverage learnings from rigorous implementation studies to facilitate the RSM adoption.</p><p><strong>Trial registration: </strong>NCT04809740, registered 3/18/2021.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1875180"},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The embedded documentation of implementation tracking (EDIT): a low-burden approach to supporting implementation documentation in health research.","authors":"Alexis Zollo, Rebecca F Hamm, Meghan B Lane-Fall, Laura Ellen Ashcraft","doi":"10.3389/frhs.2026.1855898","DOIUrl":"10.3389/frhs.2026.1855898","url":null,"abstract":"<p><strong>Introduction: </strong>Effectiveness studies often generate rich insights about implementation processes and context. However, formal implementation evaluation is often challenging to incorporate for many reasons, including limited staffing, competing study priorities, lack of implementation expertise, or the absence of dedicated funding. As a result, relevant implementation information is inconsistently documented or lost altogether. This paper describes the development and early application of the Embedded Documentation of Implementation Tracking (EDIT) tool, a pragmatic instrument designed to facilitate low-burden documentation of implementation information within innovation research.</p><p><strong>Methods: </strong>EDIT was created through an iterative, theory-informed process drawing on implementation science frameworks and investigator experience. The tool was refined through internal review and four pilot test cases use across multiple research contexts, including both NIH and VA-funded work, and multiple study types including, innovation effectiveness and implementation-effectiveness hybrid studies. Written feedback was solicited from participating teams regarding clarity, feasibility, and utility.</p><p><strong>Results: </strong>Feedback from four research teams representing four projects indicated that EDIT was understandable, practical to use during routine research activities, and helpful for capturing implementation observations without increasing workload. Users reported that the structured, yet adaptable format facilitated reflection on adaptations, determinants, contextual influences, and implementation strategies, particularly in early-stage or resource-constrained studies.</p><p><strong>Discussion: </strong>Embedding documentation within existing meetings and workflow was viewed as a major strength. EDIT provides a feasible strategy for strengthening implementation documentation capacity and producing organized insights that can better contextualize study outcomes.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1855898"},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a trauma-informed care initiative at FQHCs in Texas.","authors":"Rachel Barnes, Jihye Choi, Qiheng Yan, Aimee Rachel, Efrat K Gabay, Paula M Cuccaro","doi":"10.3389/frhs.2026.1881638","DOIUrl":"10.3389/frhs.2026.1881638","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma-informed care recognizes the high prevalence and impact of trauma across the healthcare continuum, and its implementation across healthcare settings has varied. We describe the development and implementation of a trauma-informed care initiative at community health centers across Texas.</p><p><strong>Methods: </strong>Using an inquiry-based learning approach, a train-the-trainer model disseminated trauma-informed principles across participating health centers. This approach was evaluated using formative, summative, and organizational assessments as well as qualitative interviews with trained staff.</p><p><strong>Results: </strong>34 health centers participated in the trauma-informed care initiative. We observed significant improvements in organizational assessment subdomains and an average score of 73.9% in summative assessments. Trained staff shared difficulties related to learner engagement, time, leadership buy-in, and self-efficacy to train others, however, successes included enhanced cross-departmental collaboration and incorporation of trauma-informed principles in everyday practice.</p><p><strong>Discussion: </strong>Trauma-informed care has the potential to transform healthcare delivery to ensure staff, patient, and organizational wellbeing. We describe a novel approach to implementing trauma-informed care at health centers that shows promise for organizational transformation. Future programs should consider pre-post knowledge assessments, leadership engagement, and sustainability methods such as certifications or continuing education.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1881638"},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated regulation and health spending growth: European evidence from the new SCORE index.","authors":"Emanuele Bracco","doi":"10.3389/frhs.2026.1888179","DOIUrl":"10.3389/frhs.2026.1888179","url":null,"abstract":"<p><strong>Introduction: </strong>Rising healthcare expenditure poses a major fiscal challenge for European governments, driven in part by preventable diseases associated with tobacco use, alcohol consumption, and sugar-sweetened beverages (SSBs). Although regulatory interventions are widely used to address these risk factors, most evaluations focus on overall policy stringency and implicitly assume homogeneity within product categories. This overlooks the potential importance of risk-proportional regulatory designs that differentiate products according to their relative health risks.</p><p><strong>Methods: </strong>This study investigates whether differences in the design of regulatory frameworks for tobacco, alcohol, and SSBs are associated with variations in healthcare spending growth across European countries. Specifically, it compares conventional measures of regulatory restrictiveness with a risk-proportional approach that calibrates regulatory burdens according to the relative risks of products within each category. The relationship between regulatory design, healthcare expenditure growth, and population health outcomes is examined using cross-country statistical analysis.</p><p><strong>Results: </strong>The analysis indicates that risk-proportional regulatory frameworks are more strongly associated with lower healthcare spending growth and improved population health outcomes than uniform measures of policy stringency. Regulatory systems that incentivize substitution toward lower-risk alternatives are associated with a more favourable overall risk profile of consumption.</p><p><strong>Discussion: </strong>These findings suggest that the design of health regulations, rather than their overall restrictiveness alone, may play an important role in promoting fiscal sustainability. By encouraging harm reduction within product categories, risk-proportional regulation may contribute to reducing the long-term burden of preventable diseases and the associated pressure on national healthcare budgets.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1888179"},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}