Frontiers in health services最新文献

{"title":"Acceptability, feasibility, and program outcomes of an equity-focused, adapted community-based healthy lifestyle program for children, young people, and their families in Perth, Western Australia: an implementation hybrid research protocol.","authors":"Stephanie Smith, Stephen Paull, Katie M Iwanowski, Tania Harris, Joanna C Moullin, Monica Jane, Jordan Bill, Deborah A Kerr, Christina M Pollard, Glenn Pearson, Melanie Robinson, Bonnie Furzer, Natasha Bear, Ben Jackson, Robyn Mildon, Nick Sevdalis, Richard Norman, Jacqueline A Curran, Cameron C Grant, Sarah C Armstrong, Yvonne C Anderson","doi":"10.3389/frhs.2025.1604809","DOIUrl":"10.3389/frhs.2025.1604809","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend multidisciplinary intervention programs for addressing childhood obesity. In Western Australia, community-based healthy lifestyle programs for children and young people are insufficient for demand, especially for those over-represented in obesity statistics relating to prevalence. This protocol outlines the implementation and evaluation of an adapted, evidenced, community-based program in Perth, Western Australia.</p><p><strong>Methods: </strong>This study follows a multiple-methods hybrid type II design, testing acceptability and feasibility of program scale-out and program participant outcomes. <i>Study</i> (<i>1</i>) <i>Develop the adapted healthy lifestyle program with key partners and Aboriginal and Torres Strait Islander advisors for scale-out.</i> Apply implementation strategies for program realisation. Identify critical elements and outcomes to demonstrate program success with key partners (∼30 workshop participants and ∼80 qualitative proforma respondents). Identify cultural and place-based considerations for program acceptability with Aboriginal and Torres Strait Islander Elders/advisors (∼30 workshop participants). <i>Study</i> (2) <i>Assess acceptability, appropriateness, feasibility, and local clinical outcomes of adapted healthy lifestyle program pilot.</i> Evaluate the program with children and young people aged 4-16 years with obesity or overweight and weight-related comorbidities, seeking healthy lifestyle change. The program will include weight-related assessments at baseline, 6, and 12 months with weekly sessions for 6 months (estimated <i>n</i> = 245 over 22 months, accounting for 30% drop-out). Explore program experience via focus groups with children, young people, and caregivers: ∼8-12 weeks post commencement (∼50 program participants and caregivers), ∼6 months post commencement (∼50 program completers and caregivers), and evaluation survey (e.g., declined/dropped out/completed). Engage with key partners to determine program feasibility for scale-up (∼30 workshop participants and ∼80 qualitative proforma respondents). Mixed model regression will be used to assess within-subject change in outcomes over time. Child health utility instruments will be used for cost-utility analysis. <i>Study</i> (3) <i>Assess program scalability post-pilot.</i> If determined feasible and acceptable, the program will be packaged to assist practitioners and policymakers with scale-up via exploration of currently available packages and key staff interviews. The overarching Replicating Effective Programs framework outlines the implementation stages, and the tools and strategies being applied are presented. Qualitative data will be analysed using Framework Analysis, incorporating the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change.</p><p><strong>Discussion: </strong>Implementation outcomes will be determined by evaluating acce","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1604809"},"PeriodicalIF":2.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762557","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":"Person-centred care for migrants: a narrative review of healthcare literature.","authors":"Cathy Son, Emma Forsgren, Joakim Öhlén, Richard Sawatzky","doi":"10.3389/frhs.2025.1573813","DOIUrl":"10.3389/frhs.2025.1573813","url":null,"abstract":"<p><p>According to the World Migration Report, the number of international migrants has steadily increased in the past 50 years. This has led to an increasing need for healthcare to incorporate a variety of perspectives for migrants. However, healthcare systems still show gaps in accommodating diverse cultural perspectives. Given the increasing attention to person-centred care, there is both an opportunity and a need to explicate how person-centred care (PCC) can help to improve healthcare for migrants. Therefore, we conducted a narrative literature review on cultural dimensions of PCC practice for migrants. A scoping review by Forsgren et al. (2025) identified 1,351 articles from a search of PubMed, Scopus, PsycINFO, CINAHL, and Web of Science databases. From these, nine studies that met the following inclusion criteria were selected: (1) about cultural dimensions of health care for migrants (immigrants and refugees), (2) in any health care settings, (3) written in English, and (4) published within the last 10 years (January 1, 2023-December 31, 2023). The studies included participants from diverse ethnicities, racial backgrounds, and countries of origin. Seven studies were undertaken in primary care, long-term care, or outpatient clinics; one study was on health education; and one additional study focused on the acute care environment. The review led to three main practices: (a) enhancing migrants' ability to participate in their healthcare, (b) building intercultural partnerships, and (c) promoting cultural education of healthcare providers. These practices underscore the significance of respecting diverse cultural beliefs about shared decision-making and understanding how PCC practice is perceived in different cultural contexts. The results also indicate a need for educational programs that equip healthcare providers with intercultural communication skills and knowledge to provide culturally sensitive PCC. Overall, this study highlights the importance of integrating PCC with interculturalism as a way to foster a more nuanced and responsive understanding of the cultural dimension of care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1573813"},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12307281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755266","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":"Locally-tailored vs. centrally-administered strategies for implementation of primary human papillomavirus (HPV) screening in an integrated healthcare system: a qualitative research study.","authors":"Erin E Hahn, Corrine Munoz-Plaza, Chunyi Hsu, Nancy T Cannizzaro, Quyen Ngo-Metzger, Michael K Gould, Brian S Mittman, Melissa Hodeib, Devansu Tewari, Chun R Chao","doi":"10.3389/frhs.2025.1595934","DOIUrl":"10.3389/frhs.2025.1595934","url":null,"abstract":"<p><strong>Introduction: </strong>Primary human papillomavirus <i>(</i>HPV<i>)</i> testing is recommended for cervical cancer screening for women aged 30-65 years without a history of abnormal results. However, there is little clear guidance regarding effective strategies for implementing primary HPV screening. As part of an ongoing randomized trial comparing implementation strategies for primary HPV testing (a centrally administered + usual care strategy vs. centrally administered + locally tailored strategy), we evaluated clinician experiences and perceptions of large-scale implementation of primary HPV screening in an integrated healthcare system, Kaiser Permanente Southern California.</p><p><strong>Materials and methods: </strong>We conducted qualitative interviews with internal medicine, family medicine and obstetrics/gynecology clinicians to gain insight into fidelity to the interventions and implementation strategies, barriers and facilitators to implementation, and recommendations. Participants from both arms of the trial were recruited. Interview guides were developed with the Consolidated Framework for Implementation Research (CFIR). We recruited physicians, licensed vocational nurses, and medical assistants after primary HPV screening had been implemented. Interviews were recorded and transcribed. Using a team coding approach, we developed an initial coding structure refined during iterative analysis; data were subsequently organized thematically into domains, key themes, and sub-themes using thematic analysis, followed by framework analysis informed by CFIR.</p><p><strong>Results: </strong>Thirty-two interviews were conducted. Participants in both arms of the trial noted high awareness, preparedness, buy-in, and fidelity to the new screening process. Initial barriers concerned specimen collection, proper ordering, and lab delays. An unanticipated barrier was the length of time needed to return lab results for reflexive cytology tests after a positive HPV result which reportedly increased patient anxiety. Participants in both arms reported fidelity to the centralized strategy (e.g., attending webinars, leadership announcements). In the local-tailored arm, few participants recalled the local-tailored resources.</p><p><strong>Discussion: </strong>The centralized strategy was perceived as highly acceptable and feasible, and fidelity to the associated interventions appear to be facilitators of practice change. Recommendations for improving implementation included patient education, outreach and ongoing clinician training. Findings can be applied to other health systems and settings considering primary HPV screening implementation, particularly those within the U.S. or with a similar health care model.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, identifier #NCT04371887.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1595934"},"PeriodicalIF":2.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746354","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":"Systems thinking in public health policy development.","authors":"Alan Silburn","doi":"10.3389/frhs.2025.1555284","DOIUrl":"10.3389/frhs.2025.1555284","url":null,"abstract":"<p><p>A systems thinking approach is essential for public health policy development, offering a framework to navigate the dynamic complexities inherent in public health issues. This methodology enables policymakers to comprehend the interconnections within public health systems and anticipate the potential consequences of policy implementation. This paper explores the application of systems thinking and modelling methodologies in addressing key public health concerns, such as obesity, infectious diseases, and tobacco use. A review of the literature illustrates how systems thinking informs evidence-based policy creation, improves stakeholder coordination, and mitigates challenges. However, this approach is not without limitations, as unforeseen consequences, financial repercussions, and potential stakeholder biases pose risks. The paper concludes by highlighting the importance of comprehensive, adaptive evaluation mechanisms for ongoing policy refinement, ensuring policies remain effective and relevant in dynamic social, environmental, and political contexts.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1555284"},"PeriodicalIF":2.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735873","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 interplay of leadership dynamics and person-centred practice in nursing homes: a mixed methods systematic review.","authors":"Camilla Anker-Hansen, Liv Berit Olsen, Vigdis Abrahamsen Grøndahl, Ann-Chatrin Linqvist Leonardsen, Ann Karin Helgesen, Carina Bååth, Liv Halvorsrud, Gea Restad, Brendan McCormack, Ingrid Femdal","doi":"10.3389/frhs.2025.1535414","DOIUrl":"10.3389/frhs.2025.1535414","url":null,"abstract":"<p><strong>Background: </strong>Implementing a person-centered approach in nursing homes can significantly improve patient satisfaction and care quality while also enhancing job satisfaction among healthcare staff. Leaders play a pivotal role in establishing and nurturing a culture that supports person-centered practices. While there is some empirical evidence, a more comprehensive understanding of how leaders effectively foster and sustain person-centered practices in nursing homes is needed.</p><p><strong>Aim: </strong>To investigate the role of leaders in fostering person-centeredness within nursing homes.</p><p><strong>Methods: </strong>The study is based on the PRISMA reporting guidelines. Comprehensive searches were performed in CINAHL and PubMed, with article screening and selection facilitated by Rayyan software. A convergent integrated approach from the Joanna Briggs Institute (JBI) was used to synthesize findings from both qualitative and quantitative studies.</p><p><strong>Results: </strong>The review included ten studies, comprising six qualitative and four quantitative studies. The results indicate that leadership in nursing homes that fosters person-centeredness involves creating and communicating a shared vision, empowering staff, and ensuring systematic and consistent approaches. Additionally, leaders must embody person-centered values through role modeling.</p><p><strong>Conclusions: </strong>This systematic review highlights the critical role of leadership in fostering and sustaining person-centered practices in nursing homes. Leaders carry a substantial burden of responsibility. The results suggest that a shift towards a more integrated leadership approach, incorporating both distributed and person-centered leadership models, could promote a more sustainable and supportive environment for both leaders and staff, ultimately enhancing the quality of care. These insights provide valuable guidance for nursing home leaders and policymakers aiming to strengthen person-centered practice.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1535414"},"PeriodicalIF":2.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735874","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":"\"<i>Dentists are never seen</i>\": perspectives on multiple job holding among dentists in Nairobi, Kenya.","authors":"Cyril Ogada, Laetitia C Rispel","doi":"10.3389/frhs.2025.1595302","DOIUrl":"10.3389/frhs.2025.1595302","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple job holding (MJH), the phenomenon of working in more than one paid job simultaneously, affects the achievement of universal health coverage. The dearth of research on MJH among dentists, especially in Africa, forms the backdrop to this study. This study aimed to explore the perspectives of key policy actors on MJH among dentists in Nairobi, Kenya.</p><p><strong>Methods: </strong>This qualitative study combined semi-structured interviews with key informants and in-depth interviews with dentists who are engaged in MJH. The key informants were selected purposively from the Kenyan government, the regulator, representative organizations of dentists, and oral health researchers and/or experts in human resources for health. The dentists were selected from the government, the private sector, and faith-based organizations, using snowball sampling. The interviews focused on knowledge and/or experiences of MJH, reasons for, and the consequences of MJH. The interviews were analyzed using thematic analysis.</p><p><strong>Results: </strong>Thirty interviews were conducted, comprising 20 key informants, and 10 dentists. MJH among dentists is seen as a normative practice, facilitated by a profession characterized by high rewards and few or no adverse consequences from absenteeism. Although additional income is the primary motivation for MJH, low job satisfaction, the lack of continuing professional development, perverse incentives, and a dysfunctional and resource-constrained public health sector exacerbate MJH. The lack of regulation compounds the practice, while a strong private health sector provides opportunities for multiple sources of income, affecting the provision of oral health services negatively in the public sector.</p><p><strong>Conclusion: </strong>MJH among dentists in Nairobi, Kenya is common because of high rewards and few or no adverse consequences from absenteeism. The high reported occurrence of MJH requires a multi-pronged approach that combines individual, system, and structural interventions. Such an approach should also consider the drivers of MJH, and ensure collaboration among policymakers, dentists, and health service managers to develop strategies to mitigate the potential negative consequences of MJH for patients, the health workforce, and oral healthcare delivery in Nairobi.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1595302"},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710036","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":"Work motivation and associated factors among nurses working in public hospitals of the Wolaita Zone, Southern Ethiopia.","authors":"Bereket Dejene Senbetu, Wadu Wolancho Debancho, Tsiyon Mekoya Jemaneh, Serkalem Aschalew Jima, Temesgen Geta Hardido, Tamirat Beyene Gerete","doi":"10.3389/frhs.2025.1561643","DOIUrl":"10.3389/frhs.2025.1561643","url":null,"abstract":"<p><strong>Background: </strong>Nurses' work motivation encompasses their readiness to perform effectively and achieve designated tasks and objectives. Providing high-quality nursing care becomes significantly more challenging in the absence of motivated nurses and a supportive healthcare environment. Nevertheless, there is a paucity of empirical research examining the work motivation of nurses. Hence, this study aimed to assess the level of work motivation and its associated factors among nurses working in public hospitals in the Wolaita Zone.</p><p><strong>Methods: </strong>An institutional-based cross-sectional study involving 419 nurses and 12 key informants was conducted using a mixed-methods method. Quantitative data were collected using a simple random sampling technique, while qualitative data were collected using purposive sampling. Data were collected using pretested self-administered questionnaires and in-depth interviews. Statistical Package for Social Science version 26 was used for statistical analysis. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with work motivation. Statistical significance was determined using AORs with 95% CIs and <i>p</i>-values of less than 0.05.</p><p><strong>Results: </strong>A total of 394 participants were included, yielding a response rate of 94%. About 202 nurses (51.3%; 95%CI: 46.4-56.9) reported being motivated. Several factors were negatively associated with nurses' work motivation: type of institution (AOR = 0.406; 95% CI: 0.236-0.699; <i>p</i> = 0.001), workload (AOR = 0.495; 95% CI: 00.297-0.827; <i>p</i> = 0.007), negative perceptions of respect and benefits for nurses in organizations (AOR = 0.351; 95% CI: 0.180-0.682; <i>p</i> = 0.002), negative perceptions of leadership in hospitals [(AOR = 0.487; 95% CI: 0.240,0.985; <i>p</i> = 0.045). In contrast, nurses with 1-5 years of work experience were likely to be motivated (AOR = 3.29; 95% CI: 1.101-9.846; <i>p</i> = 0.003). The analysis revealed themes related to structural-administrative factors, socio-economic factors, and individual nurse-related factors.</p><p><strong>Conclusion: </strong>The results reveal that approximately 50% of the nursing participants expressed low levels of work motivation. Significant factors influencing nurses' motivation included the type of institution, years of work experience, workload, perceptions of respect and benefits, and quality of leadership in hospitals.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1561643"},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710037","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: Health services and the 4th industrial revolution.","authors":"Joris Van De Klundert, Michal Mankowski, Harwin De Vries","doi":"10.3389/frhs.2025.1646779","DOIUrl":"10.3389/frhs.2025.1646779","url":null,"abstract":"","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1646779"},"PeriodicalIF":1.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700530","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 future of patient safety in Ghana: challenges and opportunities.","authors":"Augustine Kumah","doi":"10.3389/frhs.2025.1581468","DOIUrl":"10.3389/frhs.2025.1581468","url":null,"abstract":"<p><p>Patient safety is a critical aspect of healthcare that ensures the reduction of preventable harm to patients during the provision of care. Patient safety has recently gained increasing attention in Ghana, but significant challenges remain. These include inadequate healthcare infrastructure, workforce shortages, medication errors, hospital-acquired infections, and poor reporting and monitoring systems. Moreover, limited public awareness and weak regulatory enforcement exacerbate patient safety risks. However, Ghana also has several opportunities to improve patient safety. Adopting digital health solutions, investing in healthcare worker training, strengthening regulatory frameworks, and community engagement present promising pathways for progress. The government's commitment to Universal Health Coverage (UHC) and recent healthcare policy reforms provide an enabling environment to enhance patient safety initiatives. This article explores the future of patient safety in Ghana by examining key challenges and potential opportunities. It provides an in-depth analysis of patient safety, discusses barriers to improvement, and highlights strategies to enhance safety outcomes. The article also examines global best practices that can be adapted to the Ghanaian healthcare system. Improving patient safety in Ghana requires a multi-stakeholder approach, integrating policy reform, technology, workforce development, and public awareness campaigns. By leveraging existing opportunities and addressing challenges, Ghana can move toward a safer, more effective healthcare system that protects patients from preventable harm.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1581468"},"PeriodicalIF":1.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692643","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":"Comparison of Medicaid financing for birth centers: a nine-state policy analysis.","authors":"Rebecca H Ofrane, Leslie Kantor, Julie Blumenfeld, Slawa Rokicki","doi":"10.3389/frhs.2025.1569462","DOIUrl":"10.3389/frhs.2025.1569462","url":null,"abstract":"<p><strong>Background: </strong>The United States continues to face poor maternal health outcomes, and freestanding birth centers are a safe alternative to hospitals, offering midwifery care for low-risk birthing people. Not all birth centers accept Medicaid patients, however, and among those that do, low Medicaid facility reimbursement rates are a barrier to birth center operations and sustainability. This limits access especially for low-risk birthing people of color who may perceive traditional hospital care to be unsafe or culturally unsupportive.</p><p><strong>Methods: </strong>This cross-sectional policy analysis explored variation in U.S. Medicaid reimbursement rates for birth center facility fees. State similarity methods were used to match comparable states to New Jersey due to the state's evolving policy environment, resulting in a nine-state sample for the policy analysis.</p><p><strong>Results: </strong>Of this sample, six had published Medicaid rates for the birth center facility fee, with wide variation among the states, New Jersey's being the lowest and Massachusetts the highest, at four-and-a-half times New Jersey's rate. Significant variation in reimbursement rates was also identified when transfer to a hospital occurs.</p><p><strong>Conclusions: </strong>The findings suggest the importance of Medicaid reimbursement rates for birth centers as a policy pathway to improving access to this under-utilized care setting.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1569462"},"PeriodicalIF":1.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692642","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}