Pub Date : 2023-10-02DOI: 10.34172/ijhpm.2023.7385
Angeli Rawat, Agazi Ameha, Jonas Karlström, Lisanu Taddesse, Elias Legesse Negeri, Anne Detjen, Kristoffer Gandrup-Marino, Noah Mataruse, Karin Källander, Abraham Tariku
Background: In Ethiopia, childhood pneumonia is diagnosed in primary health care settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). Methods: Key informant interviews were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, and district management and key decision makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. Results: All participants recommended scaling up the ARIDA initiative nationally as part of integrated management of newborn and childhood illness in Primary Health Care. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement. Conclusion: Automatic respiratory rate counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.
{"title":"Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study","authors":"Angeli Rawat, Agazi Ameha, Jonas Karlström, Lisanu Taddesse, Elias Legesse Negeri, Anne Detjen, Kristoffer Gandrup-Marino, Noah Mataruse, Karin Källander, Abraham Tariku","doi":"10.34172/ijhpm.2023.7385","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7385","url":null,"abstract":"Background: In Ethiopia, childhood pneumonia is diagnosed in primary health care settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). Methods: Key informant interviews were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, and district management and key decision makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. Results: All participants recommended scaling up the ARIDA initiative nationally as part of integrated management of newborn and childhood illness in Primary Health Care. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement. Conclusion: Automatic respiratory rate counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135902585","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}
Pub Date : 2023-10-02DOI: 10.34172/ijhpm.2023.8296
Robert A.J. Borst, Rik Wehrens, Roland Bal
{"title":"The Knowledge Translation Pizza-Dilemma: A Response to Recent Commentaries","authors":"Robert A.J. Borst, Rik Wehrens, Roland Bal","doi":"10.34172/ijhpm.2023.8296","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8296","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135902586","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}
Pub Date : 2023-09-26DOI: 10.34172/ijhpm.2023.7377
Wen-Yi Chiu, Ta-Chuan Yeh, Chia-Chi Yang
Background: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. Methods: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. Results: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. Conclusions: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.
{"title":"Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital","authors":"Wen-Yi Chiu, Ta-Chuan Yeh, Chia-Chi Yang","doi":"10.34172/ijhpm.2023.7377","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7377","url":null,"abstract":"Background: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. Methods: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. Results: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. Conclusions: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135721222","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}
Pub Date : 2023-09-26DOI: 10.34172/ijhpm.2023.7994
Augustina Koduah, Leonard Baatiema, Irene A. Kretchy, Irene Akua Agyepong, Anthony Danso-Appiah, Anna Cronin de Chavez, Timothy Ensor, Tolib Mirzoev
Background: Implementing medicines pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce from low- and middleincome countries. This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to policy designers, implementers, the private sector and policy analysts. Methods: Data were collected through document reviews (n=18), in-depth interviews (n=30), focus groups (n=2) and consultative meetings (n=6) with purposefully identified policy actors. Data were analysed thematically, guided by the four components of the health policy triangle framework. Results: The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes, and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership. Conclusion: Varied contextual factors, active participation of stakeholders, nature, and complexity of policy content, and structures have all influenced the implementation of medicines pricing policies in Ghana.
{"title":"Implementation of Medicines Pricing Policies in Ghana: The Interplay of Policy Content, Actors’ Participation, and Context","authors":"Augustina Koduah, Leonard Baatiema, Irene A. Kretchy, Irene Akua Agyepong, Anthony Danso-Appiah, Anna Cronin de Chavez, Timothy Ensor, Tolib Mirzoev","doi":"10.34172/ijhpm.2023.7994","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7994","url":null,"abstract":"Background: Implementing medicines pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce from low- and middleincome countries. This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to policy designers, implementers, the private sector and policy analysts. Methods: Data were collected through document reviews (n=18), in-depth interviews (n=30), focus groups (n=2) and consultative meetings (n=6) with purposefully identified policy actors. Data were analysed thematically, guided by the four components of the health policy triangle framework. Results: The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes, and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership. Conclusion: Varied contextual factors, active participation of stakeholders, nature, and complexity of policy content, and structures have all influenced the implementation of medicines pricing policies in Ghana.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135721220","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}
Pub Date : 2023-09-25DOI: 10.34172/ijhpm.2023.7884
John C. Matulis III, Rozalina G. McCoy
A rigorous evaluation of the implementation of a diabetes quality measure implementation program across community healthcare clinics in Shanghai, China, where both quality measurement and primary care delivery are relatively recent but centrally supported, identified important concerns about the meaningfulness, feasibility, and accuracy of quality measures that are relevant to all quality measurement programs. These include the importance of stakeholder involvement in measure development and implementation, the need to select measures that accurately and reliably reflect care quality, the link between incentives for improved performance and data manipulation, the necessity for scientific credibility and practical feasibility of the measure, and the assurance that measure performance can be impacted by those being evaluated. In addition to elaborating on these aspects of quality measurement, we also discuss the need for quality measures that are balanced across established domains of quality, are not burdensome to participants, and are transparent, parsimonious, nimble, and oriented around continuous evaluation and improvement.
{"title":"Quality Measurement as a Path to High Quality Care; Comment on \"Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China\"","authors":"John C. Matulis III, Rozalina G. McCoy","doi":"10.34172/ijhpm.2023.7884","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7884","url":null,"abstract":"A rigorous evaluation of the implementation of a diabetes quality measure implementation program across community healthcare clinics in Shanghai, China, where both quality measurement and primary care delivery are relatively recent but centrally supported, identified important concerns about the meaningfulness, feasibility, and accuracy of quality measures that are relevant to all quality measurement programs. These include the importance of stakeholder involvement in measure development and implementation, the need to select measures that accurately and reliably reflect care quality, the link between incentives for improved performance and data manipulation, the necessity for scientific credibility and practical feasibility of the measure, and the assurance that measure performance can be impacted by those being evaluated. In addition to elaborating on these aspects of quality measurement, we also discuss the need for quality measures that are balanced across established domains of quality, are not burdensome to participants, and are transparent, parsimonious, nimble, and oriented around continuous evaluation and improvement.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135769611","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}
Pub Date : 2023-09-25DOI: 10.34172/ijhpm.2023.8021
Joachim Waterschoot, Sofie Morbée, Omer Van den Bergh, Vincent Yzerbyt, Eveline Raemdonck, Marie Brisbois, Mathias Schmitz, Olivier Klein, Olivier Luminet, Pascaline Van Oost, Maarten Vansteenkiste
Background: The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens’behavior, motivation and mental health. Methods: Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest. Results: Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures. Conclusion: Stringent measures are not per se demotivating or compromising of people’s well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.
{"title":"How the Stringency of the COVID-19 Restrictions Influences Motivation for Adherence and Well-Being: The Critical Role of Proportionality","authors":"Joachim Waterschoot, Sofie Morbée, Omer Van den Bergh, Vincent Yzerbyt, Eveline Raemdonck, Marie Brisbois, Mathias Schmitz, Olivier Klein, Olivier Luminet, Pascaline Van Oost, Maarten Vansteenkiste","doi":"10.34172/ijhpm.2023.8021","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8021","url":null,"abstract":"Background: The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens’behavior, motivation and mental health. Methods: Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest. Results: Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures. Conclusion: Stringent measures are not per se demotivating or compromising of people’s well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135867126","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}
Pub Date : 2023-09-20DOI: 10.34172/ijhpm.2023.7724
Boya Zhao, Jing Wu
Background: National Volume-Based Procurement (NVBP) program has been carried out in China to lower drug prices and reduce patients’ medication burden. This study aims to evaluate its impact on drug purchasing in Tianjin city, one of the first 11 cities piloting NVBP in China. Methods: Using monthly drug procurement data from Tianjin Medical Purchasing Center between 2018 and 2020, this study identified bid-winning drugs and their alternative drugs in the pilot NVBP, and evaluated the policy impacts on their procurement price (cost of defined daily dose, DDDc), volume (the number of defined daily dose, DDDs), and expenditure, during the first (initiated at April 1, 2019) and second (initiated at April 25, 2020) procurement cycles of pilot NVBP, applying interrupted time series (ITS) analysis. Included drugs were classified into 12 pharmacological subgroups for further analysis. Results: Decrease in DDDc of NVBP-covered drugs (bid-winning and non-winning drugs) were observed in the first (level change: -CNY 3.878/DDD, P<.001; trend change: -CNY 0.068/DDD, P=.001; relative change: -61.55%) and second (level change: -CNY 0.356/DDD, P=.049) procurement cycles of pilot NVBP, while no significant change was observed for the DDDc of alternative drugs, except for the increase in antidiarrheic and anti-inflammatory/antirheumatic subgroups as more expensive drugs were purchased from new suppliers in the second procurement cycle. The DDDs of bid-winning drugs significantly increased, while decreased for the non-winning original and generic drugs. Procurement expenditure was saved for NVBP-covered drugs (level change: -CNY 7.29×107, P<.001; trend change: -CNY 5.62×106, P<.001; relative change: -62.60%). However, during the second procurement cycle, procurement volume and expenditure of alternative drugs increased significantly in 7 out of 12 subgroups. Conclusion: The pilot NVBP policy in China reduced procurement price, promoted generic substitution, and saved procurement expenditure. However, the increase in procurement price, volume and expenditure of alternative drugs may reveal the significance of regulating healthcare institutions’ drug purchasing behavior.
{"title":"Impact of China’s National Volume-Based Procurement on Drug Procurement Price, Volume, and Expenditure: an Interrupted Time Series Analysis in Tianjin","authors":"Boya Zhao, Jing Wu","doi":"10.34172/ijhpm.2023.7724","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7724","url":null,"abstract":"Background: National Volume-Based Procurement (NVBP) program has been carried out in China to lower drug prices and reduce patients’ medication burden. This study aims to evaluate its impact on drug purchasing in Tianjin city, one of the first 11 cities piloting NVBP in China. Methods: Using monthly drug procurement data from Tianjin Medical Purchasing Center between 2018 and 2020, this study identified bid-winning drugs and their alternative drugs in the pilot NVBP, and evaluated the policy impacts on their procurement price (cost of defined daily dose, DDDc), volume (the number of defined daily dose, DDDs), and expenditure, during the first (initiated at April 1, 2019) and second (initiated at April 25, 2020) procurement cycles of pilot NVBP, applying interrupted time series (ITS) analysis. Included drugs were classified into 12 pharmacological subgroups for further analysis. Results: Decrease in DDDc of NVBP-covered drugs (bid-winning and non-winning drugs) were observed in the first (level change: -CNY 3.878/DDD, P<.001; trend change: -CNY 0.068/DDD, P=.001; relative change: -61.55%) and second (level change: -CNY 0.356/DDD, P=.049) procurement cycles of pilot NVBP, while no significant change was observed for the DDDc of alternative drugs, except for the increase in antidiarrheic and anti-inflammatory/antirheumatic subgroups as more expensive drugs were purchased from new suppliers in the second procurement cycle. The DDDs of bid-winning drugs significantly increased, while decreased for the non-winning original and generic drugs. Procurement expenditure was saved for NVBP-covered drugs (level change: -CNY 7.29×107, P<.001; trend change: -CNY 5.62×106, P<.001; relative change: -62.60%). However, during the second procurement cycle, procurement volume and expenditure of alternative drugs increased significantly in 7 out of 12 subgroups. Conclusion: The pilot NVBP policy in China reduced procurement price, promoted generic substitution, and saved procurement expenditure. However, the increase in procurement price, volume and expenditure of alternative drugs may reveal the significance of regulating healthcare institutions’ drug purchasing behavior.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136263373","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}
Pub Date : 2023-09-20DOI: 10.34172/ijhpm.2023.8266
Arianna Rotulo, Christina Paraskevopoulou, Elias Kondilis
{"title":"The Dangers of Fiscal Decentralisation in Healthcare: A Response to the Recent Commentaries","authors":"Arianna Rotulo, Christina Paraskevopoulou, Elias Kondilis","doi":"10.34172/ijhpm.2023.8266","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8266","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136263371","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}
Pub Date : 2023-09-19DOI: 10.34172/ijhpm.2023.8288
Ernest J. Barthélemy, Jacob Lepard, Anna E. C. Hackenberg, Joanna Ashby, Rebecca B. Baron, Ella Cohen, Jacquelyn Corley, Kee B. Park
{"title":"Advancing Global Neurotrauma Surveillance Through National Registries: A Response to Recent Commentaries","authors":"Ernest J. Barthélemy, Jacob Lepard, Anna E. C. Hackenberg, Joanna Ashby, Rebecca B. Baron, Ella Cohen, Jacquelyn Corley, Kee B. Park","doi":"10.34172/ijhpm.2023.8288","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8288","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109268","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}
Pub Date : 2023-09-17DOI: 10.34172/ijhpm.2023.7506
Niek Waltherus Stadhouders, Xander Koolman, Marit A.C. Tanke, Hans Maarse, Patrick P.T. Jeurissen
Background: Purchasing systems aim to improve resource allocation in healthcare markets. The Netherlands is characterized by four different purchasing systems: managed competition in the hospital market, a non-competitive single payer system for long-term care (LTC), municipal procurement for home care and social services, and self-procurement via personal budgets. We hypothesize that managed competition and competitive payer reforms boost reallocations of provider market share by means of active purchasing, ie, redistributing funds from high-quality providers to low-quality providers. Methods: We define a Market Activity Index (MAI) as the sum of funds reallocated between providers annually. Provider expenditures are extracted from provider financial statements between 2006 and 2019. We compare MAI in six healthcare sectors under four different purchasing systems, adjusting for reforms, and market entry/exit. Next, we perform in-depth analyses on the hospital market. Using multivariate linear regressions, we relate reallocations to selective contracting, provider quality, and market characteristics. Results: No difference was found between reallocations in the hospital care market under managed competition and the non-competitive single payer LTC (MAI between 2% and 3%), while MAI was markedly higher under procurement by municipalities and personal budget holders (between 5% and 15%). While competitive reforms temporarily increased MAI, no structural effects were found. Relatively low hospital MAI could not be explained by market characteristics. Furthermore, the extent of selective contracting or hospital quality differences had no significant effects on reallocations of funds. Conclusion: Dutch managed competition and competitive purchaser reforms had no discernible effect on reallocations of funds between providers. This casts doubt on the mechanisms advocated by managed competition and active purchasing to improve allocative efficiency.
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