International Journal of Health Policy and Management最新文献

Background: There is increasing recognition of the role governments play in addressing the health and environmental sustainability challenges within current food systems. This study seeks to understand food system policies designed and/or implemented by selected national and local governments in Africa, and the barriers and facilitators faced when designing or implementing policies to create healthy and environmentally sustainable food systems.

Methods: From an evidence-based list of proposed policies with double- or triple-duty potential to achieve healthy and environmentally sustainable food systems, a policy mapping was performed in five African countries (Benin, Côte d'Ivoire, Senegal, Togo, and Uganda) and one city in each of these countries (Ouidah, Bouaké, Saint-Louis, Sokodé, and Mbale). Semi-structured interviews were then conducted with policy stakeholders. The interview data were analysed in NVivo 14 using the thematic framework analysis approach, informed by the Health Policy Triangle (HPT).

Results: The mapping showed that African countries have designed and implemented policies that simultaneously address food insecurity and climate change, mainly through food production policies. Within food environments, countries are focussing on interventions to prevent obesity, mainly food provision or food pricing policies. However, many policy gaps remain. Several technical and political barriers were commonly experienced when designing and implementing food system policies, regardless of the jurisdiction, context or region, such as insufficient financial resources, lack of political will, limited data, and inadequate monitoring and enforcement mechanisms. The major facilitators perceived were supportive public opinion and awareness, international agreements, sound agenda-setting, multi-sector and multi-stakeholder consultations and partnerships, availability of both financial resources and data, and solid political will.

Conclusion: This article gives an overview of policies designed and implemented to achieve sustainable food systems, highlighting a strong focus through agriculture on undernutrition and climate change objectives. It also identifies their potential legislative, financial, and practical barriers and facilitators.

In their study on which we provide commentary, the authors applied a qualitative systems dynamics methodology to explore how transnational corporate power has led to policy inertia in the prevention of diet-related non-communicable disease (RD-NCD) in South Africa. This commentary explores the potential of systems thinking and causal loop diagrams to deepen understandings of - and responses to - the commercial determinants of health (CDOH). We reflect on the application of causal loop diagrams in policy processes and provide reflections that proposed strategies for change will need to take into account recent shifts in global discourse, funding streams and the balance of global power.

In their study, Shikako et al analyzed how national policies during the COVID-19 pandemic either supported or neglected the rights of persons with disabilities, aiming to inform the development of inclusive policies that align with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). They concluded that the differences in policies across countries during the COVID-19 pandemic indicate a need for greater alignment and standardization of policy responses for individuals with disabilities. While the study revealed disparities across countries and underscored the importance of disability-inclusive policy, this commentary provides actionable insights to guide governments in creating equitable policies that uphold the rights of persons with disabilities during crises and beyond. Specific recommendations in accordance with the UNCRPD include the establishment of permanent consultative committees, adopting a shared understanding of disability, addressing intersectionality and structural barriers, and utilizing non-ableist participation methods so that a diverse range of perspectives are incorporated and lived experiences shape the policies that impact them.

There are relatively few studies that have measured and explained socioeconomic inequalities in the well-being of populations. Using unique information available in the 2019 Nova Scotia Quality of Life Survey (NSQLS, n=9388), this study provides analysis of the determinants of socioeconomic inequalities in well-being of adults aged 18 and above in Nova Scotia, Canada. The population's well-being was measured using the Canadian Index of Wellbeing (CIW), which encompasses quality of life across eight domains. The Concentration index (C) approach was utilized to quantify and identify factors explaining socioeconomic inequality in well-being. A positive value of the C (0.0294; 95% confidence interval: 0.0267 to 0.0321) indicated pro-rich inequality in well-being among Nova Scotian residents. Results of the decomposition analysis indicated that the concentration of favorable mental health, education levels, and income among high socioeconomic status (SES) groups accounted for over 86% of the observed socioeconomic inequality in the population's well-being. Our findings demonstrated that inequalities in mental health, education, and income are significant obstacles to reducing inequality in well-being in Nova Scotia, Canada. Thus, policies aimed at alleviating inequalities in these factors may help to reduce socioeconomic inequality in well-being in Nova Scotia, Canada.

Background: Public-private partnerships (PPPs) in the health sector are established to achieve health outcomes by maximising the combined resources of both public and private sectors. Good governance is core to PPP function and success. This paper explores the factors that enable and constrain governance in the delivery of PPPs for primary healthcare (PHC) in low- and lower-middle-income countries (LLMICs).

Methods: A systematic search of four literature databases was conducted to identify peer reviewed articles published between 2000 and 2023 related to the governance of PPPs for PHC in LLMICs. A deductive analysis of data extracted from selected articles against the domains of Greer's TAPIC (transparency, accountability, participation, integrity, and policy capacity) governance framework was conducted to identify commonly reported enabling and constraining factors.

Results: Of the 4290 records screened, 14 were included. Common enabling factors for governance within each domain of the framework were found: Transparency: unequal and top-down resource allocation, and opaque and resource allocation was a barrier to PPP governance; Accountability and policy capacity: monitoring and evaluation; Participation: partner engagement, covering topics of developing and managing relationships, collaborative activities, and communication; and Integrity: the design of the PPP, covering formal agreements between partners, level of policy direction, and integration within the broader health system.

Conclusion: The five domains of the TAPIC governance framework provide guidance for considering governance in PPPs. The enabling factors identified in the review help facilitate the successful implementation of a PPP and thus influence the PPP's impact on health outcomes, through establishing and maintaining healthy working relationships between partners, and defining and documenting systems and processes.

Background: Smart health and senior care services have developed rapidly to cater to the aging society, but the corresponding regulations are not perfect. The platform and senior care service enterprises have chosen different strategies due to various factors, resulting in disorderly platform development and inefficient resource allocation. This research attempts to establish a regulatory mechanism to promote the active development of the platform.

Methods: In order to mitigate opportunistic behaviors in the smart health senior care service platform, drawing from evolutionary game theory, this study establishes a decision-making model involving the government, the platform, and senior care service enterprises, and scrutinizes the evolutionary behaviors and equilibrium strategies of these three parties.

Results: There are five equilibrium points among the three parties in the game, and the strategy selection shows periodic changes. The cost and level of positive government regulation, the conversion rate of smart aging construction services provided by the platform, penalties for opportunistic behavior by the platform, as well as the benefits of positive cooperation and penalties for passive cooperation by senior care service enterprises, will significantly affect the strategies of all parties involved.

Conclusion: The research results indicate that establishing a regulatory mechanism for the smart health senior care service platform can promote effective cooperation between platform and senior care service enterprises. Active government regulation is the key to the smooth operation of the platform. Through quantitative analysis, the main strategic choices of participants in the smart health senior care service platform can be explained. This model can provide a reference for formulating policies related to smart senior care.

Value-based healthcare (VBHC) has emerged as a widely embraced strategy to address pressing healthcare challenges, including workforce shortages, rising healthcare costs, and inconsistent care quality. A scoping review by van Elten et al shows that despite their expected importance of integrating VBHC with performance management systems, very few articles provide concrete examples of this integration. Drawing on existing performance management literature, the authors explore possible reasons for why VBHC practitioners and researchers have largely overlooked this topic. This commentary critically engages with their review by examining their conceptual definitions, offering alternative explanations for the apparent lack of performance management in VBHC, and suggesting directions for future interdisciplinary research.

Background: Experiencing corruption when seeking health services remains a significant problem in Nigeria. An effective response requires knowledge of the individual characteristics of those impacted by corruption when seeking healthcare. This study examined the prevalence of corruption among those seeking health services in Nigeria's public healthcare facilities and how it varies among different user groups.

Methods: We used a pre-tested interviewer-administered questionnaire to collect data from 1659 individuals randomly selected from households in two Nigerian states. We collected data on respondents' socio-demographic characteristics and experiences of corrupt practices. We undertook descriptive and binomial logistic regression analyses.

Results: Approximately 50% (823) of respondents experienced corrupt practices, such as using connections for faster treatment and bribery when seeking health services. 446 (27%) respondents bribed or made so-called unapproved payments to health providers to obtain health services. Gender was a strong predictor, with male healthcare service users being more likely to experience corrupt practices (%point risk difference=24; 95% CI=20, 29) and bribe or make an unapproved payment to obtain healthcare (%point risk difference=20; 95% CI=15, 25). Residents in the northern state were (%point risk difference=30; 95% CI=26, 35) more likely to experience corrupt practices than residents in the eastern state. People seeking healthcare in urban (%point risk difference=09; 95% CI=-05, 08) and semi-urban (%point risk difference=12; 95% CI=05, 19) locations were more likely to have bribed or made 'unapproved' payments to healthcare providers compared to rural residents.

Conclusion: Health sector corruption, in its various forms, is frequently reported in both northern and southern Nigeria. However, user experience of corruption varies according to socio-demographic characteristics, and this is often insufficiently acknowledged. To combat corrupt practices in both health sectors, anti-corruption initiatives must be tailored to particular groups and settings, addressing specific disadvantages at individual and community levels.

Nambiar and colleagues in this journal identify the main conceptual frameworks offered by public health on how to build healthy societies, drawn from key documents published over a span of 50 years. In their analysis they point to strengths and limitations of these frameworks and offer suggestions for their improvement. In this commentary, I argue that both the frameworks on offer and Nambiar and colleagues' critique are missing important perspectives on well-being itself, on the role of the democratic State, and on the "community arena" and the "policy arena" as two related but distinct arenas for political and social change toward healthy societies.

Background: The National Volume-Based Procurement (NVBP), implemented in China in 2019, aims to reduce patients' economic burden by lowering drug prices and promoting the use of NVBP drugs in public hospitals. We evaluated the impact of NVBP on medical expenditures among hypertensive patients, analyzing both the overall impact and variations in policy effects across individual hospitals.

Methods: Using medical records from 1.17 million hypertensive patients across 82 hospitals in Tianjin (2017-2021), we conducted an interrupted time series analysis to assess expenditure changes among hypertensive patients for the treatment of hypertension, dyslipidaemia, type 2 diabetes, and chronic ischemic heart disease (IHD). Multilevel model was employed to estimate the overall impact and hospital-specific variations in policy effects.

Results: NVBP implementation significantly reduced per-visit outpatient expenditures among hypertensive patients for the treatment of hypertension (-15.61%), dyslipidaemia (-25.77%), and diabetes (-17.59%) by lowering drug expenditures. Although drug expenditures for chronic IHD decreased, non-drug expenditures increased, leading to no significant change in total expenditures for chronic IHD (-8.97%). For inpatient expenditures, no significant changes in total per-admission expenditures were observed for chronic IHD or diabetes hospitalizations. Drug expenditures for diabetes decreased significantly, but diagnostic expenditures increased, while no significant change was found in chronic IHD drug expenditures. At the individual hospital level, significant variations in policy effects were observed. Despite the overall decrease in outpatient expenditures for the treatment of hypertension, dyslipidaemia, and diabetes, only 45.6%, 67.2%, and 46.3% of hospitals, respectively, showed significant decreases, while the remainder exhibited either non-significant changes or increases.

Conclusion: NVBP effectively reduced outpatient expenditures among hypertensive patients for the treatment of hypertension, dyslipidaemia, and diabetes, suggesting its potential to alleviate patients' economic burdens. However, the increases in non-drug expenditures and substantial variations in policy effects across hospitals highlight a room for further improvement in policy implementation and overall effectiveness.