International Journal of Health Policy and Management最新文献

Impacts of integrated care interventions, particularly on utilisation and financial outcomes, can be mixed, sometimes quite disappointing when compared to expectations. Positive deviants come along occasionally, but it is extremely difficult to unpick exactly why one intervention might "work" where others have not. Choi and Yoo evaluated a programme in Korea, which appears to have increased time older patients discharged from hospital spend at home, reduced their odds of a subsequent emergency admission, and decreased total expenditure, although re-admissions increased. The programme stands out particularly in its breadth of non-traditional care activity, home-based primary care and long-term (social) care services, but also broader activities such as nutrition support (eg, meal delivery), movement assistance, lifestyle education, housekeeping, and even home repair. In this commentary, I discuss this broadening of interventions to capture more social determinants of health, ask where boundaries of each sector/service should lie, and who should pay for what.

The vision to create "Healthy Societies" is a reiteration of "Health for All" first made in the Declaration of Alma-Ata almost half a century ago. We contend that this long journey is due to "Socio-Political Inertia" that has prevented societies from transforming even in the presence of enabling policies. The analysis of policy documents by Nambiar et al could help set the stage for understanding how best to advance healthy societies, but the aspirations expressed in documents require active engagement and implementation to enable societal change. We first draw inspiration from the convergence of multiple streams in Kingdon's model in exploring how to chart the journey toward healthy societies. We then argue that the vision of healthy societies should be articulated in ways that speak to the different societies that will own it and build coalitions to turn this vision into reality.

Patients often experience long journeys within the healthcare system before obtaining a diagnosis. Though progress has been made in measuring the quality of diagnosis, existing measures largely fail to capture the diagnostic process from the patient's perspective. McDonald and colleagues' paper presents 7 overarching goals for the use of patient-reported measures (PRMs) in diagnostic excellence and presents visual roadmaps to guide the development, implementation, and evaluation of these measures. To accelerate the real-world use of PRMs, organizations should initially prioritize the use of patient-reported metrics that are already in development, such as patient-reported experience measures. Pairing PRMs with artificial intelligence (AI) techniques, such as "diagnostic wayfinding" (a dynamic diagnostic refinement process that also includes analysis of electronic health record data and metadata to characterize the diagnostic journey), should also improve diagnostic performance. Ultimately, combining PRMs with technological advancements holds the potential to achieve true co-production of diagnostic excellence.

This commentary elaborates on the model proposed by Miranda et al for implementing remote patient monitoring (RPM) from an integrated care perspective. It stresses the complexity of RPM deployment as a digital health technology (DHT) and discusses essential features that developers and procurement managers should take into consideration in RPM systems to facilitate the implementation of integrated care practices. Furthermore, three major challenges for DHT implementation that align with the proposed RPM-based integrated care model are discussed: (1) the success of DHT in implementing a healthcare strategy requires elements of service innovation that align to the context of care delivery; (2) evidence generation methods influence the adoption of DHT and need an evolutive and multi-stakeholder perspective; (3) governance and policy strategies are crucial since they profoundly influence digital health priorities, investments, and resource allocation within organizations and healthcare systems.

Health system resilience in the context of economic sanctions (ES) is an underexplored area. We used data from recent studies on the impact of ES on the health systems to cross-reference and assess the applicability of the conceptual framework of health system resilience (CFHSR). Reviewing the interventions implemented under ES and aligning them with the CFHSR and COVID-19 responses, we found that the CFHSR domains encompass most strategies from the ES and COVID-19 studies. However, CFHSR does not cover several strategies related to equity and teamwork. Additionally, monitoring the consequences is missing from the experiences of COVID-19 and ES. The CFHSR appears to be reasonably effective in categorizing strategies for both COVID-19 and ES. Nonetheless, its domains can be further refined. Specifically, incorporating an intersectional equity lens could enhance this conceptual framework. The next step is to develop a practical guide to apply CFHSR to strengthen health system resilience.

Background: The 2023-2024 Gaza Genocide has generated notable scholarly discourse, influenced by various historical, political, and social contexts. These academic writings, rooted in the longstanding "war of words," illustrate how language serves as a potent weapon in conflicts. The present study aimed to analyze the academic response to the 2023-2024 War on Gaza, focusing on the different perspectives, opinions, and lexical choices in scholarly articles.

Methods: A scoping review and bibliometric analysis were conducted on articles from PubMed, pertaining to the 2023-2024 War on Gaza, spanning from October 7, 2023, to October 7, 2024. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used. Individual relevant papers' data were systematically extracted using a pre-tested form. Articles were categorized based on their stances as pro-Gaza, pro-Israel, or Neutral. Statistical analyses compared the bibliometric data of pro-Gaza and pro-Israel papers, identifying significant associated lexical fields. Factors explaining the different stances were uncovered.

Results: Out of 640 articles identified, 221 were included in the review. Among these, 126 (57%), pro-Gaza, 70 (31.7%), pro-Israel, and 25 (11.3%), Neutral. Pro-Gaza papers, often published in high-ranked journals with global affiliations, focused on humanitarian issues, called for a ceasefire and decried the genocide. Conversely, pro-Israel papers, often from local journals and affiliated with Israeli institutions, focused on political and psychosocial aspects, emphasizing self-defense narratives. Terms independently associated with pro-Gaza positions included "Gaza" in the title, "occupation," "genocide," "punishment," and "ceasefire." Pro-Israel papers featured "Israel" in the title, references to "October 7," and mentions of "Hamas."

Conclusion: This study highlights that academic narratives are profoundly influenced by historical contexts, media portrayal, official discourses, and the authors' socio-political environments. These findings underscore the intricate connection between scholarly discourse and the broader context of chronic occupation, revealing significant limitations in current global health strategies and highlighting the need to integrate humanitarian crises into these frameworks.

Background: Value-based procurement (VBP) is gaining traction in healthcare. This approach to procurement prioritizes obtaining the best health outcomes for patients while considering overall healthcare costs. Despite its recognized potential, VBP remains underutilized in hospitals. Little is known about the barriers and enablers of VBP in hospitals. This study aims to identify barriers and enablers specific to VBP in hospital procurement, utilizing the Theoretical Domains Framework (TDF).

Methods: This qualitative study comprises semi-structured interviews with 20 Dutch purchasers working at hospitals. The interviews aim to capture diverse perspectives on VBP, with the data undergoing an extensive coding and analysis process. Using redefined domains of the TDF, themes for barriers and enablers are identified.

Results: We explored the significance of broader barriers and enablers while also pinpointing new and distinctive ones specific to VBP in a hospital context. The newly identified barriers encompass challenges in procurement skills, low strategic priority, environmental context and resources, stakeholder influences, and outcome expectations. Noteworthy barriers include a cost saving focus, resistance to change, influence of the health insurer, and supplier preferences by end-users. Enablers involve stakeholder commitment, positive buyer-supplier relationships, effective storytelling, and demonstrated effectiveness of VBP. Stakeholder influence emerges as an important enabler, emphasizing the importance of the early involvement of medical specialists and other key stakeholders, overcoming resistance and fostering collaboration during VBP adoption in hospitals.

Conclusion: VBP in healthcare prioritizes optimal patient outcomes and value over costs. Although this is a promising concept, we identified several barriers and enablers for implementing VBP. While facing barriers related to procurement skills and environmental context, successful implementation relies on, among other things, training and stakeholder involvement, including early involvement of key stakeholders such as medical specialists and healthcare insurers, ambassadorship, trust-building, and effective storytelling.