International Journal of Health Policy and Management最新文献

Knowledge translation and implementation science have made many advances in the last two decades. However, research is still not making expedient differences to practice, policy, and service delivery. It is time to evolve our approach to knowledge production and implementation. In this editorial we advance research coproduction as a neglected pathway to impact. Our starting point is that research impact is a function of how research is done and who is involved, arguing that researchers and non-researchers have an equal voice and role to play. We outline principles of coproduction including sharing power, valuing different sources of knowledge and viewpoints, equality, open communication, inclusivity, and mutuality. We consider implications at micro, meso, and macro system levels. In calling for this shift in the way knowledge is produced and applied, we anticipate it leading to inclusive research that more rapidly translates to better, more equitable health and care for all.

Background: Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive.

Methods: We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates.

Results: Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99).

Conclusion: These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.

Pakistan developed an essential package of health services at the primary healthcare (PHC) level as a key component of health reforms aiming to achieve universal health coverage (UHC). This supplement describes the methods and processes adopted for evidence-informed prioritization of services, policy decisions adopted, and the lessons learned in package design as well as in the transition to effective rollout. The papers conclude that evidence-informed deliberative processes can be effectively applied to design affordable packages of services that represent good value for money and address a major part of the disease burden. Transition to implementation requires a comprehensive assessment of health system gaps, strong engagement of the planning and financing sectors, serious involvement of key national stakeholders and the private health sector, capacity building, and institutionalization of technical and managerial skills. Pakistan's experience highlights the need for updating the evidence and model packages of the Disease Control Priorities 3 (DCP3) initiative and reinforcing international collaboration to support technical guidance to countries in priority setting and UHC reforms.

Background: The primary objective of this investigation is to scrutinize the underlying motivations that may prompt those responsible for health to adopt models of collaborative consumption (CC) as business innovation. Furthermore, the study seeks to assess the congruence of determinants influencing the intention to utilize CC in healthcare, comparing perspectives between responsible for health and digital health consumers.

Methods: Two studies based on the Theory of Planned Behavior (TPB) have been conducted. Study 1 uses a qualitative approach to analyze the determinants in use CC in healthcare of responsible for health of the Italian's National Health Service. Study 2 uses a quantitative approach to analyze a sample of healthcare consumers, their salient beliefs, digital health literacy, and perceived own health status in determining the intention to use CC in healthcare.

Results: Responsible for health recognize both the benefits, like improved efficiency, and the drawbacks, such as digital illiteracy and privacy concerns. Consumer data reveals that attitudes, social norms, perceived control, and digital literacy significantly influence the intention to use CC in healthcare, with education and age being moderating factors, whereas income is not impactful.

Conclusion: The research ends with a discussion of these findings and their strategic implications for managing decision support systems in healthcare. The research highlights the need for innovation-based strategies in the health system, proposing a new socio-technical health domain to improve management through a participatory approach. The approach emphasizes business innovation, service quality, and cost-efficiency. Finally, the research addresses the gaps highlighted in CC in healthcare adoption, underscoring public-private collaboration and practical strategies for sustainable success.

Background: The importance of the international food regulatory system to global health, is often overlooked. There are calls to reform this system to promote healthy and sustainable food systems centred on the Codex Alimentarius Commission (Codex), the United Nation's (UN's) standard-setting body. Yet this presents a significant political challenge, given Codex has historically prioritized food safety risks over wider harms to public health, and is dominated by powerful food exporting nations and industry groups with a primary interest in trade expansion. To better understand this challenge, we examine who participates and contests Codex standards, using the development of the new Guidelines on Front-of-pack Nutrition Labelling (FOPNL) as a case study.

Methods: The study involved: (i) collecting Codex Committee on Food Labelling (CCFL) documents (2016-2023); (ii) identification, categorization, and enumeration of actors involved in the development of the Guidelines; and (iii) guided by a constructivist framework, analysis of how actors framed and contested key provisions of the Guidelines.

Results: Country representation was skewed towards high-income (47.9%). Member state delegations were dominated by non-health ministries (59.8%) and industry actors (16.1%). Industry actors comprised the large majority of observers (84.2%) and civil society actors representing public health interests the least (12.2%). Commercial actors used frames supporting positive FOPNL messages (eg, low in salt) opposing negative ones (eg, "high-in" sugar warnings) and called for product exemptions (eg, sports foods and baby foods). Public health actors used frames supporting simplified FOPNL to reduce consumer confusion, that hold up public health goals, and prevent inappropriate marketing.

Conclusion: Participation in the Guidelines development process suggests stronger preferences for trade facilitation and commerce over public health. Ambitions to reform the international food regulatory system may require an examination of who participates and how to address this asymmetrical representation of interests. These results suggest the need to greatly strengthen public health representation at Codex.

The editorial by McKee and colleagues is an important call to action to put a spotlight on trust and its role in the function of health systems. The authors make a good case for this focus considering how trust in health systems seems to have eroded in recent years, an erosion accelerated by the COVID-19 pandemic. They recognize that trust is complex given the many forms of trust, the importance of context, and its dynamic and unpredictable nature. However, the solutions they offer including learning how to measure trust and figuring out the causes and consequences of trust are just simple or complicated solutions to this complex challenge. Instead, we need to approach building trust in healthcare by embracing and harnessing complexity. This starts by understanding the difference between complicated and complex challenges and then by applying complex systems frameworks that offer insight into new ways forward.

Borges and colleagues rightly argue that an international treaty is needed to curtail the profit-driven behaviour of the pharmaceutical industry during pandemics. The Pandemic Agreement currently being negotiated by Member States of the World Health Organization (WHO) offers an important opportunity to equip nation states with greater leverage over industry behaviour. In this commentary, we examine the potential of current draft textual proposals for the Pandemic Agreement to redirect pharmaceutical behaviour in future pandemics. However, the future of the Agreement negotiations remains uncertain in the wake of the failure to conclude negotiations in time for the 2024 World Health Assembly (WHA). Further, there is limited consensus over proposals that could enable nation states to have greater leverage over industry behaviour. A concerted effort will need to be made to achieve a consensus text that shifts the status quo by giving nation states more power to curtail the self-interest of the pharmaceutical industry.

Borges and colleagues' article entitled "More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap," analyzes the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. They concluded that with the failure of COVID-19 Vaccine Global Access (COVAX), the health gaps have widened due to the profit-driven pharmaceutical sector. In this commentary, we highlight the role of COVAX and its attempt to bridge some access gaps since its inception and the need for reforms in policy-making and global health governance. The commentary highlights the role of global health diplomacy in promoting equity and negotiating the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver for COVID-19 vaccines at the World Trade Organization (WTO) thereby promoting global solidarity, global partnerships, access to medicine and health products, and the right to health. We conclude that political prioritization is the key to balance the impact of profit-driven pharma industry and addressing the needs of low- and middle-income countries (LMICs).

Background: This study aims to review tools that have been developed for the transferability of health technology assessment (HTA) information to different countries. HTA is increasingly being used as a tool in health policy decision-making, but its complexity and lack of local expertise have limited its usage in many countries. The World Health Organization (WHO) has taken measures to encourage countries to conduct and use HTA, including through resolutions from the Eastern Mediterranean (EM) Regional Committee in 2019. However, due to limitations in national technical capacities, there is a need to adapt HTA information from other settings to fit the specific context of each country. Therefore, this study aims to systematically review the tools that have been developed for HTA transferability and assess their strengths and limitations.

Methods: The systematic review included studies that introduced tools, methods, and frameworks for transferability of HTA information across jurisdictions. Databases such as MEDLINE, EMBASE, Cochrane Library, Epistemonikos, Web of Science, health economic database, Scopus, and Google Scholar were searched, along with relevant bibliographies. The data was extracted and synthesized using both tabulation and narrative approaches. The evaluation of the tools involved assessing various criteria, such as user-friendliness, efficiency in screening, and considerations regarding transferability factors.

Results: A total of 10 375 documents were evaluated, resulting in 17 studies that met the inclusion criteria. These 17 studies consisted of 13 newly developed tools/methods that were appraised. The majority of the models were checklists, with only a few deemed suitable for full HTA. Three models have been validated through published studies, but there is no evidence of utilization in the countries of the EM region.

Conclusion: While the existing tools provide valuable resources for evaluating transferability, there remains a need for a more comprehensive tool to support decision-makers in low-resource settings considering country context and capacity.