International Journal of Health Policy and Management最新文献

Background: In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP.

Methods: We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams.

Results: We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections.

Conclusion: Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

This editorial critiques the existing literature on decolonizing global health, using the current assault on health in Gaza as a case in point. It argues that the failure to address the ongoing violence and blatant targeting of health facilities, personnel and innocent civilians demonstrates most clearly the limitations of an approach that is strong on rhetoric and weak on mounting a forthright challenge to the entire system supporting and perpetuating settler colonialism. We propose a more radical rethinking of the position of global health institutions within the current neoliberal system and of the systems of knowledge production that continue to underpin the existing colonial approach to the health of victims of settler colonialism.

Background: Evidence on the impact of policies that regulate unhealthy food marketing demonstrates a need for a shift from pure industry self-regulation toward statutory regulation. Institutional rules, decision-making procedures, actor practices, and institutional norms influence the regulatory choices made by policy-makers. This study examined institutional processes that sustain, support, or inhibit change in the food marketing regulation in Australia using the three pillars of institutions framework - regulatory, normative, and cultural cognitive pillars.

Methods: This was a qualitative study. Twenty-four in-depth semi-structured interviews were conducted with industry, government, civil society, and academic actors who are involved in nutrition policy in Australia.

Results: The regulatory pillar was perceived to inhibit policy change through the co-regulation and self-regulation frameworks that assign rulemaking, monitoring and enforcement to industry bodies with minimal oversight by regulatory agencies and no involvement of health actors. The normative pillar was perceived to provide pathways for comprehensive statutory regulation through institutional goals and norms for collaboration that centre on a whole-of-government approach. The framing of food marketing policies to highlight the vulnerability of children is a cultural cognitive element that was perceived to be essential for getting support for policy change; however, there was a lack of shared understanding of food marketing as a policy issue. In addition, government ideologies that are perceived to be reluctant to regulate commercial actors and values that prioritize economic interest over public health make it difficult for health advocates to argue for statutory regulation of food marketing.

Conclusion: Elements of all three pillars (regulatory, normative, and cultural-cognitive) were identified as either inhibitors or pathways that support policy change. This study contributes to the understanding of factors that inhibit policy change and potential pathways for implementing comprehensive statutory regulation of unhealthy food marketing.

In this paper we draw upon the review article "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons from the First Two Years of the Pandemic" by Saulnier et al to propose some additional themes to be considered regarding ongoing conversations on health system resilience. Complementing the lessons learned brought forward in the article, we propose three thematic areas which may enrichen this conversation. These three themes are posed as questions: (1) Transformation - towards what? (2) Crises and shocks - what counts as such? and (3) Levels and scales - can tensions be reconciled? While our insights are strongly rooted in research results on health system resilience during COVID-19 in Finland, we seek to discuss their wider implications for health system resilience and beyond the context of a single country.

The concept of health system resilience has gained prominence in global health discourse, especially in response to the Ebola and COVID-19 pandemics. This commentary responds to Saulnier and colleagues' 2022 review, which used the Dimensions of Resilience Governance framework to synthesize of COVID-19 related health system resilience research and explore possible conceptual gaps. The review's findings reveal elements missing from the original framework which underscore the social nature of health systems. This commentary links the review's empirical findings to nascent theorization of health systems resilience to develop an adapted Framework for Exploratory Research on Health Systems Resilience. A key contribution of the adapted framework is to make explicit the role of actor power and highlight more clearly the distinctions between: (i) research focused on identifying the capacities needed to enable adaptation; (ii) research focused on the actors whose interests and choices determine which adaptive strategies are used, and (iii) research that assess the outcomes of such strategies.

In the context of growing interest in the commercial determinants of health (CDOH) which has been defined as "the systems, practices, and pathways through which commercial actors drive health and equity," Bennett et al propose that governments implement monitoring of unhealthy commodity industries (UCIs) (including tobacco, alcohol, and ultra-processed foods) as part of their routine public health surveillance. We explore the evidence underpinning that suggestion and provide details on how corporate monitoring might be practically implemented drawing on lessons from tobacco industry monitoring which has been an established part of tobacco control. While governments should actively support such an approach as part of efforts to address commercially driven health harms, we urge caution in governments undertaking monitoring and identify significant barriers to implementation, while also suggesting ways in which those barriers might be overcome.

This commentary article responds to the research into development of medical specialist enterprises (MSEs) in the Netherlands conducted by Ubels and van Raaij. The MSEs are a relatively new phenomenon in the Netherlands and similar conceptually to medically-led developments in other health systems. With the foundation for medical specialist organisation in place this provides several opportunities for further development. This commentary considers these opportunities, drawing from the example of New Zealand. This is because New Zealand has had considerable experience with clinically-led organisation which provides useful lessons for the MSEs. The lessons include building strong clinical governance with a focus on collaboration with other health professionals and management, working with primary care to support community service delivery, building integrated care, developing whole of system planning and service delivery approaches and population health management.

As embedded researchers in Northern Ontario, Canada, we offer our reflections on Kasaai and colleagues' 2023 "Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program." In our commentary, we draw on our experiences and what is known about embedded research training to examine how to build and strengthen the workforce for equity-centered learning health systems. Does our narrow understanding of outcomes and impacts of embedded research training in Canada affect who benefits and which systems can realize the potential of learning health systems? We identify three areas for deeper analysis: outcomes and impacts at the individual, partnership, and system level, knowledge on the social identities and needs of individuals in embedded research partnerships, and research generalism as a complement to embedded research. Our recommendations suggest tailored approaches to strengthen the workforce capacity for equity-centered learning health systems in Canada.

Background: Disparities in emergency care accessibility exist between health service areas (HSAs). There is limited evidence on whether the presence of an emergency department (ED) that exceeds a certain hospital bed capacity is associated with emergency patient outcomes at the regional level. The objective of this study was to evaluate the effect of HSAs with or without of regional or local emergency centers with 300 or more hospital beds (EC300 or nEC300, respectively) by comparing the 30-day mortality of patients with severe emergency diseases (SEDs) admitted to the hospital through the ED.

Methods: The study retrospectively evaluated data from the National Health Information Database (NHID) of the National Health Insurance Service (NHIS) Claims database and enrolled patients who were admitted from the ED for SEDs. SEDs were defined using ICD-10 (International Classification of Diseases 10th Revision) codes for 28 disease categories with high severity, and 56 HSAs were designated as published by the NHIS. We performed hierarchical logistic regression analysis using multilevel models with the generalized linear mixed model (GLIMMIX) procedure to evaluate whether EC300 was associated with the 30-day mortality of SED patients, adjusting for patient-level, prehospital-level, hospital-level, and HSA-level variables.

Results: In total, 662 478 patients were analyzed, of whom 54 839 (8.3%) died within 30 days after hospital discharge. Of the 56 HSAs, 46 (82.1%) were included in the EC300 group. After adjustment for patient-level, prehospital-level, hospital-level, and HSA-level variables, nEC300 was significantly associated with increased 30-day mortality in SED patients (adjusted odds ratio [AOR]: 1.33, 95% CI: 1.137-1.153). In addition, patients who visited EDs with fewer annual SED admissions were associated with higher 30-day mortality.

Conclusion: nEC300 had a greater risk of 30-day mortality in patients treated with SEDs than EC300. The results indicate that not only the number of EDs in each HSA is important for ensuring adequate patient outcomes but also the presence of EDs with adequate receiving capacity.