International Journal of Health Policy and Management最新文献

Background: As global aging increases, health inequalities are becoming more prominent. The purpose of this study is to examine whether increasing the level of fund pooling of the New Rural Cooperative Medical Scheme (NRCMS) helps to improve health and health inequalities among older adults.

Methods: Data from four periods of the China Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, and 2018 were used, the population for this paper was a sample of the older adults participating in the NRCMS. A sample of 955 treated participants and 13 477 control participants were included in the analysis after excluding samples with missing information. Time-varying difference-in-differences (DID) model was used to analyze the impact of the NRCMS Provincial Pooling Policy (NRCMS-PPP) on participants' health and health inequalities.

Results: The results of the study showed that the NRCMS-PPP had a significant effect on the self-rated health (SH) (estimated coefficient = 0.149, P<.01) and health relative deprivation index (HRDI) (estimated coefficient = -0.018, P=.02). Further exploration of the heterogeneous effect of it revealed that implementation is more effective in improving the health and reducing health inequalities for older population with primary education or living in rural areas. The mediation mechanism suggests that NRCMS-PPP partially mediates through total out-of-pocket medical expenses (TOME) and catastrophic health expenditure (CHE).

Conclusion: The NRCMS-PPP reduces the probability of the older adults experiencing CHE and reduces their burden of disease costs, thus improving their health and reducing their health inequality. Policy effects vary in terms of educational status and areas of residence.

Civil society actors are widely recognized for advocating the public interest in health policy. However, their role in contributing different types of evidence to inform policy is less explored. To explore this topic, members of the Healthcare Information for All (HIFA) online forum and the Supporting Inclusive and Accountable Health Systems Decisions for Universal Health Coverage (SUPPORT-SYSTEMS) research project conducted a four-week online discussion. The discussion focused on defining civil society, its role in health policy, the types of evidence it provides, and how this evidence is used and valued. Weekly focal questions encouraged HIFA members to share experiences of civil society engagement and the use of evidence in health policy-making. The thematic analysis identified four key messages. First, defining civil society requires critical reflection, as actors differ significantly in their interests, political ties, and influence. These distinctions affect how representative their evidence is and whether it reflects vested interests. Second, policy-making structures can support meaningful civil society participation, thereby strengthening the use of evidence and the legitimacy of policy decisions. Third, civil society provides valuable local and tacit knowledge that complements scientific evidence, though safeguards are needed to prevent bias or misrepresentation. Fourth, political economy factors-such as power imbalances, gatekeeping, and funding constraints-shape the influence of civil society evidence on policy. Overall, the discussion highlighted the diverse roles civil society can play in health policy and the importance of institutional mechanisms to support responsible evidence use. Thematic discussions in communities of practice (CoPs) like HIFA offer a dynamic and inclusive approach to engaging stakeholder knowledge in research projects.

This article builds on Engebretsen and Baker's editorial to explore recent developments in medical neutrality, the depoliticization of healthcare, and political intervention in the context of the war in Gaza. We examine how international health organizations have increasingly, though insufficiently, taken a political stance, criticizing the detrimental structural forces affecting Palestinians' life and health. Concomitantly, many Israeli healthcare professionals and organizations have shifted from a declared neutral stance to endorsing the state's official narrative. Additionally, we analyze the connections between settler colonialism, Israeli and US policies, medicine, and international health organizations. While the discourse of decolonization provides valuable historical context for understanding the ongoing oppression of Palestinians, it often obscures critical issues, particularly the atrocity of the October 7 attack. We conclude by discussing the shift from literal denial to interpretive and implicatory denial, emphasizing the role of international health professionals and organizations in confronting these pervasive forms of denial.

Note: This comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-nuclear-risk-editorial-may-2025.

Over a decade has passed since the World Health Organization (WHO) proposed a set of "best buys" for the prevention of non-communicable diseases (NCDs). Loffreda and colleagues' review describes how, despite the cost-effectiveness of these interventions, their adoption is often complex and governments face many challenges in both implementing and maintaining NCD prevention policies. Industry opposition and the commercial determinants of health (CDoH) remain significant challenges to an effective NCD response. In addition, the best buys may operate inequitably and are often unable to respond to the interrelated challenges posed by the global syndemic of obesity. We suggest that the next revision of the best buys adopts a more integrated approach that prioritize structural interventions, equity-focused strategies, and mechanisms to counteract industry interference.

Background: Although care pathways are a response to the calls for a major change in health system redesign initiatives, very few articles have proposed an implementation method. Indeed, no method exists for large-scale projects of care pathways, as sets of interventions within health systems. Drawing on the systems thinking approach and the pragmatic sociology, we describe the implementation methodology of the Learning Care Pathways (LCP) framework, a method to implement, learn, replicate, and scale up care pathways for and with the patient.

Methods: The LCP was conceptually developed through a series of literature reviews on key methodological concepts. As a comprehensive, theory-informed approach, the LCP emerged by linking implementation strategies, research methods, learning mechanisms and outcomes dimensions aimed at optimising care pathways.

Results: Designed around 13 steps grouped into five phases, this framework provides implementation strategies, research methods and learning mechanisms, including levers for patient involvement. The pre-implementation phase enables the selection of the pilot project's receiving environment and the design of the project. The implementation phase is designed to co-construct and implement an optimised care pathway based on a scientific analysis of the patient journey, the care pathway perceived by professionals, the care pathway from data and integrating knowledge from international clinical practice guidelines. The post implementation phase aims to demonstrate value creation and set up a learning cycle. The replication phase is designed to repeat the method locally to develop horizontal learning and to evaluate scalability. Finally, the scale up phase aims to repeat the method in other territories to accelerate knowledge creation and develop horizontal and vertical learning.

Conclusion: This framework is of particular interest to policy-makers, healthcare managers, and researchers alike, and must be the subject of several experiments to conduct reproducible research that can lead to national Learning Health Systems (LHS).

Background: Excess mortality provides a comprehensive measure to assess the true impact of the disease on mortality rates. This study aimed to quantify excess mortality attributable to COVID-19 in northeastern Iran during the pandemic period (2020-2022).

Methods: This population-based cross-sectional study utilized population and mortality data extracted from electronic systems linked to Mashhad University of Medical Sciences (MUMS). Data analysis was conducted using R Version 4.3.3. A log-linear model was employed to predict expected deaths during the two-year pandemic period, incorporating predictor variables such as the year of interest, the presence of COVID-19, and the population size for each respective year. Excess deaths were calculated as the difference between the expected and observed mortality. Furthermore, by considering the confirmed deaths directly attributed to COVID-19 and the difference between these and the excess deaths, the number of indirect deaths during the pandemic was determined.

Results: The total count of recorded deaths from all causes exceeded the expected deaths by 31.15% (6750 cases) in the first year and 44.74% (10 078 cases) in the second year. The excess deaths were 1.48 and 1.79 times greater than the official reports of COVID-19 for the first and second years, respectively. It was also found that men experienced increased rates of excess deaths in each of the two years. Moreover, urban residents experienced higher rates of excess death in the same years. Based on cause-specific excess mortality, following infectious diseases, cardiovascular diseases (CVDs) accounted for the largest proportion of excess deaths in both years of the pandemic.

Conclusion: The overall mortality burden during the COVID-19 pandemic exceeded the official reports, highlighting the undercounting of the number of direct effects and emphasizing the significance of indirect effects. These findings underscore the importance of preparedness and organization of healthcare systems prior to a pandemic.

Background: Over 80 countries have now signed up to the COP26 Health Programme-a World Health Organization (WHO)-led initiative on climate change and health-of which 45 countries have committed to reaching net zero emissions before 2050. Efforts to reduce healthcare's carbon footprint raise conceptual, ethical and practical challenges for efficient and fair resource allocation. This study investigates how civil servants leading the development and implementation of national net zero healthcare strategies conceptualise the responsibility of health systems to cut emissions and describe potential trade-offs along the way.

Methods: We undertook 11 online, semi-structured qualitative research interviews between September 2022 - May 2023 with civil servants leading national net zero healthcare strategies. The interview guide explored three main areas: responsibility for emissions, priority setting and international perspectives. Interviews were coded and analysed the data using Malterud's systematic text condensation (STC).

Results: Four main themes emerged: obligation to act, leadership, governance, and prioritization. Participants described that the healthcare system should take responsibility for its entire carbon footprint, including harms inflicted beyond national borders. We also found indications of synergistic, multi-scalar health leadership-clinical, civil service, and political-helping to accelerate the net zero healthcare agenda. Participants generally rejected the notion of direct "trade-offs" between efforts to reduce emissions and patient care, emphasising ways net zero healthcare can leverage societal health improvements more broadly. These empirical findings inform the emerging literature exploring how health systems should account for their environmental impacts.

Conclusion: Our findings highlight the sincerity of ambitions to deliver net zero healthcare and uncertainties on how to get there. Further work characterising the types of constraints and trade-offs policy-makers face on the path to net zero healthcare systems, including examples of how these have been overcome, could help integrate climate concerns into healthcare decision-making and resource allocation processes.