International Journal of Health Policy and Management最新文献

Background: The increasing utilization of high-cost drugs with multiple indications poses significant financial challenges to healthcare systems worldwide. This study evaluates the financial impact of expanding drug indications in Korea, focusing on pharmaceutical expenditure trend.

Methods: This study analyzed claims data from the National Health Insurance Service (NHIS) to examine drug characteristics and annual expenditure. Interrupted time-series analysis assessed monthly expenditure changes following indication expansions.

Results: We analyzed 57 drugs that expanded their indications between 2012 and 2023. From 2012 to 2022, drug expenditures increased 15-fold (compound annual growth rate [CAGR] 30.8%), a significantly larger rise compared to the 1.9-fold rise (CAGR 6.5%) in total pharmaceutical expenditures covered by the NHIS. Notably, expenditures increased 35-fold for 35 drugs classified under anatomical therapeutic chemical (ATC) code L (antineoplastic and immunomodulating agents) and 375-fold for 26 drugs with risk-sharing agreements (RSAs). Interrupted time-series analysis (n = 27) demonstrated significant monthly expenditure increases before expansion (US$ 0.33 million per month, P=.000). There were significant increases in expenditure between the pre- and post-expansion period (US$ 4.99-5.64 million, P=.000). Moreover, post-expansion trends showed significant additional increases in expenditure: US$ 0.13 million per month (P=.003) at +24 months and US$ 0.07 million per month (P=.037) at +36 months.

Conclusion: Despite price reduction strategies for multi-indication drugs, expenditure accelerated increase in expenditure post-expansion of indication. This highlights the need for robust post-pricing management for listed drugs. In the long term, a total budget system could ensure predictable and sustainable financing by providing clear financial boundaries within the health insurance budget.

Background: The study aims to determine adults' interest in weight loss methods and their predictors such as anthropometric parameters, physical activity, and sociodemographic factors.

Methods: A two-step procedure was adopted. First, anthropometric parameters of 1130 Polish adults were taken, and the body mass index (BMI), the waist-to-hip ratio (WHR), and the body fat (BF) percentage were calculated. Next, the participants completed a questionnaire consisting of questions about their interest in different weight loss methods, questions about physical activity, and metric questions. Interest in six arbitrarily selected weight loss methods was measured using a five-point Likert scale. For analysis ordinal logistic regression and omnibus likelihood ratio tests were used.

Results: The results proved different predictors of adults' interest in weight loss methods (measured on an ordinal scale). More interest in physical activity and diets as methods of weight loss is observed in underweight individuals (compared to normal body weight status), older, with better economic situation, and higher level of physical activity individuals. In the case of bariatric surgery and liposuction, more interest in this weight loss methods are observed in overweight (compared to normal body weight status), economically well-off participants, and in women (compared to men). More interest of liposuction as a weight loss method is observed in overweight. Interest in dietary supplements to support weight loss (DSSWL) is more in women (compared to men), higher WHR, better economic situation, higher level of education and older individuals. More interest in weight loss drugs is observed in women (compared to men) and economically well-off people.

Conclusion: The key predictors of interest in weight loss methods are body weight status, gender, and economic situation. These vary in importance depending on the type of weight loss method. Healthcare providers should recommend various weight-management strategies, having regard for the level of interest in weight loss methods and their predictors.

In his recent editorial, Professor Labonté¹ surveyed international initiatives calling for a well-being global economy. Most of these initiatives offer glowing visions but implausible theories of change. The 1974 United Nations call for a New International Economic Order (NIEO) provides a case study of an earlier instance of well-being economics (although not labelled as such). The NIEO included specific institutional and regulatory initiatives directed to achieving a fairer and more liveable world. However, it was defeated through the rise of neoliberalism from the 1980s as well as internal contradictions within the movement for a NIEO. The history of the NIEO provides useful lessons regarding the political dynamics of global transformation. Any policy initiatives, directed towards reforming the global economy for the well-being of people and planet, need to be based on a robust theory of change.

Rycroft-Malone and colleagues' editorial on research co-production highlights the potential of a co-production mode of research to narrow the gap between knowledge production and use. This commentary critiques implicit assumptions within the argument and challenges the view that traditional (Mode 1) science bears the primary responsibility for delayed implementation and questions the inherent superiority of co-production. It also highlights the importance of political and policy considerations in considering research uptake. "Mode 3" knowledge production (integrating Modes 1 and 2 discovery) offers a potentially more advanced framework that recognizes systems and organizational perspectives. A deeper, multi-layered exploration of the influence of socio-political and policy contexts is needed to understand the full potential of co-production on knowledge utilization.

Background: Cost-effectiveness (CE) is a common prioritization criterion in health benefits package (HBP) design. However, to assess CE is a time- and data-demanding process, so most HBP exercises rely wholly or partially on global evidence. Extensive investment has been made in analyses, models, and tools to support cost-effectiveness analyses (CEAs) for HBPs. However, little attention has been paid to how national HBP assessors should both understand and select CE estimates. A structured, national process to select assessment methods is essential for ensuring the accuracy, ownership, and transparency of HBP design. This can be supported by "adaptive" health technology assessment (aHTA) principles, which focus on structured methodological choices based on the time, data, and capacity available. The objective of this paper was to apply aHTA framing to CEA methods selection for HBPs, and to make recommendations on how countries may consider systematically making these choices going forward.

Methods: We first reviewed the definitions and categorization of different aHTA methods. We then conducted a scoping review of previous HBP assessments to understand how CEA methods used in HBPs fit into the aHTA framework, and a follow-up survey of authors to fill gaps. Results of the literature review and survey were interpreted and narratively synthesized.

Results: We found that previous HBP assessments used four aHTA methods, sometimes simultaneously: expert opinion (n=3/20), review (n=12/20), model adaptation (n=6/20), and new model (n=2/20). The literature review and survey found that aHTA methods for HBPs take between 1-13 months; require different data sources depending on the method(s) used; and generally, require capacity in health economics, medicine, public health, and CE modelling. We supplement our report with a discussion of key considerations for methods selection.

Conclusion: Trading off time, data, and capacity needs for different CE assessment methods can help to support structured, local design of HBP assessments.

Background: Improving healthcare productivity and efficiency through effective management practice is crucial in the healthcare sector. However, the evidence on how management practices affect hospital performance is mixed and limited in the public health system. The objectives of this study are (1) locating Chinese public hospitals' management ability in the global health system community, and (2) investigating how public hospital's management practice is correlated to the objective and subjective performances.

Methods: Using the World Management Survey (WMS) methodology, the national Global Hospital Management Survey-China (GHMS-China) was conducted from 2014 to 2016 to measure Chinese hospitals' management practices. This study utilized a national representative hospital sample from the GHMS-China and used multi-variable linear regression model to examine the association between hospital performance and management practices. This study mainly focused on the clinical outcomes for acute myocardial infarction (AMI), heart failure (HF), pneumonia children (PC), and coronary artery bypass grafting (CABG), as well as satisfaction measurements including staff turnover and subjective ratings from patient and staff.

Results: Hospitals with higher management scores have significantly lower mortality rates on AMI, lower complication rates on CABG and shorter average length of stay (LoS) for PC patients. Hospital management and subjective performance also shows a positive correlation, with a significant increase of inpatient satisfaction rating by 0.72 scores (95% CI: 0.28,1.16; P=0.001). This relationship is more pronounced in hospitals with larger bed capacities, greater competition, more autonomy, and in sub-sample group of hospitals with superior management practice. The potential mechanisms through which hospital management can foster performance include attracting more talented clinical staffs, providing more valuable and continuous training opportunities, as well as providing more standardized clinical care service.

Conclusion: Better management practice is correlated to superior hospital performance in Chinese Public Health Service System. Future studies with religious and causality study design are warranted.

Background: China has developed a novel case-based payment method called the DiagnosisIntervention Packet (DIP) to regulate healthcare providers' behavior. G city, a metropolis in southeast China, has shifted its payment policy from fixed rate per admission to DIP under regional global budget since 2018. This study examined the immediate and trend changes in provider behavior after this payment reform.

Methods: Discharge data in G city between 2016 and 2019 was used, covering more than 10 million inpatient cases in 320 hospitals. A counterfactual scenario was developed to assign insured and uninsured inpatients across the study period to specific DIP groups under consistent rules. Controlled interrupted time-series (ITS) analyses were performed, with uninsured inpatients as control. Outcomes included inpatient volume, average DIP weight (similar to case-mix index in Diagnosis-Related Groups), and two innovative indicators (average diagnostic weight and average treatment weight) to decompose the changes in DIP weight. Subgroup analyses were conducted for different hospital levels and 21 major disease categories.

Results: After the DIP reform, monthly trend of inpatient volume decreased (-1085.34, P=0.052), while monthly growth of average DIP weight increased (2.17, P=0.02). No significant changes in average diagnostic weight were observed. Monthly trend of average treatment weight increased (2.38, P=0.001) after the reform. Secondary and tertiary hospitals experienced insignificantly decreased inpatient volume and elevated average DIP weight, accompanied by negligible change in average diagnostic weight and significant increase in average treatment weight. Primary hospitals experienced reduced inpatient volume and stable average DIP weight, along with increase in average diagnostic weight and decrease in average treatment weight.

Conclusion: By differentiated payments for severity, DIP induced hospitals to shift their focus from volume to weight of inpatients. Instead of diagnostic upcoding, hospitals responded to the DIP reform primarily by increasing treatment intensity. Primary hospitals may face financial risks under regional competition.

This commentary reflects on the principles of research coproduction discussed by Rycroft-Malone et al through our experiences in Uganda, particularly within the partnership between Nottingham Trent University (UK) and Makerere University (Uganda). The commentary highlights the coproduction process we have employed in community health projects in Wakiso district, Uganda, by examining both the opportunities and challenges inherent in this collaborative approach. We further highlight the importance of continuous stakeholder engagement, contextspecific communication, and power-sharing, demonstrating how research coproduction can decolonize research methodologies and enhance the relevance and impact of health interventions. By recognising the inequities between North-South partnerships, this commentary contributes to the discourse on how research coproduction can practically be implemented to drive meaningful, community-centred change while addressing the complexities involved. The lessons drawn from our experiences offer a pathway for other global partnerships aiming to integrate the principles of research coproduction into their work.

Background: Governments worldwide are increasingly interested in scaling up effective public health innovations, but it is not always easy to institutionalize innovations, arising outside the public health system, as a part of national delivery. Evidence on how country governments can practically achieve this is limited. This article describes the institutionalization of the Chipatala Cha Pa Foni (CCPF, Health Center by Phone) social innovation into the Malawian public health, and identifies positive institutional practices that local actors drew on to achieve this.

Methods: A positive-oriented interdisciplinary multi-method qualitative case study design was adopted. Data were collected from key informant interviews, observations, and documents over 18 months. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis.

Results: Four clusters of positive institutional practices aided the institutionalization of the innovation: building high-quality relationships; creating opportunities for experiential interaction; cultivating hope; and logic attunement and awareness. We describe how these four practices operated together as a process of 'everyday creativity' to achieve institutionalization. We illustrate the importance of high-quality relationships, marked by respect, mutuality, and appreciation, as the foundation upon which hope can be built and the creativity needed for institutionalization to flourish. National ownership and sustainability of innovations are enhanced when implementation and institutionalization approaches are attuned to the logics inherent in national identity.

Conclusion: In this article, we highlight the importance of institutional and interpersonal dynamics in the institutionalization of social innovation in health systems.