Health Policy Open最新文献

The effectiveness of the states’ crisis response policies: Survival analysis on the COVID-19 transmission suppression in the United States 各州危机应对政策的有效性：美国 COVID-19 传播抑制的生存分析

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2025-03-20 DOI: 10.1016/j.hpopen.2025.100140

Hanvit Kim, Kyungmin Lee, Jungwon Yeo

Objective

This study aims to evaluate the effectiveness of various COVID-19 response policies in the United Sates that facilitated rapid virus transmission suppression and promoted quick return to normalcy during the first three years of the pandemic.

Method

We constructed comprehensive and unique time-to-event panel data that tracks the timeline of all policy implementations, and transmission waves, specifically measuring the duration from peak transmission to the desired suppression level, over 157 weeks. We then conducted a survival analysis to estimate the effectiveness of COVID-19 response policies in relation to the virus transmission dynamics. Our analysis focuses on the ten most populous U.S. states, representing diverse geographic, cultural, and political landscapes across the country. The survival analysis leverages the extensive time-to-event panel data collected from multiple sources.

Results

Our findings indicate that not all policies were equally effective in facilitating rapid transmission and promoting swift suppression return to normalcy. Containment or closure policies, such as school closures and stay-at-home orders, are associated with a shorter duration for returning to normalcy, highlighting their effectiveness in curbing COVID-19 transmission. In contrast, health system policies and vaccine policies showed mixed results.

Conclusion

The findings from our survival analysis of the novel data set provide practical insights for prioritizing policy measures among various options to effectively and timely suppress the transmission of highly contagious diseases. These insights can also enhance resource utilization and allocation within and across public health systems, while minimizing restrictions on people’s daily lives.

{"title":"The effectiveness of the states’ crisis response policies: Survival analysis on the COVID-19 transmission suppression in the United States","authors":"Hanvit Kim, Kyungmin Lee, Jungwon Yeo","doi":"10.1016/j.hpopen.2025.100140","DOIUrl":"10.1016/j.hpopen.2025.100140","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the effectiveness of various COVID-19 response policies in the United Sates that facilitated rapid virus transmission suppression and promoted quick return to normalcy during the first three years of the pandemic.</div></div><div><h3>Method</h3><div>We constructed comprehensive and unique time-to-event panel data that tracks the timeline of all policy implementations, and transmission waves, specifically measuring the duration from peak transmission to the desired suppression level, over 157 weeks. We then conducted a survival analysis to estimate the effectiveness of COVID-19 response policies in relation to the virus transmission dynamics. Our analysis focuses on the ten most populous U.S. states, representing diverse geographic, cultural, and political landscapes across the country. The survival analysis leverages the extensive time-to-event panel data collected from multiple sources.</div></div><div><h3>Results</h3><div>Our findings indicate that not all policies were equally effective in facilitating rapid transmission and promoting swift suppression return to normalcy. Containment or closure policies, such as school closures and stay-at-home orders, are associated with a shorter duration for returning to normalcy, highlighting their effectiveness in curbing COVID-19 transmission. In contrast, health system policies and vaccine policies showed mixed results.</div></div><div><h3>Conclusion</h3><div>The findings from our survival analysis of the novel data set provide practical insights for prioritizing policy measures among various options to effectively and timely suppress the transmission of highly contagious diseases. These insights can also enhance resource utilization and allocation within and across public health systems, while minimizing restrictions on people’s daily lives.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100140"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Public-Private partnership (PPP) and health service delivery in Malawi: The case of Christian Health Association of Malawi (CHAM) facilities in Mzimba district

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2025-03-12 DOI: 10.1016/j.hpopen.2025.100139

Chisomo Salangwa , Reston Munthali , Lusungu Mfune , Vegha Kaunga Nyirenda

Background

PPPs are crucial in addressing healthcare challenges in Malawi, a low-income country. These partnerships, including those with CHAM, help improve access to health services by complementing the public sector, especially in areas with inadequate infrastructure and limited healthcare resources.

Method

This study employed qualitative methods, including interviews, focus groups, and document analysis, to investigate the impact of PPP on healthcare infrastructure and access. Purposive and snowball sampling selected 30 interviewees and 20 focus groups. Thematic analysis revealed insights into PPP dynamics, resource allocation, stakeholder interactions, and socio-economic factors in healthcare.

Results

Government officials recognise PPPs’ positive impact on healthcare access, especially in rural areas, but raise concerns about sustainability due to policy inconsistencies, financial instability, and service duplication. CHAM and district health professionals highlight delayed payments, cost management, and infrastructure issues. While PPPs increase healthcare utilisation, challenges like drug shortages, staff shortages, and financial strain threaten long-term sustainability without better coordination.

Conclusion

This study explores PPPs in Malawi’s health sector, focusing on healthcare quality, efficiency, equity, and access. It identifies challenges like mistrust, misaligned incentives, data inflation, contract renegotiations, staffing shortages, and infrastructure issues. The study emphasises improving transparency, aligning incentives, and addressing sustainability through better resource management and financing.

{"title":"Public-Private partnership (PPP) and health service delivery in Malawi: The case of Christian Health Association of Malawi (CHAM) facilities in Mzimba district","authors":"Chisomo Salangwa , Reston Munthali , Lusungu Mfune , Vegha Kaunga Nyirenda","doi":"10.1016/j.hpopen.2025.100139","DOIUrl":"10.1016/j.hpopen.2025.100139","url":null,"abstract":"<div><h3>Background</h3><div>PPPs are crucial in addressing healthcare challenges in Malawi, a low-income country. These partnerships, including those with CHAM, help improve access to health services by complementing the public sector, especially in areas with inadequate infrastructure and limited healthcare resources.</div></div><div><h3>Method</h3><div>This study employed qualitative methods, including interviews, focus groups, and document analysis, to investigate the impact of PPP on healthcare infrastructure and access. Purposive and snowball sampling selected 30 interviewees and 20 focus groups. Thematic analysis revealed insights into PPP dynamics, resource allocation, stakeholder interactions, and socio-economic factors in healthcare.</div></div><div><h3>Results</h3><div>Government officials recognise PPPs’ positive impact on healthcare access, especially in rural areas, but raise concerns about sustainability due to policy inconsistencies, financial instability, and service duplication. CHAM and district health professionals highlight delayed payments, cost management, and infrastructure issues. While PPPs increase healthcare utilisation, challenges like drug shortages, staff shortages, and financial strain threaten long-term sustainability without better coordination.</div></div><div><h3>Conclusion</h3><div>This study explores PPPs in Malawi’s health sector, focusing on healthcare quality, efficiency, equity, and access. It identifies challenges like mistrust, misaligned incentives, data inflation, contract renegotiations, staffing shortages, and infrastructure issues. The study emphasises improving transparency, aligning incentives, and addressing sustainability through better resource management and financing.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100139"},"PeriodicalIF":1.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A critical Response to “How firearm legislation impacts firearm mortality”, A focused look at Canadian and Australian evidence

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2025-03-10 DOI: 10.1016/j.hpopen.2025.100137

Caillin Langmann

A recent review article in Health Policy Open, entitled “How firearm legislation impacts firearm mortality internationally: A scoping review” claims that Australian and Canadian firearms legislation is associated with reductions in homicide and suicide by firearms. Unfortunately, the review overexaggerates the effectiveness of firearms legislation in Australia and Canada, leaves out some important studies, and does not rigorously examine these articles.

Eight Australian studies are referenced that examine the association between gun control legislation, primarily the National Firearms Act (NFA), and firearm homicide. Seven studies find no association between gun control legislation and firearm homicide. Only one study finds a reduction in female homicide but this is contradicted by a study using methods controlling for confounding factors. Four studies examining suicide rates and the association with the NFA find no associated benefit, including the single study that controls for confounders. Two studies find an associated decline in firearm suicide rates with the NFA but there is a decline in non firearms homicide rates at the same time that makes it impossible to know if the decline is associated with the NFA or another variable.

The results of the Canadian studies on legislation and the association with firearms homicide points to no beneficial association when more methodologically sound methods and studies are reviewed. Canadian studies on the association with legislation and suicide by firearm demonstrate a reduction in suicide rates with a substitution for other methods and no overall reduction in suicide rates.

Overall, Australian and Canadian studies to not appear to demonstrate beneficial associations with gun control legislation.

{"title":"A critical Response to “How firearm legislation impacts firearm mortality”, A focused look at Canadian and Australian evidence","authors":"Caillin Langmann","doi":"10.1016/j.hpopen.2025.100137","DOIUrl":"10.1016/j.hpopen.2025.100137","url":null,"abstract":"<div><div>A recent review article in <em>Health Policy Open</em>, entitled “How firearm legislation impacts firearm mortality internationally: A scoping review” claims that Australian and Canadian firearms legislation is associated with reductions in homicide and suicide by firearms. Unfortunately, the review overexaggerates the effectiveness of firearms legislation in Australia and Canada, leaves out some important studies, and does not rigorously examine these articles.</div><div>Eight Australian studies are referenced that examine the association between gun control legislation, primarily the National Firearms Act (NFA), and firearm homicide. Seven studies find no association between gun control legislation and firearm homicide. Only one study finds a reduction in female homicide but this is contradicted by a study using methods controlling for confounding factors. Four studies examining suicide rates and the association with the NFA find no associated benefit, including the single study that controls for confounders. Two studies find an associated decline in firearm suicide rates with the NFA but there is a decline in non firearms homicide rates at the same time that makes it impossible to know if the decline is associated with the NFA or another variable.</div><div>The results of the Canadian studies on legislation and the association with firearms homicide points to no beneficial association when more methodologically sound methods and studies are reviewed. Canadian studies on the association with legislation and suicide by firearm demonstrate a reduction in suicide rates with a substitution for other methods and no overall reduction in suicide rates.</div><div>Overall, Australian and Canadian studies to not appear to demonstrate beneficial associations with gun control legislation.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100137"},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The regulation on the use of supplements for weight control: Case studies from Australia, the United States of America, and the United Kingdom

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2025-02-16 DOI: 10.1016/j.hpopen.2025.100136

Saiya Whitney Dawson , Dai Quy Le , Eng Joo Tan, Long Khanh-Dao Le

Background

Overweight and obesity have become more prevalent worldwide which has led to an increase in the demand for non-prescribed weight loss supplements. Given that these products are loosely regulated, they are often misused by adolescents and young adults.

Objective

This study aims to review regulatory policies for weight loss supplements in Australia, the United States, and the United Kingdom to identify areas for improvement.

Method

Peer-reviewed literature was retrieved from EMBASE, OVID, and EBSCOhost databases. Grey literature was identified using Google Advanced Search with 32 targeted keywords and region-specific government domains (.gov.au, .gov, .gov.uk). A narrative synthesis was employed to analyze and compare regulatory policies.

Results

A total of 34 articles (7 peer-reviewed and 27 grey literature documents) were included. In Australia, weight loss supplements are classified as low-risk medicines and are not subject to pre-market regulation. In the United States, the Food and Drug Administration primarily enforces regulations post-market. In contrast, the United Kingdom has implemented proactive measures through collaborations between government organizations. These include restrictions on the sale and packaging of over-the-counter laxatives and mandatory pharmacist consultations to assess patient needs.

Conclusions

The findings highlight significant regulatory gaps in Australia and the US compared to the UK. Adopting similar policies to those implemented in the UK could help reduce the accessibility of weight loss supplements among at-risk populations like adolescents and young adults. This study also discusses the implications of these findings for developing effective policies and regulations for non-prescribed weight loss supplements.

{"title":"The regulation on the use of supplements for weight control: Case studies from Australia, the United States of America, and the United Kingdom","authors":"Saiya Whitney Dawson , Dai Quy Le , Eng Joo Tan, Long Khanh-Dao Le","doi":"10.1016/j.hpopen.2025.100136","DOIUrl":"10.1016/j.hpopen.2025.100136","url":null,"abstract":"<div><h3>Background</h3><div>Overweight and obesity have become more prevalent worldwide which has led to an increase in the demand for non-prescribed weight loss supplements. Given that these products are loosely regulated, they are often misused by adolescents and young adults.</div></div><div><h3>Objective</h3><div>This study aims to review regulatory policies for weight loss supplements in Australia, the United States, and the United Kingdom to identify areas for improvement.</div></div><div><h3>Method</h3><div>Peer-reviewed literature was retrieved from EMBASE, OVID, and EBSCOhost databases. Grey literature was identified using Google Advanced Search with 32 targeted keywords and region-specific government domains (.gov.au, .gov, .gov.uk). A narrative synthesis was employed to analyze and compare regulatory policies.</div></div><div><h3>Results</h3><div>A total of 34 articles (7 peer-reviewed and 27 grey literature documents) were included. In Australia, weight loss supplements are classified as low-risk medicines and are not subject to pre-market regulation. In the United States, the Food and Drug Administration primarily enforces regulations post-market. In contrast, the United Kingdom has implemented proactive measures through collaborations between government organizations. These include restrictions on the sale and packaging of over-the-counter laxatives and mandatory pharmacist consultations to assess patient needs.</div></div><div><h3>Conclusions</h3><div>The findings highlight significant regulatory gaps in Australia and the US compared to the UK. Adopting similar policies to those implemented in the UK could help reduce the accessibility of weight loss supplements among at-risk populations like adolescents and young adults. This study also discusses the implications of these findings for developing effective policies and regulations for non-prescribed weight loss supplements.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100136"},"PeriodicalIF":1.7,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The early market access vehicle – An innovative demand-driven model to catalyse introduction of new optimal health products in low- and middle-income countries

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-12-16 DOI: 10.1016/j.hpopen.2024.100135

Ademola Osigbesan , Ikechukwu Amamilo , Aayush Solanki , Robert Matiru , James Conroy , Alya Omar , Karin Hatzold , Carolyn Amole , Kehinde Onasanya , Janet Ginnard

Low-and middle-income countries (LMICs) account for a significant proportion of the burden of disease for communicable illnesses globally; with malaria, tuberculosis (TB), and HIV/AIDS being the leading causes of death. Despite this disparity, LMICs often have limited or delayed access to newer optimal health products compared to high-income countries (HICs). This limitation in access, driven by a myriad of barriers, undermines the potential health benefits that could be gained in LMICs through the introduction of better health products. To improve this inequity, governments in HICs, non-governmental organizations, and pharmaceutical companies, often resort to establishing donation programs for LMICs, to circumvent some of the access barriers. While well-implemented donation programs have the potential to improve access to new products, poorly executed donation programmes are common. These often have negative effects such as: overreliance on donations by recipient countries, dumping of short-dated or unwanted products, costs of waste disposal where unsuitable or excess products are received, and a lack of focus on access sustainability planning. Unitaid’s early market access vehicle (EMAV) is an innovative demand-driven access model for introducing new optimal health commodities in LMICs. An EMAV entails a conditional purchase commitment to the manufacturer for a defined quantity of selected products in exchange for a set of access commitments, required to facilitate equitable access in the target markets. EMAVs are designed to link catalytic donations to pathways for sustainable access. Unitaid, in collaboration with its partners, has leveraged the EMAV to introduce two innovative health products in a number of LMICs. This article discusses the EMAV model and builds the case on why stakeholders working on new product access should consider this approach as an alternative to traditional donation programmes.

{"title":"The early market access vehicle – An innovative demand-driven model to catalyse introduction of new optimal health products in low- and middle-income countries","authors":"Ademola Osigbesan , Ikechukwu Amamilo , Aayush Solanki , Robert Matiru , James Conroy , Alya Omar , Karin Hatzold , Carolyn Amole , Kehinde Onasanya , Janet Ginnard","doi":"10.1016/j.hpopen.2024.100135","DOIUrl":"10.1016/j.hpopen.2024.100135","url":null,"abstract":"<div><div>Low-and middle-income countries (LMICs) account for a significant proportion of the burden of disease for communicable illnesses globally; with malaria, tuberculosis (TB), and HIV/AIDS being the leading causes of death. Despite this disparity, LMICs often have limited or delayed access to newer optimal health products compared to high-income countries (HICs). This limitation in access, driven by a myriad of barriers, undermines the potential health benefits that could be gained in LMICs through the introduction of better health products. To improve this inequity, governments in HICs, non-governmental organizations, and pharmaceutical companies, often resort to establishing donation programs for LMICs, to circumvent some of the access barriers. While well-implemented donation programs have the potential to improve access to new products, poorly executed donation programmes are common. These often have negative effects such as: overreliance on donations by recipient countries, <em>dumping</em> of short-dated or unwanted products, costs of waste disposal where unsuitable or excess products are received, and a lack of focus on access sustainability planning. Unitaid’s early market access vehicle (EMAV) is an innovative demand-driven access model for introducing new optimal health commodities in LMICs. An EMAV entails a conditional purchase commitment to the manufacturer for a defined quantity of selected products in exchange for a set of access commitments, required to facilitate equitable access in the target markets. EMAVs are designed to link catalytic donations to pathways for sustainable access. Unitaid, in collaboration with its partners, has leveraged the EMAV to introduce two innovative health products in a number of LMICs. This article discusses the EMAV model and builds the case on why stakeholders working on new product access should consider this approach as an alternative to traditional donation programmes.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"8 ","pages":"Article 100135"},"PeriodicalIF":1.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The cost of the reemergence of monkeypox: An overview of health financing in Africa 猴痘重现的代价：非洲卫生筹资概览

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-11-24 DOI: 10.1016/j.hpopen.2024.100132

Taiwo Oluwaseun Sokunbi, Elijah Orimisan Akinbi

引用次数: 0

Closing the equity gap: A call for policy and programmatic reforms to ensure inclusive and effective HIV prevention, treatment and care for persons with disabilities in Eastern and Southern Africa 缩小公平差距：呼吁进行政策和方案改革，以确保东部和南部非洲对残疾人进行包容和有效的艾滋病毒预防、治疗和护理

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-10-16 DOI: 10.1016/j.hpopen.2024.100131

Tafadzwa Dzinamarira , Christine Peta , Enos Moyo , Roda Madziva , Rouzeh Eghtessadi , Tatenda Makoni , Godfrey Musuka

In this paper, we explore the critical barriers that persons with disabilities face in accessing HIV services in the Eastern and Southern Africa (ESA) region, despite significant advancements in overall accessibility. We highlight the intersectional challenges experienced by individuals with disabilities, particularly women, and outline a comprehensive approach to bridge the existing gaps in policy and programmatic efforts. Specifically, we aim to address the exclusion of persons with disabilities from essential HIV prevention, treatment, and care services, a situation that has profound implications for their health, social inclusion, and economic productivity. In this discussion, we examine the current landscape, identify specific policy and programmatic hurdles, and propose targeted reforms, in an effort to contribute to the ongoing discourse on health equity and inclusivity.

在本文中，我们探讨了东部和南部非洲（ESA）地区的残疾人在获得艾滋病服务方面所面临的关键障碍，尽管在整体无障碍环境方面取得了重大进展。我们强调了残疾人（尤其是女性）所经历的交叉挑战，并概述了弥合政策和计划工作中现有差距的综合方法。具体而言，我们旨在解决残疾人被排除在基本的艾滋病预防、治疗和护理服务之外的问题，这种情况对他们的健康、社会包容和经济生产力有着深远的影响。在本次讨论中，我们将审视当前的状况，找出具体的政策和项目障碍，并提出有针对性的改革建议，努力为当前有关健康公平性和包容性的讨论做出贡献。

引用次数: 0

Patient’s willingness to pay for improved community health insurance in Tanzania 坦桑尼亚患者对改进社区医疗保险的支付意愿

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-09-29 DOI: 10.1016/j.hpopen.2024.100130

Kassimu Tani , Brianna Osetinsky , Sally Mtenga , Günther Fink , Fabrizio Tediosi

Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients’ willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient’s gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.

在全球范围内，实现全民医保仍是一项重大挑战。中低收入国家的医疗保险覆盖率仍然很低，只有少数非洲国家的覆盖率达到了 50%。本研究旨在调查影响坦桑尼亚患者药物支付意愿（WTP）的因素以及各种版本的改进型社区医疗保险基金（iCHF）。我们在坦桑尼亚基隆贝罗区和萨姆区的所有医院、保健中心和随机抽取的 8 家药房开展了一项基于设施的横断面研究，根据患者进入诊室的顺序，每 3 位患者中抽取 1 位排队患者，对 1748 位患者进行了访谈。我们采用多阶段权变估值法对客户退出访谈时收集的数据进行了探讨。我们采用了随机效用模型，并通过有序对数模型估算了 WTP。自变量包括：患者的性别、年龄、婚姻状况、教育程度、就业状况、非传染性疾病（NCD）状况、医疗保险状况以及医疗机构级别类型。我们的研究结果表明，大多数患者的 WTP 金额相当于目前的临时医保基金保费，并且愿意支付包括额外药物保障在内的额外临时医保基金保费。在对人口特征进行调整后，我们发现，参加保险计划或享受使用费减免的患者对药物的购买意愿较低，而患有非传染性疾病（NCDs）和在私人机构就医的患者对药物的购买意愿较高。此外，具有中学或以上教育水平的患者一般表现出较高的保费 WTP。相反，参加私人保险和享受使用费减免的患者，以及在公共设施就医的患者，对非物质文化遗产保费的购买意愿较低。这些结果突出表明，有必要采取有针对性的干预措施，以解决系统性缺陷并改善药品的可及性。我们的结论是，在为坦桑尼亚非正规部门设计医疗保险计划时，考虑非传染性疾病状况、教育水平和收入状况的政策非常重要，其目标是提高对慢性阻塞性肺病的使用率。

{"title":"Patient’s willingness to pay for improved community health insurance in Tanzania","authors":"Kassimu Tani , Brianna Osetinsky , Sally Mtenga , Günther Fink , Fabrizio Tediosi","doi":"10.1016/j.hpopen.2024.100130","DOIUrl":"10.1016/j.hpopen.2024.100130","url":null,"abstract":"<div><div>Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients’ willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient’s gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"7 ","pages":"Article 100130"},"PeriodicalIF":1.7,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving antibiotic prescribing – Recommendations for funding and pricing policies to enhance use of point-of-care tests 改进抗生素处方--关于加强使用护理点检测的供资和定价政策的建议

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-09-28 DOI: 10.1016/j.hpopen.2024.100129

Sabine Vogler , Caroline Steigenberger , Friederike Windisch

Introduction

Diagnostics can contribute to the improved quality of antibiotic prescribing. However, there is potential to enhance the use of point-of-care tests (POCTs) in general practice. This paper presents fit-for-purpose policy recommendations related to funding and pricing for POCTs applied for community-acquired acute respiratory tract infections (CA-ARTIs).

Methods

The development of the recommendations was informed by an analysis of the current status of funding and pricing policy frameworks for CA-ARTI POCTs in European countries, and an identification of barriers and facilitators for their uptake. Draft recommendations were developed and subsequently revised based on written and verbal feedback from meetings with experts.

Results

The proposal includes four recommendations for policy interventions related to funding and three recommendations regarding pricing policies. Two of the funding policy-related recommendations concern physicians’ remuneration, and two relate to product-specific reimbursement (public coverage) of the CA-ARTI POCTs. The pricing-related recommendations include a proposal to explore the introduction of price regulation, to pilot subscription-fee procurement models and to enhance more strategic approaches in public procurement of CA-ARTI POCTs.

Conclusions

Optimised pricing and funding policies could make a difference in enhancing uptake of CA-ARTI POCTs. It is crucial for the successful implementation of policies to consider country settings. Additionally, supportive policy action is recommended, including the systematic use of health technology assessment, stakeholder communication, and monitoring and evaluation.

引言诊断有助于提高抗生素处方的质量。然而，在全科诊疗中加强使用床旁检测（POCT）仍有潜力可挖。本文提出了与社区获得性急性呼吸道感染（CA-ARTI）POCTs 的筹资和定价相关的政策建议。方法：对欧洲各国社区获得性急性呼吸道感染 POCTs 的筹资和定价政策框架的现状进行了分析，并确定了推广应用的障碍和促进因素，为建议的制定提供了参考。根据与专家会面时获得的书面和口头反馈，制定了建议草案，并随后进行了修订。结果该建议包括四项与资金相关的政策干预建议和三项与定价政策相关的建议。其中两项与资金政策相关的建议涉及医生薪酬，两项涉及 CA-ARTI POCTs 的特定产品报销（公共覆盖）。与定价相关的建议包括探索引入价格监管、试行订阅费采购模式以及在 CA-ARTI POCTs 的公共采购中加强更具战略性的方法。成功实施政策的关键是要考虑各国的国情。此外，还建议采取支持性政策行动，包括系统地利用卫生技术评估、利益相关者沟通以及监测和评估。

{"title":"Improving antibiotic prescribing – Recommendations for funding and pricing policies to enhance use of point-of-care tests","authors":"Sabine Vogler , Caroline Steigenberger , Friederike Windisch","doi":"10.1016/j.hpopen.2024.100129","DOIUrl":"10.1016/j.hpopen.2024.100129","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnostics can contribute to the improved quality of antibiotic prescribing. However, there is potential to enhance the use of point-of-care tests (POCTs) in general practice. This paper presents fit-for-purpose policy recommendations related to funding and pricing for POCTs applied for community-acquired acute respiratory tract infections (CA-ARTIs).</div></div><div><h3>Methods</h3><div>The development of the recommendations was informed by an analysis of the current status of funding and pricing policy frameworks for CA-ARTI POCTs in European countries, and an identification of barriers and facilitators for their uptake. Draft recommendations were developed and subsequently revised based on written and verbal feedback from meetings with experts.</div></div><div><h3>Results</h3><div>The proposal includes four recommendations for policy interventions related to funding and three recommendations regarding pricing policies. Two of the funding policy-related recommendations concern physicians’ remuneration, and two relate to product-specific reimbursement (public coverage) of the CA-ARTI POCTs. The pricing-related recommendations include a proposal to explore the introduction of price regulation, to pilot subscription-fee procurement models and to enhance more strategic approaches in public procurement of CA-ARTI POCTs.</div></div><div><h3>Conclusions</h3><div>Optimised pricing and funding policies could make a difference in enhancing uptake of CA-ARTI POCTs. It is crucial for the successful implementation of policies to consider country settings. Additionally, supportive policy action is recommended, including the systematic use of health technology assessment, stakeholder communication, and monitoring and evaluation.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"7 ","pages":"Article 100129"},"PeriodicalIF":1.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From theory to practice: Harmonizing taxonomies of trustworthy AI 从理论到实践：统一可信人工智能的分类标准

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES

Health Policy Open

Pub Date : 2024-09-05 DOI: 10.1016/j.hpopen.2024.100128

Christos A. Makridis , Joshua Mueller , Theo Tiffany , Andrew A. Borkowski , John Zachary , Gil Alterovitz

The increasing capabilities of AI pose new risks and vulnerabilities for organizations and decision makers. Several trustworthy AI frameworks have been created by U.S. federal agencies and international organizations to outline the principles to which AI systems must adhere for their use to be considered responsible. Different trustworthy AI frameworks reflect the priorities and perspectives of different stakeholders, and there is no consensus on a single framework yet. We evaluate the leading frameworks and provide a holistic perspective on trustworthy AI values, allowing federal agencies to create agency-specific trustworthy AI strategies that account for unique institutional needs and priorities. We apply this approach to the Department of Veterans Affairs, an entity with largest health care system in US. Further, we contextualize our framework from the perspective of the federal government on how to leverage existing trustworthy AI frameworks to develop a set of guiding principles that can provide the foundation for an agency to design, develop, acquire, and use AI systems in a manner that simultaneously fosters trust and confidence and meets the requirements of established laws and regulations.

人工智能的能力日益增强，给组织和决策者带来了新的风险和漏洞。美国联邦机构和国际组织制定了多个可信人工智能框架，概述了人工智能系统必须遵守的原则，以确保其使用是负责任的。不同的可信人工智能框架反映了不同利益相关者的优先事项和观点，目前尚未就单一框架达成共识。我们对主要的框架进行了评估，并提供了关于可信赖的人工智能价值的整体观点，使联邦机构能够根据独特的机构需求和优先事项制定特定机构的可信赖的人工智能战略。我们将这种方法应用于退伍军人事务部，这是美国最大的医疗保健系统实体。此外，我们还从联邦政府的角度出发，介绍了如何利用现有的可信人工智能框架来制定一套指导原则，为机构设计、开发、获取和使用人工智能系统奠定基础，同时促进信任和信心，并满足既定法律法规的要求。

{"title":"From theory to practice: Harmonizing taxonomies of trustworthy AI","authors":"Christos A. Makridis , Joshua Mueller , Theo Tiffany , Andrew A. Borkowski , John Zachary , Gil Alterovitz","doi":"10.1016/j.hpopen.2024.100128","DOIUrl":"10.1016/j.hpopen.2024.100128","url":null,"abstract":"<div><div>The increasing capabilities of AI pose new risks and vulnerabilities for organizations and decision makers. Several trustworthy AI frameworks have been created by U.S. federal agencies and international organizations to outline the principles to which AI systems must adhere for their use to be considered responsible. Different trustworthy AI frameworks reflect the priorities and perspectives of different stakeholders, and there is no consensus on a single framework yet. We evaluate the leading frameworks and provide a holistic perspective on trustworthy AI values, allowing federal agencies to create agency-specific trustworthy AI strategies that account for unique institutional needs and priorities. We apply this approach to the Department of Veterans Affairs, an entity with largest health care system in US. Further, we contextualize our framework from the perspective of the federal government on how to leverage existing trustworthy AI frameworks to develop a set of guiding principles that can provide the foundation for an agency to design, develop, acquire, and use AI systems in a manner that simultaneously fosters trust and confidence and meets the requirements of established laws and regulations.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"7 ","pages":"Article 100128"},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0