Pub Date : 2025-11-17DOI: 10.1016/j.hpopen.2025.100152
Mary Schwoerer, Timothy F. Leslie
This study explores the impact of mental health policy reforms on geographic variations in inpatient psychiatric facility utilization and mental health outcomes in Virginia. Following the enactment of Senate Bill 260 (SB260), we observed significant changes in utilization patterns, particularly in regions with higher proportions of Medicaid-eligible populations. We identify nuanced factors influencing facility usage, including proximity to facilities and demographic characteristics, shedding light on the complex dynamics of mental health care access. Notably, our analysis indicates a notable increase in overall utilization of Virginia’s state-operated mental hospitals post-SB260, suggesting a greater fulfillment of unmet needs for inpatient care. Moreover, our research underscores the necessity to reconsider IMD exclusion laws, emphasizing the potential benefits of policy changes for underserved populations. This research contributes to mental health policy discussions by offering evidence-based considerations for future reforms aimed at improving access and equity in mental health care delivery in Virginia.
{"title":"Virginia’s inpatient mental healthcare geography post SB260","authors":"Mary Schwoerer, Timothy F. Leslie","doi":"10.1016/j.hpopen.2025.100152","DOIUrl":"10.1016/j.hpopen.2025.100152","url":null,"abstract":"<div><div>This study explores the impact of mental health policy reforms on geographic variations in inpatient psychiatric facility utilization and mental health outcomes in Virginia. Following the enactment of Senate Bill 260 (SB260), we observed significant changes in utilization patterns, particularly in regions with higher proportions of Medicaid-eligible populations. We identify nuanced factors influencing facility usage, including proximity to facilities and demographic characteristics, shedding light on the complex dynamics of mental health care access. Notably, our analysis indicates a notable increase in overall utilization of Virginia’s state-operated mental hospitals post-SB260, suggesting a greater fulfillment of unmet needs for inpatient care. Moreover, our research underscores the necessity to reconsider IMD exclusion laws, emphasizing the potential benefits of policy changes for underserved populations. This research contributes to mental health policy discussions by offering evidence-based considerations for future reforms aimed at improving access and equity in mental health care delivery in Virginia.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100152"},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.hpopen.2025.100151
Mercedes Tejería-Martínez, Vanesa Jordá, José María Sarabia
Health inequalities remain a major challenge in global development, particularly in sub-Saharan Africa (SSA), where disparities are exacerbated by limited access to healthcare and widespread socioeconomic inequities. This study examines health inequality in 10 SSA countries using Body Mass Index as a health outcome. Drawing on data from the Demographic and Health Surveys, we employ conditional inference trees to assess the extent of health disparities by classifying populations into groups based on shared socioeconomic status, demographic characteristics, and lifestyle choices. Our analysis reveals significant health inequality, particularly in Mauritania, Eswatini, and Kenya, while Egypt emerges as the most equal country in terms of health outcomes. Furthermore, our findings show that disparities are largely driven by illegitimate sources of inequality, such as wealth and education, while legitimate factors linked to personal decisions have a minimal impact. Demographic factors, particularly age, are the largest contributors to health disparities in most countries, with gender also standing as a major determinant in many countries. These findings underscore the need for targeted health policies that address the root causes of inequality, such as expanding access to healthcare, implementing social protection programs, and promoting gender equality in health.
{"title":"Structural drivers of health inequality in sub-Saharan Africa: Evidence and policy implications","authors":"Mercedes Tejería-Martínez, Vanesa Jordá, José María Sarabia","doi":"10.1016/j.hpopen.2025.100151","DOIUrl":"10.1016/j.hpopen.2025.100151","url":null,"abstract":"<div><div>Health inequalities remain a major challenge in global development, particularly in sub-Saharan Africa (SSA), where disparities are exacerbated by limited access to healthcare and widespread socioeconomic inequities. This study examines health inequality in 10 SSA countries using Body Mass Index as a health outcome. Drawing on data from the Demographic and Health Surveys, we employ conditional inference trees to assess the extent of health disparities by classifying populations into groups based on shared socioeconomic status, demographic characteristics, and lifestyle choices. Our analysis reveals significant health inequality, particularly in Mauritania, Eswatini, and Kenya, while Egypt emerges as the most equal country in terms of health outcomes. Furthermore, our findings show that disparities are largely driven by illegitimate sources of inequality, such as wealth and education, while legitimate factors linked to personal decisions have a minimal impact. Demographic factors, particularly age, are the largest contributors to health disparities in most countries, with gender also standing as a major determinant in many countries. These findings underscore the need for targeted health policies that address the root causes of inequality, such as expanding access to healthcare, implementing social protection programs, and promoting gender equality in health.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"10 ","pages":"Article 100151"},"PeriodicalIF":2.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Health insurance literacy (HIL) plays a vital role in individuals’ ability to understand, select, and use health insurance services. Despite its significance, limited national-level research has been conducted in Iran.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from November 2024 to February 2025 with 1,625 beneficiaries of the Iranian Health Insurance Organization (IHIO). A validated researcher-developed questionnaire was used assessing the insured groups’ knowledge, attitudes, information-seeking, utilization of services, digital and financial literacy and numeracy. Data were analyzed using t-tests, ANOVA, and multiple linear regression.</div></div><div><h3>Results</h3><div>The mean HIL score was50.85 ± 20.41. Approximately 25.3% of the participants had low and 35.6% moderate HIL. Significant differences were observed across provinces. The variables associated with the HIL included gender, marital status, occupation, education level, insurance fund type, income, and age. The higher education, employment, and older age were positively associated with the higher HIL scores.</div></div><div><h3>Conclusion</h3><div>HIL allegedly plays an essential role in the informed healthcare decision-making and equitable service utilization. Disparities seemingly exist across the demographic and regional groups in terms of HIL. Therefore, the tailored educational programs, workplace training, and clearer insurance communication tools are recommended to improve the HIL and reduce inequalities in Iran’s healthcare system.</div><div>What is already known about the topic?</div><div>Health insurance literacy (HIL), a subdomain of health literacy, is essential for informed decision-making and effective use of insurance benefits. Globally, inadequate HIL is linked to the delays in care, increased healthcare costs, and poor service utilization. In Iran, research on HIL has been limited to local studies or tool development, with no national-scale investigation addressing regional disparities or sociodemographic determinants.</div><div>What does this study add to the literature?</div><div>This is the first nationally representative study of HIL in Iran, covering over 1,625 individuals from diverse insurance funds and provinces. It revealed significant inequalities in HIL related to age, gender, education, employment, income, and geographic location—providing empirical evidence to inform the national health policy making.</div><div>What are the policy implications?</div><div>Findings underscore the need for targeted and equity-oriented HIL interventions. Policymakers should implement accessible public education campaigns, digital advisory platforms, and workplace-based training to improve HIL among vulnerable groups. Such strategies can support more informed insurance use and promote equitable access to healthcare.</div></div><div><h3>Background</h3><div>Health literacy, defined as “the capacity of individuals t
{"title":"Health insurance literacy and the associated factors in Iran: A national-scale study","authors":"Zahra Asadi-Piri , Foroozan Abdollahi-pour , Namam Ali Azadi , Rajabali Daroudi , Ebrahim Jaafaripooyan","doi":"10.1016/j.hpopen.2025.100150","DOIUrl":"10.1016/j.hpopen.2025.100150","url":null,"abstract":"<div><h3>Background</h3><div>Health insurance literacy (HIL) plays a vital role in individuals’ ability to understand, select, and use health insurance services. Despite its significance, limited national-level research has been conducted in Iran.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from November 2024 to February 2025 with 1,625 beneficiaries of the Iranian Health Insurance Organization (IHIO). A validated researcher-developed questionnaire was used assessing the insured groups’ knowledge, attitudes, information-seeking, utilization of services, digital and financial literacy and numeracy. Data were analyzed using t-tests, ANOVA, and multiple linear regression.</div></div><div><h3>Results</h3><div>The mean HIL score was50.85 ± 20.41. Approximately 25.3% of the participants had low and 35.6% moderate HIL. Significant differences were observed across provinces. The variables associated with the HIL included gender, marital status, occupation, education level, insurance fund type, income, and age. The higher education, employment, and older age were positively associated with the higher HIL scores.</div></div><div><h3>Conclusion</h3><div>HIL allegedly plays an essential role in the informed healthcare decision-making and equitable service utilization. Disparities seemingly exist across the demographic and regional groups in terms of HIL. Therefore, the tailored educational programs, workplace training, and clearer insurance communication tools are recommended to improve the HIL and reduce inequalities in Iran’s healthcare system.</div><div>What is already known about the topic?</div><div>Health insurance literacy (HIL), a subdomain of health literacy, is essential for informed decision-making and effective use of insurance benefits. Globally, inadequate HIL is linked to the delays in care, increased healthcare costs, and poor service utilization. In Iran, research on HIL has been limited to local studies or tool development, with no national-scale investigation addressing regional disparities or sociodemographic determinants.</div><div>What does this study add to the literature?</div><div>This is the first nationally representative study of HIL in Iran, covering over 1,625 individuals from diverse insurance funds and provinces. It revealed significant inequalities in HIL related to age, gender, education, employment, income, and geographic location—providing empirical evidence to inform the national health policy making.</div><div>What are the policy implications?</div><div>Findings underscore the need for targeted and equity-oriented HIL interventions. Policymakers should implement accessible public education campaigns, digital advisory platforms, and workplace-based training to improve HIL among vulnerable groups. Such strategies can support more informed insurance use and promote equitable access to healthcare.</div></div><div><h3>Background</h3><div>Health literacy, defined as “the capacity of individuals t","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100150"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.hpopen.2025.100142
Taiwo Oluwaseun Sokunbi , Abbas Bashir Umar , Uko Bassey Eyo
The U.S. decision to withdraw from the World Health Organization (WHO) under President Trump’s second term has significant implications for global health financing, particularly in Africa. As the largest contributor to the WHO, the U.S. provided 12–15% of the organization’s total funding between 2022 and 2023, and its withdrawal threatens essential health programs addressing HIV/AIDS, maternal and child health, tuberculosis, and malaria, which heavily rely on external funding. Reduced funding will disproportionately affect low- and middle-income African countries, increasing the financial burden on households and limiting access to critical healthcare services.
{"title":"Implications of U.S. withdrawal from the World Health Organization on health financing in Africa","authors":"Taiwo Oluwaseun Sokunbi , Abbas Bashir Umar , Uko Bassey Eyo","doi":"10.1016/j.hpopen.2025.100142","DOIUrl":"10.1016/j.hpopen.2025.100142","url":null,"abstract":"<div><div>The U.S. decision to withdraw from the World Health Organization (WHO) under President Trump’s second term has significant implications for global health financing, particularly in Africa. As the largest contributor to the WHO, the U.S. provided 12–15% of the organization’s total funding between 2022 and 2023, and its withdrawal threatens essential health programs addressing HIV/AIDS, maternal and child health, tuberculosis, and malaria, which heavily rely on external funding. Reduced funding will disproportionately affect low- and middle-income African countries, increasing the financial burden on households and limiting access to critical healthcare services.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100142"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID-19 pandemic represented a significant shock to healthcare systems, which faced substantial challenges on multiple fronts. In addition to organizational and clinical issues, one important challenge that required attention was adapting hospital service reimbursement systems to address a new disease with initially unknown costs and consequences. In this paper, we quantify the gap between DRG tariffs and the actual hospitalization costs of COVID-19 cases, through a comparison with pre-COVID-19 cases of respiratory tract infections, at San Martino Polyclinic Hospital, Genoa, Italy. We collected and analyzed a unique administrative dataset comprising Hospital Discharge Records (HDRs). We used propensity score matching to compare health outcomes and hospitalization costs of patients with confirmed SARS-CoV-2 pneumonia and patients in a control group of pre-COVID-19 patients with similar characteristics. We found that COVID-19 infection leads to a higher probability of being admitted to the Intensive Care Unit (ICU) and death, fewer days of hospitalization, increased hospital services, and increased costs of these services. Factors that increased hospitalization costs included female gender, age group 65–74 years, being admitted to ICU, death, increased length of stay (LOS), and the association between mechanical respiration DRGs and COVID-19 infection. In the period examined, DRG reimbursements were underestimated in severe COVID-19 cases requiring mechanical respiration. Knowledge of the factors that influence COVID-19 hospitalization costs may lead to a more comprehensive DRG tariff and, overall, to more effective management of financial resources in the event of future similar outbreaks.
{"title":"Adjusting hospital reimbursements to the onset of a new disease: Lesson from Covid-19","authors":"Francesco Copello , Michela Dattaro , Lucia Leporatti , Marcello Montefiori","doi":"10.1016/j.hpopen.2025.100148","DOIUrl":"10.1016/j.hpopen.2025.100148","url":null,"abstract":"<div><div>The COVID-19 pandemic represented a significant shock to healthcare systems, which faced substantial challenges on multiple fronts. In addition to organizational and clinical issues, one important challenge that required attention was adapting hospital service reimbursement systems to address a new disease with initially unknown costs and consequences. In this paper, we quantify the gap between DRG tariffs and the actual hospitalization costs of COVID-19 cases, through a comparison with pre-COVID-19 cases of respiratory tract infections, at San Martino Polyclinic Hospital, Genoa, Italy. We collected and analyzed a unique administrative dataset comprising Hospital Discharge Records (HDRs). We used propensity score matching to compare health outcomes and hospitalization costs of patients with confirmed SARS-CoV-2 pneumonia and patients in a control group of pre-COVID-19 patients with similar characteristics. We found that COVID-19 infection leads to a higher probability of being admitted to the Intensive Care Unit (ICU) and death, fewer days of hospitalization, increased hospital services, and increased costs of these services. Factors that increased hospitalization costs included female gender, age group 65–74 years, being admitted to ICU, death, increased length of stay (LOS), and the association between mechanical respiration DRGs and COVID-19 infection. In the period examined, DRG reimbursements were underestimated in severe COVID-19 cases requiring mechanical respiration. Knowledge of the factors that influence COVID-19 hospitalization costs may lead to a more comprehensive DRG tariff and, overall, to more effective management of financial resources in the event of future similar outbreaks.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100148"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/j.hpopen.2025.100147
Adriano Massuda , Michelle Fernandez , Marco Antonio Catussi Paschoalotto , Elisandréa Sguario Kemper
This study examines the policy investments in Primary Health Care (PHC) within the health systems of Brazil, Chile, and Colombia, highlighting their contributions toward achieving Universal Health Coverage (UHC). Employing a qualitative methodology, the research includes an institutional historical review and interviews with key stakeholders to analyze the development of PHC financing policies and practices in these countries. Brazil, with its Unified Health System (SUS), demonstrates federal leadership through initiatives like Requalifica UBS and the new PAC, albeit facing challenges in regional equity and monitoring. Chile emphasizes central governance but struggles with municipal funding capacity and infrastructure renewal. Colombia lacks targeted PHC investment policies but shows promise through emerging frameworks such as the Planes Maestros. The findings underline the critical role of integrated governance, sustainable funding, and advanced technological investment in strengthening PHC systems. Recommendations include enhancing territorial diagnostics, fostering public–private partnerships, and aligning investments with demographic and regional needs. Therefore, this research contributes to understanding PHC financing structures, offering actionable insights for improving equity and access. Limitations include the study’s focus on three countries and qualitative scope, suggesting future research should adopt broader comparative frameworks and mixed methodologies to evaluate the long-term impacts of PHC investments globally.
{"title":"Primary health care policy investments in the Latin America context: Health systems experiences from Brazil, Chile, and Colombia","authors":"Adriano Massuda , Michelle Fernandez , Marco Antonio Catussi Paschoalotto , Elisandréa Sguario Kemper","doi":"10.1016/j.hpopen.2025.100147","DOIUrl":"10.1016/j.hpopen.2025.100147","url":null,"abstract":"<div><div>This study examines the policy investments in Primary Health Care (PHC) within the health systems of Brazil, Chile, and Colombia, highlighting their contributions toward achieving Universal Health Coverage (UHC). Employing a qualitative methodology, the research includes an institutional historical review and interviews with key stakeholders to analyze the development of PHC financing policies and practices in these countries. Brazil, with its Unified Health System (SUS), demonstrates federal leadership through initiatives like Requalifica UBS and the new PAC, albeit facing challenges in regional equity and monitoring. Chile emphasizes central governance but struggles with municipal funding capacity and infrastructure renewal. Colombia lacks targeted PHC investment policies but shows promise through emerging frameworks such as the Planes Maestros. The findings underline the critical role of integrated governance, sustainable funding, and advanced technological investment in strengthening PHC systems. Recommendations include enhancing territorial diagnostics, fostering public–private partnerships, and aligning investments with demographic and regional needs. Therefore, this research contributes to understanding PHC financing structures, offering actionable insights for improving equity and access. Limitations include the study’s focus on three countries and qualitative scope, suggesting future research should adopt broader comparative frameworks and mixed methodologies to evaluate the long-term impacts of PHC investments globally.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100147"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.hpopen.2025.100145
Victor Chimhutu , Armel Dagrou , Archlove Takunda Tanyanyiwa
The informal market for medicines poses great danger to public health as they expose populations to counterfeit and expired medicines, among many vices. Ivory Coast is one of the countries where this market is growing. The country has been trying to end this market unsuccessfully. This study aims to investigate the perceived role of the state in the regulation and efforts to end this market. A qualitative case study design was used, with in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods for data collection. 20 IDIs and 3 FGDs with 13 participants in total were conducted with sellers, buyers, and pharmaceutical experts. We found that: the informal market plays an integral role in the health system and that it provides employment to many. Additionally, this informal market is complex and requires a lot of cooperation and coordination at many levels to successfully end it, which is resource demanding. Based on some of these reasons, there is an ambivalence in the regulation and the quest to end this market. The study concludes that the government of Ivory Coast needs to be decisive in its roles of regulation and that of ensuring that medicines are available and accessible.
{"title":"They don’t want to close Roxy: a qualitative account on the perceived efforts by Ivory Coast to end the informal market for medicines","authors":"Victor Chimhutu , Armel Dagrou , Archlove Takunda Tanyanyiwa","doi":"10.1016/j.hpopen.2025.100145","DOIUrl":"10.1016/j.hpopen.2025.100145","url":null,"abstract":"<div><div>The informal market for medicines poses great danger to public health as they expose populations to counterfeit and expired medicines, among many vices. Ivory Coast is one of the countries where this market is growing. The country has been trying to end this market unsuccessfully. This study aims to investigate the perceived role of the state in the regulation and efforts to end this market. A qualitative case study design was used, with in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods for data collection. 20 IDIs and 3 FGDs with 13 participants in total were conducted with sellers, buyers, and pharmaceutical experts. We found that: the informal market plays an integral role in the health system and that it provides employment to many. Additionally, this informal market is complex and requires a lot of cooperation and coordination at many levels to successfully end it, which is resource demanding. Based on some of these reasons, there is an ambivalence in the regulation and the quest to end this market. The study concludes that the government of Ivory Coast needs to be decisive in its roles of regulation and that of ensuring that medicines are available and accessible.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100145"},"PeriodicalIF":1.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.hpopen.2025.100146
Susan Usher , Sara Allin , Lara Gautier , Katherine Fierlbeck , Veena Sriram , Aidan Bodner , Camille Trapé , Leah Shipton , Alessia Montecalvo , Peter Berman
Background
Studies of COVID-19 pandemic responses reveal shortcomings that may relate to the organization of public health systems.
Objective
This study uncovers the organizational factors that may strengthen pandemic responses in high-income countries through a comparative analysis of four Canadian provinces.
Methods
We undertook a qualitative multiple case study, collecting data through document review and 103 interviews with government and non-governmental actors involved in pandemic response. Analysis explored how differences in the organization of provincial public health systems influenced decision-making, advisory, coordination and adaptation processes.
Results
The scale of the pandemic positioned the Premier as legitimate decision-maker in all provinces regardless of the distribution of authority in their public health systems. Capacity for generating public health advice was increased through existing or new organizations and highlighted the advantage of links to university expertise. All public health systems relied on healthcare resources for testing programs despite differences in the integration of public health under healthcare governance structures; centralization of healthcare governance was a facilitator. Adapting pandemic control measures to population needs was supported by linkages between organizations capable of apprehending needs and organizations that made decisions.
Conclusions
This study builds on the literature of pandemic responses across high-income countries and uncovers organizational factors that may enhance agility to rapidly expand capacities, connect actors for emergency responses, and strengthen public health systems.
{"title":"The influence of public health organization on response to the COVID-19 pandemic in four Canadian provinces: A comparative qualitative analysis","authors":"Susan Usher , Sara Allin , Lara Gautier , Katherine Fierlbeck , Veena Sriram , Aidan Bodner , Camille Trapé , Leah Shipton , Alessia Montecalvo , Peter Berman","doi":"10.1016/j.hpopen.2025.100146","DOIUrl":"10.1016/j.hpopen.2025.100146","url":null,"abstract":"<div><h3>Background</h3><div>Studies of COVID-19 pandemic responses reveal shortcomings that may relate to the organization of public health systems.</div></div><div><h3>Objective</h3><div>This study uncovers the organizational factors that may strengthen pandemic responses in high-income countries through a comparative analysis of four Canadian provinces.</div></div><div><h3>Methods</h3><div>We undertook a qualitative multiple case study, collecting data through document review and 103 interviews with government and non-governmental actors involved in pandemic response. Analysis explored how differences in the organization of provincial public health systems influenced decision-making, advisory, coordination and adaptation processes.</div></div><div><h3>Results</h3><div>The scale of the pandemic positioned the Premier as legitimate decision-maker in all provinces regardless of the distribution of authority in their public health systems. Capacity for generating public health advice was increased through existing or new organizations and highlighted the advantage of links to university expertise. All public health systems relied on healthcare resources for testing programs despite differences in the integration of public health under healthcare governance structures; centralization of healthcare governance was a facilitator. Adapting pandemic control measures to population needs was supported by linkages between organizations capable of apprehending needs and organizations that made decisions.</div></div><div><h3>Conclusions</h3><div>This study builds on the literature of pandemic responses across high-income countries and uncovers organizational factors that may enhance agility to rapidly expand capacities, connect actors for emergency responses, and strengthen public health systems.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100146"},"PeriodicalIF":1.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-03DOI: 10.1016/j.hpopen.2025.100144
Pavitra Paul
Background
The World Health Organization (WHO) Global Action Plan for the Prevention and Control of Non-communicable diseases (NCDs) 2013–2030 emphasises that effective NCD prevention and control requires leadership, coordinated multisectoral and multistakeholder engagement across a broad range of sectors, and partnerships with relevant civil-society organisations and private-sector entities. This study identifies country specific policy instruments and levers, and thus, unfolds the context specific contributions of a national multisectoral commission to tackle the problems of NCDs.
Methods
The data from twenty-six countries (low-income countries: 2, lower-middle-income countries: 9, upper-middle-income countries: 11 and high-income countries: 4) spread over all six WHO regions are analysed at two levels – the first level of analysis examines the correlation between having a national multisectoral commission and the select risk factors for NCDs. In the second level of analysis, a series of regression-based models is applied for understanding the effect of having a national multisectoral commission on the probability of dying from any of four NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases), and also on the health adjusted life expectancy (HALE) at birth and at age 60 years.
Results
Our results comprehend that (a) a national multisectoral commission is acting through a varied combinations of different instruments and levers, and such combinations do not follow any definite pattern, and (b) a consistent improvement of HALE is better sustained with having a national multisectoral commission for NCDs.
Conclusion
To conclude, this study establishes the need for further research on the performance of a national multisectoral commission, agency or mechanism for NCDs with a three-dimensional approach that is with an approach that includes (1) the national multisectoral commission, agency or mechanism for NCDs with its attributes, (2) the distribution of risk factors across different population groups, and (3) the demography and its determinants of health for the population.
{"title":"A national multisectoral commission: Contours and Contributions to the Population Health Development","authors":"Pavitra Paul","doi":"10.1016/j.hpopen.2025.100144","DOIUrl":"10.1016/j.hpopen.2025.100144","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization (WHO) Global Action Plan for the Prevention and Control of Non-communicable diseases (NCDs) 2013–2030 emphasises that effective NCD prevention and control requires leadership, coordinated multisectoral and multistakeholder engagement across a broad range of sectors, and partnerships with relevant civil-society organisations and private-sector entities. This study identifies country specific policy instruments and levers, and thus<em>,</em> unfolds the context specific contributions of a national multisectoral commission to tackle the problems of NCDs.</div></div><div><h3>Methods</h3><div>The data from twenty-six countries (low-income countries: 2, lower-middle-income countries: 9, upper-middle-income countries: 11 and high-income countries: 4) spread over all six WHO regions are analysed at two levels – the first level of analysis examines the correlation between having a national multisectoral commission and the select risk factors for NCDs. In the second level of analysis, a series of regression-based models is applied for understanding the effect of having a national multisectoral commission on the probability of dying from any of four NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases), and also on the health adjusted life expectancy (HALE) at birth and at age 60 years.</div></div><div><h3>Results</h3><div>Our results comprehend that (a) a national multisectoral commission is acting through a varied combinations of different instruments and levers, and such combinations do not follow any definite pattern, and (b) a consistent improvement of HALE is better sustained with having a national multisectoral commission for NCDs.</div></div><div><h3>Conclusion</h3><div>To conclude, this study establishes the need for further research on the performance of a national multisectoral commission, agency or mechanism for NCDs with a three-dimensional approach that is with an approach that includes (1) the national multisectoral commission, agency or mechanism for NCDs with its attributes, (2) the distribution of risk factors across different population groups, and (3) the demography and its determinants of health for the population.</div></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"9 ","pages":"Article 100144"},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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