Health Policy Open最新文献

The purpose of this study was to outline the main non-communicable chronic diseases that led older people to death in Brazil and Italy before the SARS-CoV-2 pandemic according to age gaps and region of residence. This study has identified that the highest mortality rate among Brazilian and Italian women took place in lower-income areas, potentially due to insufficient public policies to increase income and improve health, which would in turn reduce the risk of chronic diseases and increase life expectancy. Men showed higher mortality rates in different regions, and tended to die earlier. Our results highlight socioeconomic differences in the areas with the highest death rates due to non-communicable chronic diseases, emphasizing the relevance of public policies to meet the needs of the overall population.

The number of homebound and bedridden elderly has been increasing in Thailand, as the aging population rapidly grows and rates of chronic diseases increase. However, decreasing family size may reflect a decline in the ability of families to provide care. Society, as a result, enhances the need for long-term care (LTC) policy to provide home care and social support for the homebound and bedridden elderly. This paper examines how care-receipt satisfaction in LTC impacts the homebound and bedridden elderly's overall happiness, using a two-year panel of 279 individuals from the Thai Health Promotion Foundation dataset. We use the pooled two-stage least square (Pooled-2SLS) model and random effect two-stage least square (RE-2SLS) model to control the endogeneity problem. The empirical results show that care-receipt satisfaction on LTC service can generate a positive impact on the overall happiness of the homebound and bedridden elderly.

In the United States, federal and local governments have attempted to contain the spread of Coronavirus Disease 2019 (COVID-19) by implementing a variety of policies such as stay-at-home orders and mask mandates. Perceptions can influence behaviors; therefore, it is important to understand how people perceive the stringency of COVID-19 policies, what factors shape perceived policy stringency, and whether and how policy perceptions impact the practice of prevention behaviors. With rolling-cross sectional survey data collected in the US from June to October 2020 and other external sources of data, the study examines the impact of objective risk of the pandemic, information seeking, and political ideology at the individual and the state levels on perceived policy stringency, and the impact of perceived policy stringency on prevention behaviors such as mask wearing and social distancing. The findings reveal that objective risk and political ideology are significantly associated with perceived policy stringency. The perceived policy stringency has negative associations with prevention behaviors. The findings provide important implications for the development process of compulsory public health policies during the pandemic.

Introduction

Document analysis is commonly used in health policy analysis (HPA) studies, but the purpose and rigour of application is unclear. This review explored the application and utility of document analysis in HPA studies conducted in low-and-middle income countries (LMICs), intending to derive lessons for strengthening this methodology.

Methods

Employing a qualitative systematic review approach, nine electronic databases were searched for LMIC HPA articles that employed document analysis. Articles were subjected to systematic retrieval, storage and quality-assessment. Thematic analysis was used in coding, extraction and analysis of data.

Results

Only 28 studies had sufficiently detailed document analyses and met the inclusion criteria. Document analyses were mainly complimentary to primary data collection forms. The majority, barring four studies, lacked clear purpose and utility in answering the research questions, and rigour in methodology and the reporting thereof. The approach to document analyses bore no relationship to the policy phase investigated. Challenges in accessing documents contributed to methodological difficulties.

Conclusion

Well-executed document analysis has potential to strengthen HPA studies. Health Policy researcher skill in applying this methodology needs strengthening and could be improved by: purposive alignment of the method to research questions; rigorously applying and reporting on search strategy with rigour; source, organize and store documents systematically; apply robust data coding and analysis; and clearly linking document contribution to study findings and conclusions.

The high cost of health care for people with behavioral health (BH) conditions or intellectual and developmental disabilities (IDD) in the United States led one state to implement the Provider-led Arkansas Shared Savings Entity (PASSE) program. PASSE is a managed care model that puts provider-led organizations at risk for the highest need people with BH conditions or IDD in Medicaid, a public health insurance program for low-income residents. Drawing on key informant interviews and payment models across the United States, we describe the PASSE program, how it compares with state Medicaid programs for similar populations, and prospects for the program. Key informants cited several PASSE features as promising mechanisms to improve beneficiary outcomes: expanded care coordination, service flexibility, incentives for community investments, accountability for cost and quality across physical health, behavioral health, and long-term care, quality target accountability, fostered competition, and provider ownership. Informants worry that PASSE features will be insufficient to catalyze changes in provider behavior. Efforts may be targeted to control costs primarily through service reductions with uncertain effects on quality of care. PASSE hinges on improved care coordination and increased efforts to address social determinants of health. Success or failure in these areas will likely determine whether PASSE leads to improved outcomes for two of the most costly and vulnerable populations.

Objectives

To explore physician descriptions of the influence of pay for performance (P4P) programs on their medical decision-making for the delivery of health care through three antecedents of behavior intention—attitude toward program compliance, perceived behavioral control, and subjective norms.

Study design/setting

This study utilized a qualitative descriptive research methodology to capture physician descriptions through semi-structured interviews and a focus group. Primary data was collected from actively practicing physicians in the United States with P4P experience.

Principal findings

The findings imply that multiple factors influence physicians’ attitudes toward program compliance summarized by four primary themes: (a) program compliance and beliefs of physicians in delivering patient care, (b) design, control, and performance motivation, (c) physician performance measurements and the opinions of others, and (d) patient care and compensation program considerations.

Conclusions

The findings suggest that physician involvement in the design, implementation, communication, and on-going evaluation of P4P models influence physician behavior. The findings also suggest that physicians are motivated by the delivery of what they believe is good patient care more than by P4P financial incentives. Finally, the most influential voices for physician P4P compliance includes their physician peers and administrators. Outside of the larger societal benefit of P4P compliance, individual family, friends, policymakers, payors, and others have little to no influence on physician decision-making.

Introduction

Patient satisfaction is a key indicator of health care quality. We investigated women’s satisfaction with antenatal, natal and immediate postnatal care, as well as the association between women’s satisfaction with the care they received and background characteristics.

Methods

We conducted a survey in the capital and two regions of Georgia. 400 women, who gave birth to healthy babies during the preceding twelve months before the date of data collection, were the target population. Women’s opinion about the organization of maternal care (tangibility, availability, accessibility) and process characteristics (responsiveness, reliability, empathy, communication and courtesy) were measured. Women satisfaction with antenatal, natal and postnatal services was also measured.

Results

Women’s satisfaction with antenatal, natal, and immediate postnatal services was high. The respondents’ perception about the tangibility of maternity houses was quite positive, more than three quarters of the respondents agreed or strongly agreed with the statements that maternity houses/units were attractive and medical equipment was up to date. Regression analysis on satisfaction with antenatal, natal, and immediate postnatal showed that those who paid for services were less satisfied than those who did not pay. Women in urban areas were more satisfied with antenatal and natal services than in rural areas. High educated women were less satisfied than women with the lowest education level.

Conclusions

In general, women are satisfied with maternal care in Georgia. The high level of satisfaction can be due to the improvement in structural factors of maternal health care such as tangibility, availability, and accessibility.

Public efforts to limit the spread of the coronavirus rely on motivating people to cooperate with the government. We test the effectiveness of different governmental messengers to encourage preventive health actions. We administered a survey experiment among a sample (n = 1,545) of respondents across the United States, presenting them with the same social media message, but experimentally varying the government sender (i.e., Federal, State, County, a combination of Federal + County, and a control condition) to test whether local relevance influences messaging efficacy. We find that in an information saturated environment the messenger does not matter. There is, however, variation in treatment response by partisanship, education, income, and the degree to which respondents are affected by the pandemic. While the main effect of the level of government on intended behavior is null, public health organizations are universally perceived as more trustworthy, relevant, and competent than anonymous messengers.