Health Care Analysis最新文献

Israel's aging population and demographic growth have driven a surge in hospitalizations, prompting the Ministry of Health to expand community-based care. In 2019, a financial incentive was introduced, special payments to health maintenance organizations (HMOs) for Hospital at Home (HaH) services, implemented in 2020. This study examines changes in the volume and geographic distribution of HaH following this policy. We analyzed retrospective Ministry of Health data on all HaH admissions from 2017-2023, excluding COVID-19 cases. Data included length of stay, referral source (hospital vs. community), patient age, and residence. HMOs reported 70,203 HaH admissions during the study period, increasing from only 8 in 2017 to 33,141 in 2023. Growth was most rapid after the payment policy was introduced. The mean monthly HaH days rose sharply, reaching 2762 in 2023. Over time, the proportion of HaH admissions from central Israel increased, while peripheral areas saw a relative decline. Readmission rates to HaH were low-3% within 1 week, and 8%, 15%, and 23% within 1, 3, and 6 months, respectively. HaH could play a significant role in meeting Israel's growing demand for inpatient care. To maximize its impact, policy efforts should address barriers to expansion, particularly in peripheral regions, and promote more equitable geographic access.

The diagnosis and perception of autism have undergone significant transformations throughout history. Initially conceptualised as a symptom of schizophrenia, autism later emerged as a distinct diagnosis, evolving into the broader classification of autism spectrum disorder (ASD). This essay explores the main shifts in the understanding of autism throughout its history and different approaches to its treatment. While the traditional psychiatric perspective aligns with a naturalist view of disease, the Neurodiversity Movement advocates for a normative approach, emphasising societal adaptation over medical intervention. The study examines historical milestones, including the contributions of Eugen Bleuler, Grunya Sukhareva, Leo Kanner, and Hans Asperger, alongside the conceptual transition from low- and high-functioning autism to the spectrum model. It also discusses the implications of language in shaping autism discourse, highlighting the shift from person-first to identity-first terminology. The essay ultimately argues that the expansion of the autism diagnosis supports the neurodiversity paradigm, which fosters greater inclusion and empowerment of neurodivergent individuals. However, considerations of severity and linguistic framing remain crucial in advancing this perspective.

The COVID-19 pandemic presented unprecedented challenges for health and social care practice worldwide. Ensuring effective collaboration between health and social care is essential to meet population health needs- especially during crisis. Interprofessional education for collaborative practice (IPECP) during students' pre-licensure education is an important primer for collaboration in practice. Within IPECP, students are provided opportunities to learn about, with, and from each other, lending to professional and interprofessional socialization and processes of developing an interprofessional identity. Few studies have followed health professions graduates longitudinally from pre-licensure into professional practice to understand how IPECP supports new professionals' readiness for collaborative practice. The COVID-19 pandemic coincided with the timing of this longitudinal study of students' experiences of IPECP and collaboration upon entry to practice. This interpretive, narrative analysis provides novel insights to how collaboration was experienced during the pandemic and implications for interprofessional identity development. The participant narratives provide insight into the contexts, settings, and experiences that were critical catalysts for connection and collaboration between professionals. Findings support a need for IPECP throughout pre-licensure and into practice and provides important direction for innovative curricula, policy and practice development to prepare future collaborative practitioners and interprofessional teams.

In recent years, artificial intelligence (AI) has become more important in healthcare. It has the ability to completely change how patients are diagnosed, treated, and cared for. To make sure AI is properly supervised in healthcare, many problems need to be solved. This calls for a broad approach that includes policy, technology, and involving important people. This study investigates the governance of AI within healthcare, highlighting the importance of policy, technology, and stakeholder engagement. Adopting a mixed-methods research design, the study encompasses surveys, interviews, and document analysis to comprehensively explore diverse perspectives on AI governance. Purposive sampling techniques were employed to gather 897 valid samples, ensuring diversity across stakeholder groups. Surveys gathered quantitative data on demographic characteristics and attitudes toward AI governance, while interviews provided deeper insights into stakeholders' experiences and recommendations. Document analysis supplemented data collection by reviewing policy documents, guidelines, and academic literature related to AI governance. This study merges quantitative and qualitative data to thoroughly investigate AI governance, enabling the identification of policy implications and actionable recommendations. This study contributes novel insights by adopting a comprehensive approach to AI governance in healthcare, integrating policy, technology, and stakeholder engagement perspectives. Unlike previous studies focusing solely on individual aspects of AI governance, this research provides a holistic understanding of the complex dynamics involved. This research offers important insights into AI governance by investigating the impact of stakeholder engagement, ethical considerations, digital health disparities, governance structures, and health communication strategies on AI integration in healthcare, ultimately aiding in policy development and implementation.

Recently, the most critical psychological challenges have compelled healthcare professionals to confront their mental health issues. Consequently, many employees experiencing elevated levels of psychological stress have reported disengagement and dissatisfaction across various aspects of their work. Given the strong association between individual well-being and job satisfaction, how healthcare employees regulate their emotions and psychological health to attain job satisfaction remains largely unexplored. To address this issue, the present study investigates the effects of mindfulness, emotional intelligence, and employee well-being on healthcare workers' emotional and mental health while considering the mediating role of employee satisfaction and the moderating role of digital leadership. Data were collected through a structured questionnaire distributed to 633 healthcare employees in China. We employed SPSS and Smart PLS for reliability, discriminant validity, and structural equation modeling analyses. The findings reveal that mindfulness (MFN), emotional intelligence (EI), and employee well-being (EWB) significantly and positively influence both emotional health (EH) and mental health (MH). Furthermore, employee satisfaction (ES) mediated the relationship between mindfulness, emotional intelligence, and employee well-being to emotional and mental health. The moderating role of digital leadership (DL) was also examined, demonstrating its influence on emotional and mental health. These findings hold important implications for healthcare professionals, managers, policymakers, practitioners, and other stakeholders seeking to enhance employee well-being and job satisfaction in healthcare settings.

This article examines the complex interplay of cultural practices, genetic health risks, and evolving legal frameworks surrounding consanguineous marriage, with a focus on England and Wales. Consanguineous unions, increase offspring's risk of autosomal recessive genetic disorders and congenital anomalies due to heightened homozygosity. The 'Born in Bradford' study revealed that 37% of babies in the cohort were born to related parents, with over 60% of marriages in the Pakistani-origin population being consanguineous. This was associated with a near doubling of the congenital anomaly risk (3% to 6%) and accounted for an estimated 30% of all congenital anomalies and 25% of infant mortality in Bradford. While Norway and Sweden have recently banned or are set to ban first-cousin marriages, citing public health and forced marriage concerns, England and Wales maintain a permissive stance. Proposed legislation, like the Marriage (Prohibited Degrees of Relationship) Bill 2025, aims to prohibit these unions and is argued to mitigate NHS strain. However, such proposals face significant human rights challenges (right to marry, privacy, non-discrimination) and concerns about driving the practice underground. The paper concludes by advocating for nuanced, culturally sensitive public health strategies-including enhanced genetic counselling, targeted education, and proactive screening-to empower informed choice and improve health outcomes without legal coercion, aiming to balance state responsibility with individual and cultural freedoms.

Health care price transparency tools have proliferated across the United States in recent years. While these tools are primarily intended to help control rising healthcare costs, they are also frequently described as empowering patients by providing the financial information needed to make more fully informed decisions about medical care. If these tools do empower patients, then the money and time invested in developing and maintaining them could plausibly be justified even if price transparency proves largely ineffective at cost-containment. Using Nancy Kass's public health ethics framework, I explore whether price transparency can rightly be seen as achieving the aim of empowering patients. In examining this issue, I distinguish between what I call passive price transparency initiatives (where the information is made available for patients to find, should they choose to look for it) from active price transparency initiatives (where information about costs is given directly to patients). Most existing price transparency initiatives are passive, and I argue that these programs, rather than empowering patients, instead risk increasing patient burdens in a way that is most significant for those who are already worse off. Only active price transparency (in other words, price disclosure) can be seen as empowering patients in a fair and not overly burdensome way.

Caring for relatives of older nursing home residents during COVID-19 was sometimes morally challenging for nursing home nurses. We identified four moral challenges: (1) providing versus withholding information, (2) respecting relatives' wishes versus acting in accordance with professional standards, (3) acting in accordance with versus contrary to advance care plans, and (4) heeding versus ignoring visiting prohibitions. Care ethicist Margaret Urban Walker's framework of moral responsibility together with values listed in the ICN code of ethics for nurses were used as points of departure for reflection on these moral challenges. Each challenge was described, and moral responsibilities were charted and discussed in terms of moral relationships between nursing home nurses and the relatives of older residents, nurses' moral identity as a nurse, and nursing's moral values as listed in the ICN code of ethics for nurses. Nursing home nurses' moral responsibilities could be connected to many moral values of the nursing profession, such as empathy, responsiveness, caring, advocacy, equality, inclusivity, and compassion. However, these values have a limited effect on direct moral action, as different values can be addressed for opposite action alternatives.

Experiencing meaning and fulfillment in healthcare work is recognized as important for those in nursing, medicine, respiratory therapy, social work, and other health disciplines. Critically, moral distress, compassion fatigue, staff burnout, and individual health have all been linked as related phenomena when such experiences are compromised. And yet, we may question whether we truly understand the meaning of meaningfulness and fulfillment. What calls health providers to come to work, again and again, despite the complex and difficult situations that they have to deal with? What are sources of meaning and fulfillment? How do we understand these phenomena? The context of newborn intensive care deserves special consideration as healthcare providers manage clinical acuity, respond to infant illness, support stressed families, navigate ethical decision-making, and work through complex team dynamics. In this paper, we explore and reflect on anecdotes of meaning and fulfillment as described by healthcare providers to explicate these phenomena.

China's tiered healthcare system is designed to guide patients through a two-way referral process, with primary care as the first point of contact. However, prevalent bypassing of lower-tier facilities undermines the system's effectiveness. While previous research has examined healthcare choices, the cognitive drivers of bypassing behaviour remain insufficiently understood. A case study design was employed, involving 23 semi-structured interviews with hypertensive patients in Shenzhen. Deductive thematic analysis, guided by dual process theory, explored the cognitive mechanisms underlying bypassing, focusing on intuitive (System 1) and deliberative (System 2) decision-making. Bypassing behaviour emerged from the interplay between Systems 1 and 2 processes. System 1, driven by automatic heuristics, reinforced habitual hospital use and social norms, maintaining status quo bias and the belief that tertiary hospitals offer superior care. System 2, involving reflective risk assessment, led patients to favour hospitals due to concerns over service quality and adequacy. Importantly, System 1 established bypassing as the default, while System 2 provided retrospective justifications, entrenching this decision. However, a subset of patients, influenced by health status and personal circumstances, exhibited more flexibility, opting for primary care for convenience or accessibility. This delineates the cognitive model's boundary conditions, revealing that behavioural outcomes are not deterministic but contingent on individual and situational factors. The application of dual process theory offers a nuanced understanding of bypassing behaviour within China's tiered healthcare system, emphasising the roles of both instinctive and analytical cognitive processes. Findings suggest the need for multidimensional interventions targeting both cognitive pathways to improve primary care utilisation.