Health Economics Policy and Law最新文献

Health policy reforms often fail due to design flaws, implementation gaps, and political barriers. This paper examines the role of government stewardship in addressing these barriers drawing on lessons from healthcare reforms in Sanming, China, a city that has become a nationally recognised model for comprehensive health system reform. Employing a qualitative approach, the analysis traces how six core stewardship functions - strategic visioning, institutional alignment, instrument design, partnership management, accountability reinforcement, and learning facilitation - enabled Sanming's government to control costs and improve service delivery and health outcomes. Sanming's experience illustrates the potential for local government stewardship to catalyse reform in the face of constraints. Interviews indicated that strengthened stewardship enabled the government to set strategic direction for the health system, mobilise stakeholders, formulate workable policies, and adapt to changing needs during implementation. However, participants identified persistent challenges, including uneven distribution of capacity across agencies, changes in the external policy environment, and deficient stakeholder feedback loops. While specific to the local context, the core stewardship competencies identified in the paper offer a generalisable framework for strengthening reform governance in other settings. As countries seek to build resilient and equitable health systems, the lessons from Sanming's stewardship model provide a timely contribution to the global health reform discourse.

Legal provisions in trade agreements, including those related to intellectual property (IP), can impede access to medicines. The 12-party Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) is currently undergoing a review. This provides an opportunity to update the CPTPP's Intellectual Property Chapter to remove certain provisions that were negotiated in the context of its precursor, the Trans Pacific Partnership (TPP), many of which have been suspended. These include several 'TRIPS-Plus' provisions - IP provisions exceeding the requirements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This paper reviews the CPTPP's TRIPS-Plus provisions, including those suspended and those still in place, and argues for their removal based on evidence of their likely effects on medicines access and recent changes in the political environment. Since the CPTPP was signed in 2018, accumulated evidence has demonstrated that TRIPS-Plus provisions negatively impact access to medicines. Lack of access to COVID-19 medical products in low- and middle-income countries has highlighted major problems with TRIPS. Furthermore, the US has diverged from a TRIPS-Plus agenda, rendering the suspended provisions obsolete. Removing the CPTPP's TRIPS-Plus provisions, while challenging, would preserve Parties' policy flexibility to design their laws in ways that protect access to medicines.

Mixed markets can enhance welfare compared to full public or private provision. However, this welfare gain depends on the extent to which market distortions exist. Recent literature demonstrates distortions in mixed long-term care markets worldwide. Our study explores potential distortions in the Dutch institutional market. While all Dutch residential nursing homes are non-profit, for-profit organisations, including private equity (PE) firms, have increasingly entered the market, offering round-the-clock care provided in home-like settings as an alternative to non-profit residential care.We analysed claims data from 2017-2021 for dementia patients aged 70 and older using multinomial logit and Cox Proportional Hazards models. Specifically, we compared risk selection, upgrading, and care quality (measured by avoidable hospitalisations and mortality) between for-profit and non-profit providers.Our findings do not suggest increased risk selection, higher upgrading, or lower care quality by for-profit (PE-owned) providers compared to non-profit providers. Consequently, we did not find evidence of strong market distortions in the Dutch institutional long-term care market. These results contrast with the existing international literature, suggesting that adverse incentives in the Netherlands may be influenced more by the way care is provided (in home-like settings versus in residential nursing homes) and financing structures rather than ownership type alone.

The European Union (EU) is currently overhauling its pharmaceutical regulations, seeking to mature a single market for medicines as part of a 'European Health Union'. We reflect on the interactions between regulations and markets in these reforms and investigate what this single market for medicines may mean in practice. We note how the proposed reforms aim to ensure equitable access to innovative treatments, yet at the same time, tie this access directly to regulatory exclusivities, limiting price competition. The reforms also do not seek full pricing transparency: prices will remain largely opaque and be set at the national levels rather than created through market exchange and open competition at the EU level. The envisioned single market for medicines thus remains a market that operates without direct reference to price - a situation not addressed head-on by the proposed reforms.

Compounded by 14 years of public welfare austerity, health equality presents a challenge that extends beyond healthcare in isolation because it also engages the more recondite politics of public health. Recent policy has addressed the issue by requiring National Health Service (NHS) bodies to integrate their services with those of local authorities. We consider how this adds significant new difficulty to the already complex process of NHS resource allocation. We argue that these duties require a new framework to gauge the values, evidence and criteria needed to set priorities for public health; not simply as a desirable objective, but a necessity in law. We consider current approaches to priority setting for medical treatment, and the responses already offered by current ethical frameworks. We then discuss the new ethical, political, and practical challenges posed by public health priority setting for health equality. Informed by this context, we engage an intersectional lens to explore a 'non-ideal' solution grounded in Professor Sir Michael Marmot's framework to reduce health inequalities.

During the 1970s and 1980s, over 30,000 people in the UK were infected with HIV and/or hepatitis C because of treatment with blood and blood products for conditions such as haemophilia or through blood transfusion. We used the social harms perspective to understand the experiences of those affected. We conducted in-depth interviews with 41 infected people and 11 family members and analysed the data according to five dimensions of social harm: physical harms, psychological harms, cultural harms, economic harms, and harms of misrecognition. We found that people were harmed by the medical system, the social context that perpetuated stigma and shame against them, and successive governments being largely unwilling to address the many health, social, and economic impacts of infection on families. What stood out were the many reports of harms of misrecognition, which were often experienced as more irreconcilable than the circumstances of infection itself. They were also harms that have been largely ignored.While patient safety encompasses a broad field of work, much of the research focuses on physical harm and medical error. The social harms lens can provide important insights into patient safety incidents as it can help explain the complexity of the different dimensions of harm that individuals and their families experience.

Despite the tremendous waste due to Medicaid fraud and abuse, not much scholarly attention has been paid to state variation in the investigations. This study explores the factors influencing variations in Medicaid fraud and abuse investigations across U.S. states, with a focus on the role of All-Payer Claims Databases (APCDs) and state political context. To test the impacts of price transparency and political factors, we built a dataset spanning eight years (2014 to 2021) and covering 49 states, excluding North Dakota. We then conducted a fixed-effects panel data analysis based on the results of a Hausman test. The impact of APCDs is statistically significant, suggesting its association with more fraud and abuse detection. A Democratic governor tends to be associated with fewer Medicaid fraud investigations. The findings of this research demonstrate that the operation of APCDs can influence the number of Medicaid fraud investigations conducted by Medicaid Fraud Control Units (MFCUs). Moreover, political discretion plays a role in the number of state investigations into Medicaid fraud and abuse.

The Making Care Primary (MCP) model represents a sharp shift in Medicare's approach to primary care, yet its current design risks duplicating failures from prior alternative payment models. Our editorial suggests refinements to address these gaps. To prevent early provider dropout from MCP's rigid track-based system, we propose a sliding-scale infrastructure payment model that adjusts based on practice needs rather than abrupt phase-outs. Given MCP's reliance on community-based organisations (CBOs) for social determinants of health interventions, we also advocate for direct, outcomes-based contracts between providers and CBOs, ensuring accountability for patient outcomes rather than passive referrals. We recommend that MCP enforce data-sharing mandates for commercial insurers and Medicaid agencies, drawing from Washington State's successful Multi-Payer Collaborative, to avoid payer disengagement that plagued previous multi-payer models. To expand beyond conventional quality measures, we propose integrating patient-centred outcomes from the International Consortium for Health Outcomes Measurement, making sure MCP captures meaningful clinical impact. Finally, we propose programme adjustments frequently at two- to three-year intervals to refine risk adjustment methodologies. These approaches could enhance MCP's sustainability, preventing the financial instability and misaligned incentives that undermined past value-based care initiatives.