Health Economics Policy and Law最新文献

In public healthcare systems, effectiveness is a central requirement for determining which services should be offered and reimbursed. Yet, due to its technical nature and to the need for specification through specialised bodies, the nature of this principle remains underexplored. This article bridges the gap by conducting a comparative analysis of effectiveness' operation in three distinct healthcare systems: Germany, France, and England. We argue that effectiveness can be recognised as a foundational legal principle governing reimbursement decisions, revealing a substantive and a formal dimension. Substantively, effectiveness requires a consideration of an intervention's ability to bring about a clinical benefit, accounting both for its desired outcomes and its risks. The applied evidentiary standard calls for a careful scrutiny of the available scientific evidence, as well as the state of medical knowledge. The exceptions to this standard are extremely limited and do not undermine the validity of the wider principle. Formally, the article emphasises the central role that administrative authorities conducting Health Technology Assessment (HTA) play, with delegated decisions ranging from the definition of the applicable evidentiary standards to the issuing of binding guidelines. It is argued that mechanisms must be put in place to ensure these bodies' expertise, independence, and transparency.

Telemedicine is increasingly playing a vital role in European health systems, offering great potential for improving healthcare access and outcomes. Funded between September 2022 and December 2024, the Joint Action 'Strengthening eHealth including telemedicine and remote monitoring for health care systems for CANcer prevention and care' (eCAN JA) provided evidence-base for person-centred implementation of telemedicine services among cancer patients in the European Union (EU). Through a mixed-method approach, this foresight study gathered insights from key decision-makers in 14 EU Member States and eight cancer patient associations via two surveys and a joint workshop, conducted within the Sustainability Work Package (WP4) of the eCAN JA. Our results show that EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person services for cancer care. The policy recommendations from our study can be summarised as follows: (i) develop legal frameworks to complement in-person care with telemedicine; (ii) improve digital literacy and information technology infrastructure while ensuring privacy and health equity; and (iii) engage patients in the co-design of telemedicine services. Implementing these recommendations will enhance the integration of telemedicine into cancer care in Europe.

Private equity (PE) firms are increasingly investing in healthcare, seeking short-term returns through market consolidation, price increases, asset sales, and financial engineering. Although PE is transforming the healthcare sector, many countries lack systematic data to determine whether a regulatory response is warranted. Using data from PitchBook, we document substantial and growing PE investment in health care across 25 of 38 Organization of Economic Cooperation and Development (OECD) countries, totalling over 8,400 reported deals and $1.4 trillion in capital between 2013 and 2023. Outpatient clinics represent the dominant target of investment, while hospital and elder care sectors have attracted investments in select countries. Exploratory regression analyses suggest that PE firms are less likely to invest in countries with a social health insurance system and that PE deal volume is positively associated with health expenditures. Country-specific deviations from model predictions underscore the importance of unmeasured country-specific factors such as regulation, payment policy, and market competition. Eight case studies illustrate the operational, financial, and social implications of PE investments, as well as diverse regulatory contexts. Given the lack of disclosure requirements, a key policy priority for governments is to enhance transparency to enable effective monitoring of the financialisation of health care delivery.

This study aims to understand if the American public supports five policies related to the involvement of healthcare providers in immigration enforcement efforts such as documenting legal status in medical charts to actively assisting immigration enforcement. We also seek to establish whether public attitudes are stable on this issue using an experiment highlighting the implications of these policies for immigrants, communities, and the broader public. To assess public attitudes, we fielded a survey (N = 6049) from 7 March to 26 March 2025. We randomly assigned respondents to one of six treatments highlighting various implications of these policies for immigrants and communities. We found a divided public on the topic, with a substantial number of Americans willing to blur the lines between immigration policy and the provision of healthcare. Respondents were most receptive to tracking the number of undocumented patients served and least supportive of assisting in detaining patients. We found substantial differences based on party affiliation and presidential vote choice but not personal connections or residence inside or outside of border states. Our findings suggest that a majority of Americans support some level of immigration enforcement in healthcare settings while public opinion on this issue is hard to move.

With population aging, the establishment of universal long-term care insurance (LTCI) has emerged as a critical policy issue. This paper examines the effects of China's LTCI pilots on the physical accessibility of home and community-based services (HCBS) and specific services for older adults. Using three-wave panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we analyze the rollout of LTCI pilots across different cities from 2014 to 2021, employing a time-varying difference-in-differences (DID) approach. Our findings indicate that LTCI significantly improves access to HCBS for older adults, particularly in personal daily care. Heterogeneity analysis indicates that LTCI has a stronger positive effect on the accessibility of HCBS for older adults with physical impairment, lower financial transfers from children, or living alone or with a spouse only, and the positive effect is more salient in regions with higher reimbursement for HCBS and more generous coverage. This study provides compelling evidence regarding the pivotal role of institutional design of LTCI in shaping older adults' care-seeking behavior and system-level resource allocation. It offers nuanced insights into the evaluation of differentiated pilot programs across cities, which can inform the development of a uniform national LTCI policy and carry implications for other developing countries.

Private sector entities can invest in and own the means of healthcare provision, creating opportunities and risks for health systems. While private investment can enhance access to capital, promote competition, and foster innovation, it can also exacerbate incentives for providers to engage in supplier-induced demand, undue price increases, quality compromises, and 'cherry-picking' of the most profitable patients and services. Despite the growing presence of private investors in the healthcare sector, heterogeneity in investor types remains poorly understood. This limits the ability of policymakers to consider whether, and to what extent, regulatory intervention is called for in relation to different forms of investor-ownership. By drawing on principal-agent theory, this article begins to address this gap by presenting a typology of investor-ownership in health services provision. Examining the policy relevance of such a typology, we present a case study analysis of current regulations directed at ownership across five countries, representing different health system models. We find that regulatory frameworks that differentiate between types of for-profit investor-ownership are largely absent in Europe, but more developed in the US. We argue that growing private investments require a combination of entry regulation and behavioural oversight to better align the incentives of investor-owners with public health objectives.

Growing demand for social care and resource constraints compel decision-makers to decide how to allocate public resources to social care. Such decisions may result in differences in access to social care between groups in society. In this study we conducted a secondary analysis of articles included in a systematic review on the underpinnings of resource allocation decisions in social care, extending that work to examine the potential consequences of such decisions. We conducted the review in accordance with the PRISMA framework. Through a thematic framework analysis of 37 of the 42 articles included in the parent review, we identified five groups in society that may be disproportionately affected by the consequences of resource allocation decisions on social care: (1) individuals with long-term social care needs (2) informal caregivers, (3) lower socio-economic groups, (4) individuals with limited health literacy skills, and (5) individuals living across different regions. Our findings highlight that allocation decisions in social care particularly affect women and individuals facing language barriers and may create local variation in provision of social care. These findings suggest potential for inequitable access to social care in society and underscore the need for decision-makers to consider the consequences of their allocation decisions.

How the role of health technology assessment (HTA) agencies in relation to medical technologies (MedTech) is framed in the literature reflects and influences governance, shaping perceptions and guiding decisions. We identify different academic discourses to advance MedTech policy debates, in light of several factors potentially influencing this role. This is the first time that discourse on the role of HTA agencies in relation to MedTech has been reviewed. We conducted a comprehensive search, screened for eligibility, and synthesised findings using discourse analysis. 119 articles were included, from which 5 discourses were constructed. The first discourse describes the HTA agency as an independent evaluator of appropriate evidence for all health technologies. The second discourse explicitly categorises MedTech as separate from pharmaceuticals and expands the role of evaluator to include encouraging evidence generation for MedTech. The third discourse moves away from the role of independent evaluator and describes the HTA agency as a convenor of all stakeholder perspectives, using an experimental approach. The fourth and fifth discourses critically reflect on the role of HTA agencies, the fourth on their level of normative reflection and the fifth on their level of nuanced, clinical expertise. We conclude with recommendations for policy and research.

The role of healthcare provider ownership in shaping health system performance remains contested. An umbrella review was conducted to synthesise evidence on the relationship between healthcare provider ownership and performance in high-income countries. Systematic reviews were included that examined performance of healthcare providers based on ownership status. Searches yielded 1,862 results, with 31 systematic reviews meeting the inclusion criteria, and one further systematic review identified through grey literature searches. Following the exclusion of 10 reviews classified as low-quality and two previous umbrella reviews both published in 2014, 20 reviews were eligible for data extraction and synthesis. Inconsistent evidence was found across reviews between healthcare provider ownership and several performance indicators including health outcomes, technical efficiency, and patient satisfaction. Private hospitals tend to serve wealthier patients, select less complex or costly patients, and charge higher payments for care than public comparators. Private for-profit (FP) providers of hospital and long-term care generally had poorer workforce outcomes than private not-for-profit or public providers, including reduced staffing levels, higher workloads, and lower job satisfaction. Private PF hospitals and nursing homes had improved financial performance based on revenues or profit margins. Our findings underscore the need for nuanced regulatory responses to the expansion of private FP provision within publicly funded systems.