Health Economics Policy and Law最新文献

This article explores possible connections between health crises, economic policy choices, and the rise of populist movements, drawing on evidence from the interwar period. It considers how differing policy responses to the Great Depression may have been associated with contrasting trajectories in both public health and political developments. In Germany, the adoption of austerity measures in the early 1930s appears to have coincided with worsening economic conditions, declining health indicators, and growing electoral support for far-right movements. By contrast, expansionary initiatives introduced under the New Deal in the U.S. were likely accompanied by strengthened social protections, improvements in health outcomes, and what some observers have interpreted as a mitigation of pressures toward political radicalisation. Taken together, these historical experiences offer insights into contemporary developments, where perceived inadequacies in responding to intertwined health and economic crises could potentially contribute to eroding institutional trust and increasing receptiveness to populist narratives.

This paper examines Health System Resilience (HSR) through a political science lens, arguing that the capacity of health systems to become resilient is shaped not only by technical capabilities and available resources but also by the political theories underpinning health systems and health policy. While HSR has gained prominence in health research as a concept, its integration with political theories remains limited - particularly within political science literature. Drawing on a scoping review, the paper finds that political dimensions - such as governance and leadership, institutional path dependency, and power dynamics - are rarely and unevenly addressed in the literature. Most sources adopt a fragmented view of policy and politics, infrequently identifying the Political Determinants of Health (PDoH) systematically or analysing them through robust political theory. As a result, resilience is often depoliticised and treated as a managerial issue rather than a contested political process. In light of these findings, the paper proposes new opportunities to scrutinise how HSR is shaped by the interplay of actors, ideas, and institutions. In doing so, it contributes to developing a political science of health that fosters stronger interdisciplinary engagement. The paper calls on political scientists to engage more proactively with public health scholarship to support politically informed and more effective resilience strategies.

Private investment in residential long-term care has surged around the world. Growing evidence shows that this is changing the institutional logic and the inner workings of the sector, prioritising the financial interests of asset holders above those of other stakeholders (eg. clients, care professionals and regulators). We know little about how policy makers and regulators are responding to private investment and profit-making in the long-term care sector. This paper addresses that gap by analysing policies prompting the growth of private investment and profit-making in residential long-term care, the emerging power struggles in some cases between asset holders and other stakeholders in long-term care, the controversies that have arisen and the concomitant responses of regulators and policy makers in Ontario (Canada), Lombardy (Italy), the Netherlands and England (United Kingdom). We show that the institutional context (eg. legal frameworks, policies and regulations) shapes controversies concerning quality, accessibility and affordability of care, and argue that regulators and policymakers in the constituencies we studied are responding reactively to such controversies rather than proactively anticipating and preventing unwanted effects. Our analysis provides policymakers with valuable insights regarding the regulation and governance of private investment and profit-making in the residential long-term care sector.

Joint clinical assessments (JCAs) under the European Union (EU) Regulation 2021/2282 on health technology assessment (HTA-R) and its implementing regulations have been linked to various implementation challenges. However, legal implications of practically relevant issues have mostly remained unexplored. This study investigated potential legal implications of disparities regarding patient population, intervention, comparator, and outcomes (PICOs) in JCAs from respective member states (MSs), and of managing conflicts of interest (CoIs) of experts involved in a JCA. Moreover, we discussed potential consequences for patient access. JCA reports are not legally binding for MS; PICO disparities can underpin the required justification for their non-consideration at national level. Legal action against negative reimbursement decisions due to unjustified non-consideration falls under national jurisdiction. Furthermore, too strict CoI management might leave perspectives of MSs with fewer experts and thus a higher chance of CoI occurrence unheard, requiring corresponding expert elicitation at national level. These implications might lead to an increased workload for health technology developers and national HTA bodies, potentially fostering marketing strategies and access delays. Thorough scoping processes and prioritising the need for a JCA's scientific excellence could facilitate more streamlined national HTA procedures and accelerated patient access.

We study private equity involvement (or lack thereof) in the long-term care (LTC) sector and its recent developments in the United States, Ireland and Poland. Based on the similarities and differences across these countries' LTC systems, which can be treated as ideal types of the variety in typical models of LTC systems, we develop a systematic approach to the analysis of private equity engagement in the sector. Specifically, we define the comparison criteria as follows: the debates about the role and place of private equity in LTC; the extent of private equity investments in LTC; the reasons for private equity entry into the LTC sector; the business strategies of private equity firms; the regulations relative to private equity in LTC. Our case study comparison demonstrates that policy responses to population aging and care needs are deeply political processes, leading to a variety of solutions shaped by institutional legacies, cultural contexts, and the power dynamics between states, markets, and civil society.

Health technology assessment (HTA) processes provide evidence to inform the supply of healthcare, often comparing results from economic evaluation to a policy threshold to judge cost-effectiveness. However, recommended policy thresholds may not always align with empirical estimates of the opportunity costs of health care expenditure, captured by marginal productivity of healthcare expenditure ('k'). Such estimates are needed to inform the net health impact of funding decisions. We map policy thresholds in HTA guidelines against published estimates of k. We extract information from HTA guidelines identified in a previous literature review, including recommended perspective, relevant costs and outcomes, and justification for the threshold. Studies estimating k were obtained from a separate review. Of the 47 included HTA guidelines, 20 state an explicit policy threshold and 12 justify their choice. Estimates of k were available for 13 countries. Among the eight countries with explicit policy thresholds and k estimates, three matched. The recommended perspective influences whether k alone is sufficient or appropriate to inform cost-effectiveness judgements. It is important that guideline setters are aware of empirical estimates of k; and that economic evaluations consider k to reflect health opportunity costs even where the policy threshold is justified on other grounds.

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.