International Journal of Health Planning and Management最新文献

Artificial intelligence (AI) applications are complex and rapidly evolving, and thus often poorly understood, but have potentially profound implications for public health. We offer a primer for public health professionals that explains some of the key concepts involved and examines how these applications might be used in the response to a future pandemic. They include early outbreak detection, predictive modelling, healthcare management, risk communication, and health surveillance. Artificial intelligence applications, especially predictive algorithms, have the ability to anticipate outbreaks by integrating diverse datasets such as social media, meteorological data, and mobile phone movement data. Artificial intelligence-powered tools can also optimise healthcare delivery by managing the allocation of resources and reducing healthcare workers' exposure to risks. In resource distribution, they can anticipate demand and optimise logistics, while AI-driven robots can minimise physical contact in healthcare settings. Artificial intelligence also shows promise in supporting public health decision-making by simulating the social and economic impacts of different policy interventions. These simulations help policymakers evaluate complex scenarios such as lockdowns and resource allocation. Additionally, it can enhance public health messaging, with AI-generated health communications shown to be more effective than human-generated messages in some cases. However, there are risks, such as privacy concerns, biases in models, and the potential for 'false confirmations', where AI reinforces incorrect decisions. Despite these challenges, we argue that AI will become increasingly important in public health crises, but only if integrated thoughtfully into existing systems and processes.

This letter responds to Duopah et al.'s study on illicit drug use in Limerick City, drawing parallels with Taiwan's experiences in drug policy development and highlighting lessons from other countries with advanced harm reduction policies, including Portugal and Switzerland. The application of Kingdon's multiple streams model is used to analyse cross-cultural policy development. Taiwan's shift from punitive to health-oriented strategies, such as supervised injection facilities and rehabilitation programs, is explored. This letter emphasises the challenges of stakeholder engagement, particularly in integrating the perspectives of people who use drugs, and discusses the broader implications for international policy adaptation, especially in countries with similar health system challenges. Taiwan's development of multi-tiered interventions and integrated care models serves as an example of evidence-based policymaking. These insights highlight the potential for global cross-cultural learning in drug policy development.

The horrific attacks on Gaza have had a profound impact on Gaza's health system, culminating in a multidimensional crisis. The deliberate destruction of vital infrastructure, such as hospitals, schools, housing, and public facilities, coupled with the deaths and injuries of medical personnel and support workers has only exacerbated the situation and further highlighted the existing gaps. This unprecedented catastrophe proves the criticality of adopting a new national inclusive integrated approach to meeting the immediate and long-term needs of the population. In this perspective, we explore the recovery roadmap features for rebuilding the health system in Gaza, specifically focusing on determining the primary challenges that might emerge, the trajectory of recovery, and the expected crisis scenarios. The existing evidence and perspectives of key stakeholders, including state and non-state health authorities in Palestine were synthesised. Despite some local and international initiatives undertaken to generate a concrete road to recovery, there remains a need for realistic, innovative, and comprehensive Marshall plans to rebuild Gaza's health system. The article draws on insights and gaps in current efforts and underscores the urgent need to address the challenges of rebuilding the health system. The authors strive to offer an inclusive and realistic path with the potential scenarios toward recovery and resilience considering the mass levels of loss and damage, and ways to move forward for building back a resilient health system in Gaza.

The World Health Organisation's International Health Regulations were amended in May 2024, with a number of implications for countries to amend their legal and institutional frameworks. This perspective highlights two key areas of focus in the amendments-the importance of multisectoral coordination and subnational work - and explores their links to health security challenges and to concrete country experiences. National legal and institutional frameworks constitute a key enabling mechanism for effective public health systems capable of preventing, detecting, and responding promptly to public health events and emergencies, and the recent IHR amendments provide a new impetus for WHO Member States to make these changes.

The global health and care workforce (HCWF) is facing an evolving crisis, requiring urgent and sustained action. There is a critical need for enhanced workforce planning, management, and leadership, which are currently at risk of being overshadowed by political inertia, particularly in the post-COVID-19 context. A comprehensive approach tailored to the specific needs of different countries is outlined here, offering actionable insights for policymakers and stakeholders to address the HCWF crisis effectively. Key areas for critical analysis and improvement include identifying major challenges, developing policies that effectively address the HCWF crisis, and strengthening the implementation of evidence-based policies. These areas are detailed based on recent developments in the international debate, with the aim of providing comprehensive guidance for understanding the problems and identifying clear actions for improvement.

Background: A limited benefit package for outpatient care in Chinese universal health coverage led to high out-of-pocket outpatient payments, and even medical impoverishment. The outpatient pooling fund model was introduced in China's Urban Employee Basic Medical Insurance to reduce cost-sharing for outpatient care. This study attempts to examine the dynamic effects of the outpatient pooling scheme on financial risk protection for its enrollees.

Methods: A total of 18,097 individual-level observations covering 52 prefectures were extracted from six waves of China Health and Nutrition Survey (2000-2015). The difference-in-differences model with multiple periods and event study were employed to investigate the dynamic effects of reform on catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and potential mechanisms.

Results: Our results showed outpatient pooling scheme generated a significant effect on reducing the probability of incurring CHE (β = -0.004, 95% CI = -0.009 to -0.006) and IHE (β = -0.007, 95% CI = -0.012 to -0.001), especially for elderly people over 60 years old. The realization of this effect may depend on the reduction of outpatient cost-sharing, increased outpatient care utilization, as well as decreased inpatient care utilization after reform. However, event study found the effectiveness of outpatient pooling reducing CHE and IHE occurrences appeared to be weak even insignificant in more recent years relative to the initial years of policy implementation.

Conclusions: Establishing an outpatient pooling system is effective to alleviate the financial risk caused by health expenditures in China. Optimising health service delivery aimed at enhancing health insurance purchasing efficiency are deemed imperative for sustaining the policy effectiveness.

Trust is a challenging and complex concept and takes on particular significance in the context of community engagement and communication in healthcare. For the purpose of making health services more inclusive and of tackling discrimination where it occurs, there is a need to articulate a vision for inclusion that communities of historically disadvantaged or stigmatised patients can trust. This article considers examples of diversity and inclusion 'signals' on the public websites of two large public hospitals in Melbourne, Australia. We suggest that there is value in public communications reaffirming respect for diversity and a commitment to inclusion in health services. We also make the case for interdisciplinary research into how trust-signalling strategies, that is, rhetorical strategies employed to reassure or convince, are developed by and for health services for the purposes of community engagement, and the specific effects that they may engender. Websites' framing of messages that affirm institutional commitments to fostering an inclusive environment and addressing barriers can serve as a means of explicitly encouraging patients and healthcare workers from marginalised communities to overcome potential obstacles to fuller healthcare engagement and workforce participation respectively.

Background: The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid.

Purpose: This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare.

Methods: 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy.

Results: The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2 days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent.

Conclusions: Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.

As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community-based health insurance (CBHI) -considered one of the pillars of this programme- must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed-method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon et al. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above-average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU.

Background: Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined.

Methods: A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions.

Results: Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct.

Conclusion: Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.