International Journal of Health Planning and Management最新文献

The increasing prevalence of private health insurance (PHI) in tax-funded healthcare systems challenges the principles of equity and universalism. A significant proportion of PHI holders in such systems receive their insurance as an employment benefit, granting them access to privately funded healthcare alongside the publicly funded system. This dual access raises critical questions about how individuals navigate between the two sectors and how their experiences shape their perceptions of public healthcare. The aim of this study is to explore how the use of PHI-funded healthcare services influences perceptions of and satisfaction with the public healthcare system. Specifically, we examine when PHI holders choose privately funded care over public services, how they perceive the two sectors, and whether they would purchase PHI independently if it were not offered as an employment benefit. An interview study was conducted in 2022 with 19 individuals in Sweden who receive PHI as an employment benefit. Using thematic analysis, the findings reveal a preference for privately funded services due to faster access and higher service quality. However, the medical quality of specialised care in the public sector is still regarded as high. PHI is perceived as providing a sense of security through prompt care, but few respondents expressed a willingness to purchase it privately, suggesting it is seen more as a convenience than a necessity. These findings highlight the role of PHI in shaping expectations and satisfaction within tax-funded healthcare systems, offering insights into its potential impact on public trust and support of universal healthcare.

President Trump's 2025 implementation of tariffs has been described as a form of economic warfare. The public health community has long viewed conventional forms of warfare as a determinant of health and developed appropriate responses. In this editorial, we argue that this community must now respond in a similar way to all forms of economic warfare. We describe the ways in which economic warfare is waged, which include tariffs, trade sanctions, currency manipulation, and cyberattacks, and the health consequences that arise from them. Drawing on historical examples like the Opium Wars, we highlight the intertwined nature of economic and military conflicts. We also describe how advances in technology have created new opportunities, such as the exclusion of Russia from the SWIFT payment system. The health consequences are profound, with research indicating declines in life expectancy and disruptions in access to essential medicines and equipment. We argue for a comprehensive public health response, made urgent by the rejection, by the current U.S. administration, of the post-war international order. We call for use of innovative research methods to assess the health impacts of economic measures, drawing parallels with studies on the health effects of military conflicts and economic crises and advocacy for a proactive public health stance, akin to the efforts of organisations like the International Physicians for the Prevention of Nuclear War, to make visible the health consequences of economic warfare and help those who seek to hold governments accountable for their actions.

The United States (U.S.) has long played a central role in shaping global health governance, supporting United Nations agencies and funding vital programs and initiatives. However, recent political shifts, including, funding cuts, changing geopolitical priorities and a retreat from multilateralism, are threatening the stability of global health systems and research. This editorial examines the cascading consequences of these shifts, particularly for low- and middle-income countries (LMICs). The U.S. withdrawal is not just a budgetary adjustment, but a significant political disruption with unforeseen effects on global inequities. It also redirects research priorities towards security-driven agendas and undermines capacity-building efforts in LMICs. As the U.S. steps back, new actors will try to fill the vacuum, but the direction of this transition remains uncertain. Whether it paves the way for a more decentralised and equitable global health research ecosystem will depend on how global health stakeholders respond. Crucially, LMICs must seize this moment not only to replace lost funding, but to assert greater autonomy, reimagine health systems financing and build more sustainable, locally led models of research and policy leadership. This editorial calls for urgent diversification of funding sources, strengthened South-South collaborations and increased autonomy for LMICs in setting their own research priorities.

The 74th WHO Europe Regional Committee introduced a set of health priorities comprising core areas of public health and expanded tasks to respond to multiple crises and emergent needs of populations and health systems. No systematic procedure of competencies development and routine review has been established to align changing health policy priorities and workforce. We argue for a transformative approach to competencies development from theoretical constructs to actionable pathways. A rapid qualitative assessment of three of the most relevant public health workforce competencies frameworks in the WHO European region was undertaken using selected priorities and the public health workforce as cases. The results highlight that existing competencies frameworks provide some helpful guidance, but gaps exist in specific and generic competencies and leadership. Further research and policy are needed, calling European and national policymakers to action to invest in public health competencies development to respond to evolving priorities.

Improving quality of care for chronic conditions is central to addressing the large burden of premature mortality from non-communicable diseases. This paper presents the main results from case studies of health care purchasing arrangements in Chile, China, Indonesia and South Africa, which involved paying providers of primary care services using capitation with performance pay to improve service quality and health outcomes for chronic conditions. In all four settings, changes to payment methods were accompanied by other enabling interventions to provide incentives to deliver health services in a better way, such as training and non-financial incentives. However, the incentives in these programs were insufficient to drive significant changes in provider behaviour needed to improve quality. Design and implementation challenges included voluntary enrolment, quality metrics, performance targets, risk adjustment, payment certainty and levels, and withholding payments. The design and implementation challenges contributed to low patient volume or provider programme uptake resulting in lower-than-expected effects. The findings from this analysis underscore the importance of adjusting quality measures for patient health risk and complexity to avoid penalising health care providers for accepting patients with higher health risks. Relative or progressive quality targets may be more appropriate where wide diversity in providers' capacities exist, particularly in national programs, and may be used to encourage gradual quality improvements over time. Uncertainty about timing and levels of payment may have also undermined impact. Withholding performance payments as a penalty may reduce resources for quality improvements in these settings.