Pub Date : 2025-10-22DOI: 10.1016/j.hlpt.2025.101126
Alexander Roediger , Lennart Pirktl , Georg Schönbächler , Helmut Brand
Objectives
There is a lively debate about the fair price of medicines, mainly led by experts. Little is known about the public’s opinion, although in most health systems with universal coverage medicines are procured by public money through payers or governments. This study assesses public opinion about fair medicine prices, the criteria that define fairness, and the policy implications.
Methods
A population survey amongst 1000 people across the Swiss population in all 3 language regions has been conducted between September and October 2024.
Results
Access for all (986), transparency of the cost structure (914) and a price reflecting the costs of a medicine (911) have ranked as the most relevant factors for a fair price of medicine. In contrast, the additional benefit of a new therapy is considered less important as a criterion. A large majority supports pharmaceutical companies making a profit. Asked how to align the different objectives, the majority supports the statement that medicines prices should be the result of a fair process (568), followed by the statement that governments should control profits (431).
Conclusions
This study suggests that citizens consider the balance between patient access and investment in research and development as the most relevant for a fair price of a medicine. When access and cost create a dilemma, citizens favour fair procedures. In contrast to expert opinions, the additional benefit of a medicine seems to be a less relevant criterion. The survey results indicate a nuanced and pragmatic approach to fairness, considering societal, scientific, and economic factors.
{"title":"Determining fair medicines prices. What do citizens think?","authors":"Alexander Roediger , Lennart Pirktl , Georg Schönbächler , Helmut Brand","doi":"10.1016/j.hlpt.2025.101126","DOIUrl":"10.1016/j.hlpt.2025.101126","url":null,"abstract":"<div><h3>Objectives</h3><div>There is a lively debate about the fair price of medicines, mainly led by experts. Little is known about the public’s opinion, although in most health systems with universal coverage medicines are procured by public money through payers or governments. This study assesses public opinion about fair medicine prices, the criteria that define fairness, and the policy implications.</div></div><div><h3>Methods</h3><div>A population survey amongst 1000 people across the Swiss population in all 3 language regions has been conducted between September and October 2024.</div></div><div><h3>Results</h3><div>Access for all (986), transparency of the cost structure (914) and a price reflecting the costs of a medicine (911) have ranked as the most relevant factors for a fair price of medicine. In contrast, the additional benefit of a new therapy is considered less important as a criterion. A large majority supports pharmaceutical companies making a profit. Asked how to align the different objectives, the majority supports the statement that medicines prices should be the result of a fair process (568), followed by the statement that governments should control profits (431).</div></div><div><h3>Conclusions</h3><div>This study suggests that citizens consider the balance between patient access and investment in research and development as the most relevant for a fair price of a medicine. When access and cost create a dilemma, citizens favour fair procedures. In contrast to expert opinions, the additional benefit of a medicine seems to be a less relevant criterion. The survey results indicate a nuanced and pragmatic approach to fairness, considering societal, scientific, and economic factors.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101126"},"PeriodicalIF":3.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.hlpt.2025.101125
Frank R. Lichtenberg , Y. Tony Yang
Objectives
To assess whether innovation in medical procedures and products—proxied by the expansion of Healthcare Common Procedure Coding System (HCPCS) codes linked to Medicare Coverage Determinations (MCDs)—is associated with declines in disability among U.S. adults from 1997 to 2019.
Methods
We link HCPCS codes to ICD condition categories using Local Coverage Determinations (LCD) and merge these with Medical Expenditure Panel Survey (MEPS) data to construct 21 condition-year disability indicators. We estimate two-way fixed-effects models with distributed lags (0–15 years) at the condition-year level, controlling for prevalence, mean age, educational attainment, and comorbidity counts, with year and condition fixed effects; standard errors are clustered by condition. The analytic file includes ∼1.50 million condition observations from 317,000 people. This LCD-anchored mapping is a conservative lower bound because many services are paid case-by-case without an LCD.
Results
For 19 of 21 disability indicators, at least some lagged innovation coefficients are negative and statistically significant. The mean time from innovation to measurable disability reduction is 11.5 years, consistent with diffusion and time-to-benefit dynamics. Estimated 1997–2019 disability reductions attributable to prior innovation include: Supplemental Security Income (SSI) recipiency −21.3 % (largest effect), with double-digit declines for inability to work, Social Security recipiency, and school limitations; the median reduction across indicators is ∼7 %.
Conclusions
Growth in Medicare-covered technology—measured via HCPCS/MCD linkages—is associated with meaningful, long-run reductions in multiple dimensions of disability. Findings highlight the importance of accounting for diffusion lags in health technology assessment and suggest value in monitoring coverage-enabled innovation alongside real-world outcomes.
{"title":"Medicare-covered innovation and U.S. disability, 1997–2019: Evidence from healthcare procedure codes and health survey data","authors":"Frank R. Lichtenberg , Y. Tony Yang","doi":"10.1016/j.hlpt.2025.101125","DOIUrl":"10.1016/j.hlpt.2025.101125","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess whether innovation in medical procedures and products—proxied by the expansion of Healthcare Common Procedure Coding System (HCPCS) codes linked to Medicare Coverage Determinations (MCDs)—is associated with declines in disability among U.S. adults from 1997 to 2019.</div></div><div><h3>Methods</h3><div>We link HCPCS codes to ICD condition categories using Local Coverage Determinations (LCD) and merge these with Medical Expenditure Panel Survey (MEPS) data to construct 21 condition-year disability indicators. We estimate two-way fixed-effects models with distributed lags (0–15 years) at the condition-year level, controlling for prevalence, mean age, educational attainment, and comorbidity counts, with year and condition fixed effects; standard errors are clustered by condition. The analytic file includes ∼1.50 million condition observations from 317,000 people. This LCD-anchored mapping is a conservative lower bound because many services are paid case-by-case without an LCD.</div></div><div><h3>Results</h3><div>For 19 of 21 disability indicators, at least some lagged innovation coefficients are negative and statistically significant. The mean time from innovation to measurable disability reduction is 11.5 years, consistent with diffusion and time-to-benefit dynamics. Estimated 1997–2019 disability reductions attributable to prior innovation include: Supplemental Security Income (SSI) recipiency −21.3 % (largest effect), with double-digit declines for inability to work, Social Security recipiency, and school limitations; the median reduction across indicators is ∼7 %.</div></div><div><h3>Conclusions</h3><div>Growth in Medicare-covered technology—measured via HCPCS/MCD linkages—is associated with meaningful, long-run reductions in multiple dimensions of disability. Findings highlight the importance of accounting for diffusion lags in health technology assessment and suggest value in monitoring coverage-enabled innovation alongside real-world outcomes.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101125"},"PeriodicalIF":3.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.hlpt.2025.101124
Tingting Zhang , Yuhan Wei , Xiangbin Yan , William Yu Chung Wang
Objectives
: The geographically uneven distribution of healthcare resources is a serious global problem. Online healthcare platforms serve as a viable means to redistribute healthcare resources across regions. This study aims to investigate the factors influencing patients’ healthcare channel choices in the context of online–offline healthcare service integration by employing cue utilization theory and cognitive dissonance theory.
Methods
: This study adopted a scenario-based survey method to collect data. The questionnaire was designed and distributed via an online survey platform. The proposed research model was empirically tested using the data collected and structural equation modeling methods.
Results
: The results showed that channel accessibility, flexibility, and physician communication negatively affected both cognitive and emotional dissonance. Physician competence was found to negatively affect cognitive dissonance, while physician empathy was found to negatively affect emotional dissonance. In addition, both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior, with physicians’ suggestions playing a moderating role in the relationship between cognitive dissonance and patient behavior. Moreover, the influence of emotional dissonance on subsequent channel-selection and the moderating effect of a physician’s suggestion on this relationship differ fundamentally between online and offline contexts.
Conclusions
: These results enrich the literature on the integration of online and offline channels in the healthcare field and patients’ channel-selection behavior in this context. Furthermore, the study findings have practical implications for healthcare service facility management and policymakers in promoting the integration of online and offline healthcare services.
Public interest summary
The uneven distribution of healthcare resources is a significant global issue, and online platforms can help redistribute resources. This study explores the factors influencing patients’ healthcare channel choices in the context of online-offline healthcare service integration using cue utilization and cognitive dissonance theories. The research model was tested using data from a scenario-based survey and structural equation modeling methods. Results showed that channel accessibility, flexibility, and physician communication negatively affected cognitive and emotional dissonance. While physician competence was found to negatively affect cognitive dissonance, physician empathy was found to negatively affect emotional dissonance. Both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior with physicians’ suggestions playing a moderating role, where the stren
{"title":"Going online or offline? Patients’ selection of healthcare service channels","authors":"Tingting Zhang , Yuhan Wei , Xiangbin Yan , William Yu Chung Wang","doi":"10.1016/j.hlpt.2025.101124","DOIUrl":"10.1016/j.hlpt.2025.101124","url":null,"abstract":"<div><h3>Objectives</h3><div><strong>:</strong> The geographically uneven distribution of healthcare resources is a serious global problem. Online healthcare platforms serve as a viable means to redistribute healthcare resources across regions. This study aims to investigate the factors influencing patients’ healthcare channel choices in the context of online–offline healthcare service integration by employing cue utilization theory and cognitive dissonance theory.</div></div><div><h3>Methods</h3><div><strong>:</strong> This study adopted a scenario-based survey method to collect data. The questionnaire was designed and distributed via an online survey platform. The proposed research model was empirically tested using the data collected and structural equation modeling methods.</div></div><div><h3>Results</h3><div><strong>:</strong> The results showed that channel accessibility, flexibility, and physician communication negatively affected both cognitive and emotional dissonance. Physician competence was found to negatively affect cognitive dissonance, while physician empathy was found to negatively affect emotional dissonance. In addition, both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior, with physicians’ suggestions playing a moderating role in the relationship between cognitive dissonance and patient behavior. Moreover, the influence of emotional dissonance on subsequent channel-selection and the moderating effect of a physician’s suggestion on this relationship differ fundamentally between online and offline contexts.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> These results enrich the literature on the integration of online and offline channels in the healthcare field and patients’ channel-selection behavior in this context. Furthermore, the study findings have practical implications for healthcare service facility management and policymakers in promoting the integration of online and offline healthcare services.</div></div><div><h3>Public interest summary</h3><div>The uneven distribution of healthcare resources is a significant global issue, and online platforms can help redistribute resources. This study explores the factors influencing patients’ healthcare channel choices in the context of online-offline healthcare service integration using cue utilization and cognitive dissonance theories. The research model was tested using data from a scenario-based survey and structural equation modeling methods. Results showed that channel accessibility, flexibility, and physician communication negatively affected cognitive and emotional dissonance. While physician competence was found to negatively affect cognitive dissonance, physician empathy was found to negatively affect emotional dissonance. Both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior with physicians’ suggestions playing a moderating role, where the stren","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101124"},"PeriodicalIF":3.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.hlpt.2025.101123
Xizi Wan , Yiyu Ao , Zhongmou Huang , Miao Yu
Objectives
Digital health technologies hold potential to address persistent healthcare access inequities in rural China by overcoming geographic and temporal barriers. Empirical evidence regarding their implementation efficacy remains essential to guide policy development in rural health services. This study investigates whether the adoption of digital health technologies improves healthcare accessibility among rural populations in China.
Methods
Using nationally representative data from 2021 Chinese Livelihood Status Survey, we employed a probit regression model to assess the effects of digital health on healthcare accessibility. Methodological rigor was ensured through comprehensive robustness testing, including dependent variable substitution, instrumental variable (IV) analysis addressing endogeneity concerns, propensity score matching (PSM) to mitigate selection bias, and sensitivity analyses for omitted variables. Additionally, heterogeneity analyses were conducted to assess differential effects of digital health across key demographic and socioeconomic subgroups within rural communities.
Results
Our findings indicate that digital health adoption significantly improves healthcare accessibility among rural residents by 4.5 %. This result remains consistent across all robustness tests. Heterogeneity analyses reveal substantially larger gains for marginalized subgroups, particularly elderly individuals, those with lower educational attainment, low-income households, and residents in underserved areas characterized by physician shortages or underdeveloped care systems. The positive effect is further strengthened in regions with more advanced broadband infrastructure.
Conclusions
Digital health significantly improves healthcare access for rural populations in China, supplementing traditional services in resource-scarce settings. These results support the need for nationally coordinated and contextually tailored digital health initiatives to effectively reduce disparities in both technological access and healthcare delivery.
{"title":"Digital health services and rural healthcare access: Evidence from China","authors":"Xizi Wan , Yiyu Ao , Zhongmou Huang , Miao Yu","doi":"10.1016/j.hlpt.2025.101123","DOIUrl":"10.1016/j.hlpt.2025.101123","url":null,"abstract":"<div><h3>Objectives</h3><div>Digital health technologies hold potential to address persistent healthcare access inequities in rural China by overcoming geographic and temporal barriers. Empirical evidence regarding their implementation efficacy remains essential to guide policy development in rural health services. This study investigates whether the adoption of digital health technologies improves healthcare accessibility among rural populations in China.</div></div><div><h3>Methods</h3><div>Using nationally representative data from 2021 Chinese Livelihood Status Survey, we employed a probit regression model to assess the effects of digital health on healthcare accessibility. Methodological rigor was ensured through comprehensive robustness testing, including dependent variable substitution, instrumental variable (IV) analysis addressing endogeneity concerns, propensity score matching (PSM) to mitigate selection bias, and sensitivity analyses for omitted variables. Additionally, heterogeneity analyses were conducted to assess differential effects of digital health across key demographic and socioeconomic subgroups within rural communities.</div></div><div><h3>Results</h3><div>Our findings indicate that digital health adoption significantly improves healthcare accessibility among rural residents by 4.5 %. This result remains consistent across all robustness tests. Heterogeneity analyses reveal substantially larger gains for marginalized subgroups, particularly elderly individuals, those with lower educational attainment, low-income households, and residents in underserved areas characterized by physician shortages or underdeveloped care systems. The positive effect is further strengthened in regions with more advanced broadband infrastructure.</div></div><div><h3>Conclusions</h3><div>Digital health significantly improves healthcare access for rural populations in China, supplementing traditional services in resource-scarce settings. These results support the need for nationally coordinated and contextually tailored digital health initiatives to effectively reduce disparities in both technological access and healthcare delivery.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101123"},"PeriodicalIF":3.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.hlpt.2025.101120
Giuseppe Orlando
Objectives:
This study examines how baseline health risks in Cuba, Spain, Italy, and Germany relate to COVID-19 mortality trajectories and to identify system features associated with better outcomes. While previous comparative studies have emphasized GDP levels or hospital capacity, few have systematically linked baseline health risks and health-system models to pandemic trajectories; this study addresses that gap.
Study design:
Cross-country observational study of four contrasting health system models using publicly available secondary data (Cuba: state-socialist; Spain/Italy: Mediterranean welfare states; Germany: corporatist Bismarckian).
Methods:
We applied Multi-Dimensional Scaling (MDS) in two complementary stages: (i) a cross-sectional map of Baseline Health Indicators (BHI; eight pre-pandemic variables), and (ii) a trajectory-based map of Pandemic Trajectory Metrics (PTM; monthly reported indicators, 2020–2023) using correlation distance.
Results:
The BHI stage revealed distinct pre-pandemic configurations: Cuba separated on higher cardiovascular mortality and male smoking; Spain on elevated female smoking; Italy on older age structure and higher population density; and Germany on demographic pressures with higher diabetes prevalence. In the PTM stage, Cuba recorded the lowest cumulative COVID-19 mortality among the four (776 deaths per million), whereas European countries reached 2070–3261 deaths per million.
Conclusions:
The two-stage design clarifies how baseline risk profiles relate to pandemic trajectories. The Cuba–Europe separation is stable under the perturbations examined, while within-Europe distances are more variable; accordingly, we refrain from ranking Italy, Spain, and Germany. Reduced separability among the European cases is consistent with increasing financialization/marketisation and policy convergence in their health systems, which may compress structural differences in delivery and epidemic response and thus limits discrimination in the PTM space at our sample size and resolution.
{"title":"Multi-dimensional scaling of healthcare system profiles and pandemic outcomes in Cuba, Spain, Italy, and Germany","authors":"Giuseppe Orlando","doi":"10.1016/j.hlpt.2025.101120","DOIUrl":"10.1016/j.hlpt.2025.101120","url":null,"abstract":"<div><h3>Objectives:</h3><div>This study examines how baseline health risks in Cuba, Spain, Italy, and Germany relate to COVID-19 mortality trajectories and to identify system features associated with better outcomes. While previous comparative studies have emphasized GDP levels or hospital capacity, few have systematically linked baseline health risks and health-system models to pandemic trajectories; this study addresses that gap.</div></div><div><h3>Study design:</h3><div>Cross-country observational study of four contrasting health system models using publicly available secondary data (Cuba: state-socialist; Spain/Italy: Mediterranean welfare states; Germany: corporatist Bismarckian).</div></div><div><h3>Methods:</h3><div>We applied Multi-Dimensional Scaling (MDS) in two complementary stages: (i) a cross-sectional map of <em>Baseline Health Indicators</em> (BHI; eight pre-pandemic variables), and (ii) a trajectory-based map of <em>Pandemic Trajectory Metrics</em> (PTM; monthly reported indicators, 2020–2023) using correlation distance.</div></div><div><h3>Results:</h3><div>The BHI stage revealed distinct pre-pandemic configurations: Cuba separated on higher cardiovascular mortality and male smoking; Spain on elevated female smoking; Italy on older age structure and higher population density; and Germany on demographic pressures with higher diabetes prevalence. In the PTM stage, Cuba recorded the lowest cumulative COVID-19 mortality among the four (776 deaths per million), whereas European countries reached 2070–3261 deaths per million.</div></div><div><h3>Conclusions:</h3><div>The two-stage design clarifies how baseline risk profiles relate to pandemic trajectories. The Cuba–Europe separation is stable under the perturbations examined, while within-Europe distances are more variable; accordingly, we refrain from ranking Italy, Spain, and Germany. Reduced separability among the European cases is consistent with increasing financialization/marketisation and policy convergence in their health systems, which may compress structural differences in delivery and epidemic response and thus limits discrimination in the PTM space at our sample size and resolution.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101120"},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Self-sampling devices and commercial Human Papillomavirus (HPV) tests are evolving. Despite the encouraging results of a “paper smear” in 2002, along with the advantages of its transportation, brushes are more commonly used than paper-based cards for self-sampling in HPV testing. Thus, the study aimed to investigate this technology and analyze its reliability.
Methods
A review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, from August to October 2024, and updated in July 2025. Six databases - Pubmed, Embase, CINAHL, Cochrane, Scopus and China National Knowledge Infrastructure (CNKI) - were used to retrieve records, with search strings translated accordingly across them.
Results
Of 122 studies, 10 met the inclusion criteria and were considered for analysis. The study populations were predominantly at higher risk of HPV infection. The findings reveal an overall agreement range of 82.4 % to 93.3 % between self-collected samples on FTA elute (Flinders Technology Associates) card/cartridge and physician-collected samples, which is slightly inferior to that found for Evalyn Brush, the most popular self-collection device worldwide. There is a lack of standardized procedures in the diagnostic chain using paper-based cards, but the use of POI (Preventive Oncology International) card and Whatman 903 filter paper expand the potential scenario of alternative low cost devices.
Conclusions
Paper-based cards, particularly the FTA elute card/cartridge, show promising results for HPV self-sampling, with high concordance, sensitivity, and specificity. However, current evidence is limited by small sample sizes, heterogeneity across studies, and lack of standardized protocols, underscoring the need for further research to validate their reliability and expand their application in HPV testing and beyond.
{"title":"Is the paper-based card a reliable storage medium for self-sampling HPV tests? A scoping review","authors":"Giselle Aparecida de Souza Rezende, Mariana Trevisan Rezende, Cláudia Martins Carneiro","doi":"10.1016/j.hlpt.2025.101122","DOIUrl":"10.1016/j.hlpt.2025.101122","url":null,"abstract":"<div><h3>Objectives</h3><div>Self-sampling devices and commercial Human Papillomavirus (HPV) tests are evolving. Despite the encouraging results of a “paper smear” in 2002, along with the advantages of its transportation, brushes are more commonly used than paper-based cards for self-sampling in HPV testing. Thus, the study aimed to investigate this technology and analyze its reliability.</div></div><div><h3>Methods</h3><div>A review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, from August to October 2024, and updated in July 2025. Six databases - Pubmed, Embase, CINAHL, Cochrane, Scopus and China National Knowledge Infrastructure (CNKI) - were used to retrieve records, with search strings translated accordingly across them.</div></div><div><h3>Results</h3><div>Of 122 studies, 10 met the inclusion criteria and were considered for analysis. The study populations were predominantly at higher risk of HPV infection. The findings reveal an overall agreement range of 82.4 % to 93.3 % between self-collected samples on FTA elute (Flinders Technology Associates) card/cartridge and physician-collected samples, which is slightly inferior to that found for Evalyn Brush, the most popular self-collection device worldwide. There is a lack of standardized procedures in the diagnostic chain using paper-based cards, but the use of POI (Preventive Oncology International) card and Whatman 903 filter paper expand the potential scenario of alternative low cost devices.</div></div><div><h3>Conclusions</h3><div>Paper-based cards, particularly the FTA elute card/cartridge, show promising results for HPV self-sampling, with high concordance, sensitivity, and specificity. However, current evidence is limited by small sample sizes, heterogeneity across studies, and lack of standardized protocols, underscoring the need for further research to validate their reliability and expand their application in HPV testing and beyond.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101122"},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on “Applying artificial intelligence to clinical decision support in mental health: What have we learned?”","authors":"Alejandro García-Rudolph , David Sanchez-Pinsach , Eloy Opisso , Beatriz Castaño","doi":"10.1016/j.hlpt.2025.101121","DOIUrl":"10.1016/j.hlpt.2025.101121","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101121"},"PeriodicalIF":3.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.hlpt.2025.101119
Kendra Ratnapradipa, Ronnie Horner, Josiane Kabayundo, Meghan Brashear, Shinobu Watanabe-Galloway
Objectives
To assess behavioral healthcare demand relative to provider availability and identify public health regions in Nebraska that could benefit from improved broadband access to enhance telehealth services.
Methods
An ecological, cross-sectional design was used. Behavioral Risk Factor Surveillance System, Health Professions Tracking Service, and Federal Communications Commission broadband access data were analyzed. Behavioral health demand was measured through the age-adjusted prevalence of four indicators: binge drinking, marijuana use, diagnosed depression, and poor mental health days.
Results
The percentage of the population lacking broadband coverage ranged from 0.06 % to 66 % across health districts. The ratio of a health indicator (e.g., binge drinking) to the number of providers varied widely. Two health districts with a high ratio of health problems to providers, combined with low broadband coverage, stood out as potential areas that could benefit from broadband expansion.
Conclusion
The findings emphasize the critical need to improve broadband access in rural Nebraska to support telehealth services. Telehealth could be a valuable tool for addressing behavioral healthcare shortages in regions with adequate broadband infrastructure.
{"title":"Using mental health demand to prioritize areas for improving telehealth capacity","authors":"Kendra Ratnapradipa, Ronnie Horner, Josiane Kabayundo, Meghan Brashear, Shinobu Watanabe-Galloway","doi":"10.1016/j.hlpt.2025.101119","DOIUrl":"10.1016/j.hlpt.2025.101119","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess behavioral healthcare demand relative to provider availability and identify public health regions in Nebraska that could benefit from improved broadband access to enhance telehealth services.</div></div><div><h3>Methods</h3><div>An ecological, cross-sectional design was used. Behavioral Risk Factor Surveillance System, Health Professions Tracking Service, and Federal Communications Commission broadband access data were analyzed. Behavioral health demand was measured through the age-adjusted prevalence of four indicators: binge drinking, marijuana use, diagnosed depression, and poor mental health days.</div></div><div><h3>Results</h3><div>The percentage of the population lacking broadband coverage ranged from 0.06 % to 66 % across health districts. The ratio of a health indicator (e.g., binge drinking) to the number of providers varied widely. Two health districts with a high ratio of health problems to providers, combined with low broadband coverage, stood out as potential areas that could benefit from broadband expansion.</div></div><div><h3>Conclusion</h3><div>The findings emphasize the critical need to improve broadband access in rural Nebraska to support telehealth services. Telehealth could be a valuable tool for addressing behavioral healthcare shortages in regions with adequate broadband infrastructure.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101119"},"PeriodicalIF":3.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.hlpt.2025.101118
Y. Tony Yang
{"title":"Beyond checkbox participation: The radical promise of reflective stakeholder engagement in medical device assessment","authors":"Y. Tony Yang","doi":"10.1016/j.hlpt.2025.101118","DOIUrl":"10.1016/j.hlpt.2025.101118","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101118"},"PeriodicalIF":3.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To analyze the total, direct, and indirect effects of services and work process on healthcare network points, namely, primary healthcare (PHC), secondary healthcare (SHC), and tertiary healthcare (THC), on the time to begin oral cancer treatment in Brazil.
Study design
Retrospective observational ecological study.
Methods
Data were obtained from the Brazilian Unified Health System, using health regions as units of analysis. The outcome was the proportion of oral cancer patients who waited >60 days to start treatment. Independent variables were represented by PHC, SHC, and THC data. Structural equation modeling assessed total, direct, and indirect effects on the outcome using standardized factor loadings (SFLs). Analyses were conducted at a 5 % significance level.
Results
Health regions that performed oral biopsies in PHC tended to begin the treatment earlier (Direct effect, SFL = −0.155, p = 0.038), and those with better socioeconomic status had undergone higher rates of oral cancer biopsy in PHC, which decreased the mean time to begin oral cancer treatment (Indirect effect, SFL = −0.041, p = 0.035). Health regions with a higher proportion of advanced-stage diagnoses tended to experience greater delays in treatment (Direct effect, SFL = 0.252, p = 0.001).
Conclusions
Findings suggest associations between PHC actions, socioeconomic conditions, and treatment timeliness across health regions, but the ecological design precludes causal inference and warrants caution due to ecological fallacy. These results underscore the need for individual-level studies to clarify links between early diagnosis and timely cancer care.
目的分析巴西卫生保健网点即初级卫生保健（PHC）、二级卫生保健（SHC）和三级卫生保健（THC）的服务和工作流程对口腔癌开始治疗时间的总、直接和间接影响。研究设计回顾性观察生态学研究。方法以卫生区域为分析单位，从巴西统一卫生系统获取数据。结果是等待60天开始治疗的口腔癌患者的比例。自变量由PHC、SHC和THC数据表示。结构方程模型使用标准化因子负荷（SFLs）评估对结果的总、直接和间接影响。分析以5%的显著性水平进行。结果进行口腔活检的卫生地区患者开始治疗的时间更早（直接影响，SFL = - 0.155, p = 0.038），社会经济状况较好的卫生地区患者接受口腔癌活检的比例更高，这缩短了他们开始口腔癌治疗的平均时间（间接影响，SFL = - 0.041, p = 0.035）。晚期诊断比例较高的卫生地区往往会出现更大的治疗延误（直接影响，SFL = 0.252, p = 0.001）。结论：研究结果表明，卫生区域的初级保健行动、社会经济条件和治疗及时性之间存在关联，但生态设计排除了因果推理，并因生态谬误而值得谨慎。这些结果强调需要进行个体水平的研究，以澄清早期诊断和及时癌症治疗之间的联系。
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