Health Policy最新文献

The COVID-19 pandemic jeopardized individuals' health and economic stability, and the associated shocks might have decreased individuals' trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals' institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus.

Background: New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms.

Method: This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure. We undertook a longitudinal qualitative investigation -encompassing interviews and documentary analysis- of the implementation of interorganizational and digital interoperability infrastructures intended to support integrated care policies.

Findings: Our findings underscore the long-term symbiotic relationship between institutional interorganizational frameworks and the construction of interoperability infrastructures, emphasizing how they mutually reinforce each other to support their ongoing evolution. Iterative, flexible, and experimental approaches to implementation provide opportunities to adapt to local realities while learning in the making.

Conclusion: This study underlines the importance of adaptable, locally-informed implementation strategies in supporting the vision of integrated care, and the need to understand such development as a long-term, ongoing process of construction and learning.

Background and objective: Article 57 of the proposed European Union (EU) Pharmaceutical Legislation (PL, Directive) will require market authorization applicants to publicly declare any direct financial support for R&D received from public authorities. Our research aims to identify the categories needed to capture direct or indirect public contributions to R&D, provide a framework for standardized reporting of public contributions, and reduce ambiguity in the interpretation of "direct" and "indirect" public contributions.

Methods: An iterative mixed-methods approach is applied: a targeted literature review was conducted, complemented by interviews with representatives of different stakeholder groups to identify categories of public contributions to R&D, followed by searches for relevant data sources.

Results: 26 publications on primary data relevant to analyses of public contributions were identified, finding that between half of all drugs approved and >90 % of drug targets are associated with public sector institutions and/ or their spin-outs. Eight categories of public contributions to medical innovations were identified along the value chain (from basic research to post-market surveillance).

Discussion and conclusion: The framework offers a structured and systematic approach for identifying data on public and philanthropic contributions to developing medical products (medicines and devices). This information is often not comprehensively documented. Therefore, aligned public policies enforcing transparent and standardized reporting in sufficient granularity on R&D investments and conditions are key.

Background: The rising complexity of the population's needs has made health and social care integration a priority for the future. Despite the presence of supporting policies and funding, the number of successful experiences that endure over time is limited.

Objective: This work aims to investigate how health and social care integration occur and identify factors facilitating its endurance.

Methods: We conducted a multiple case study on four long-lasting health and social care integration cases in Italy, where a new policy for enhancing integration was introduced. 20 senior managers employed in the four cases were interviewed and 33 official documents and websites were collected. The interviews' transcripts and documents were coded using an abductive approach.

Results: The modalities of health and social care integration can vary according to the level of integration, type of network governance, and level of customization. There is no one predominant solution as the modalities depend on the specific context. To support policy-makers and health and social care providers in designing and implementing a sustainable health and social care integration in their contexts, this study provides six possible macro factors that clarify the priorities for integration.

Conclusions: This paper clarifies the modalities of integration and provides macro factors for enduring health and social care integration over time, providing avenues for future supporting policies.

Tuberculosis, a disease of poverty, continues to disproportionately affect socioeconomically disadvantaged populations worldwide. This is particularly concerning given the recent resurgence of TB following the COVID-19 pandemic. In South Korea, despite substantial socioeconomic development, TB remains a prominent problem, ranking as the leading infectious killer in the country. The severe stigma associated with TB, coupled with the significant vulnerability of TB patients, has resulted in the voices of these patients being completely underrepresented in both policy and research. This article addresses this research gap by conducting a qualitative assessment of Korea's national TB control efforts through the lens of the UN's AAAQ (Availability, Accessibility, Acceptability, Quality) right to health framework. Through field observations and 20 in-depth interviews with TB patients, healthcare providers, policymakers, and advocates, we explore the lived experiences of socioeconomically disadvantaged TB patients in accessing care and support in Korea. Findings reveal that the failure to integrate the right to health into TB care and support, including inadequate availability, accessibility, acceptability, and quality of services tailored to the needs of this population, contributes significantly to Korea's TB burden. The findings have important implications for TB policy and practice in countries with high TB burdens or those experiencing a resurgence of TB. Prioritizing the right to health in TB care and support is crucial to effectively combat this disease.

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Background: Independent prescribing is set to expand amongst community pharmacists in England in the next few years. This study aims to explore the different accountabilities and responsibilities associated with independent prescribing compared to more traditional pharmacist roles.

Objective: To inform commissioning frameworks that will allow independent prescribing by community pharmacists to be commissioned safely and appropriately at scale.

Design/methodology: A series of qualitative semi-structured interviews were undertaken with key stakeholders. Interviews were analysed using thematic analysis, and over-arching themes developed from emergent findings.

Conclusions: This study identified three themes, supported by twelve sub-themes, associated with pharmacist independent prescribing being viewed positively. Those three themes were 'self', 'environmen't and 'competence'. Whilst pharmacists are well placed through their initial education and training to undertake a prescribing role, we found that there are perceived differences in responsibility between a prescribing and a non-prescribing role, attitude towards risk and the training and support needed to adapt to those changes. These differences are explored leading to a series of overarching themes and recommendations, including that ongoing support is critical and should be built into commissioning frameworks, that newly qualified prescribers need to start prescribing immediately after qualifying and that experiential learning should be built into all training programmes.

Objectives: Dementia is a major health and social care challenge in high-income countries where most people are cared for in their own homes. This study aimed to elicit caregiver preferences for alternative bundles of home care services in the Milan metropolitan area.

Methods: A binary discrete choice experiment was administered to a sample of informal caregivers of people with dementia recruited through a network of non-profit organizations. The experiment included four attributes: 1) number of home care hours per month; 2) type of care; 3) caregiver peer support group organization; 4) monthly family's cost (in euros), each articulated into three levels. A mixed logit model was applied to analyze the responses using Stata.

Results: A total of 93 self-administered questionnaires were collected in January-April 2023. Two-thirds of both caregivers (67.7 %) and care recipients (65.6 %) were female, with a mean age of 59.0 (±12.1) years and 82.2 (±6.5) years, respectively. The experiment showed that increased home care hours, mixed health and social home care, caregiver meetings with professional support and lower monthly costs were mostly valued by caregivers. Some preference heterogeneity was detected in relation to care recipient's characteristics (e.g., age).

Conclusions: These results are expected to inform policymakers about caregiver priorities in the field of dementia based on the values placed on hypothetical public home care services.

Background: Despite the high prevalence of obesity in Germany, few effective political measures have been implemented to protect population health and improve the sustainability of food systems. One argument frequently raised against policy implementation is the lack of acceptability for policy measures in the German population.

Aim: We aimed to evaluate the acceptability of policy measures currently discussed in Germany's national nutrition strategy and how perceived policy characteristics and participant characteristics influence policy acceptability.

Method: We conducted an online survey with 2001 participants between 06.12.2023 and 05.01.2024, in which we collected data on perceived policy characteristics (acceptability, equity, societal and personal effectiveness), as well as participant values and beliefs.

Results: Most policies were highly acceptable, with policies such as the introduction of free school lunches (84 % acceptability), the introduction of a ban on fast food advertising aimed at children (71 %) or a sugar tax (53 %) being acceptable to a majority of the sample. The least acceptable policy was the introduction of a tax on animal products (36 %). Logistic regression analyses showed that perceived equity and societal and personal effectiveness predicted policy acceptability. Likewise, environmental values and beliefs about state intervention of participants influenced policy acceptability.

Conclusion: The high acceptability observed in this study suggests an opportunity for German policymakers to implement evidence-based and acceptable nutritional strategies to improve population health.

Background: Public reporting is crucial to enhance transparency, accountability, and informed provider choice. Therefore, providing accessible and reliable information on provider performance and activities is key for all healthcare areas and the utilization of information by patients, providers and related audiences.

Objective: This study provides an extensive analysis of public reporting websites across nine high income countries, focusing on five healthcare areas, and aims to understand how these websites support patients in making informed choices about healthcare providers.

Methods: We apply a comparative cross-country analysis to examine public reporting websites based on a framework consisting of five components: healthcare area, objectives and target audience, quality dimensions, data collection and methodology for quality indicator calculation, and visualization. Using literature and internet search as well as expert interviews, we selected 20 public reporting websites across nine high-income countries.

Results: The websites vary widely within and across countries for most components of our framework. Notably, we found that within countries, same data used by different websites can lead to confusing or even contradictory information about the same provider, depending on the websites' reporting methods and data usage.

Conclusion: The findings suggest that establishing national standards for public reporting may reduce the risk of presenting contradictory information to patients and thus, improve provider choice. Our results lay the basis for developing such national standards.