Pub Date : 2025-02-01DOI: 10.1016/j.healthpol.2025.105246
Bo Hu, Nicola Brimblecombe, Javiera Cartagena-Farias, Wagner Silva-Ribeiro
Good quality housing is vitally important to public health. However, its economic consequences for the long-term care sector and implications for health policy have not been thoroughly examined. This study investigates the impacts of housing improvements on future costs of long-term care in England. Using data from two national surveys, the English Longitudinal Study of Ageing (ELSA) and the Health Survey for England (HSE), we combined a Markov model with a macrosimulation model to make projections of long-term care costs under a series of housing intervention scenarios. We project that, without housing interventions, formal care costs will increase from £22.4 billion to £40.8 billion and unpaid/informal care costs will increase from £55.2 billion to £90.8 billion between 2022 and 2042. In a scenario where all housing problems are remedied, formal and unpaid care costs in 2042 are projected to be £2.8 billion and £7.1 billion lower than the no intervention scenario, respectively. There are substantial synergies between health and housing policies. Well-designed housing improvement programmes delay the progression of long-term care needs, resulting in lower long-term care costs. The cumulative savings of long-term care costs over time can pay back the investment needed for housing improvements.
{"title":"Projected costs of long-term care for older people in England: The impacts of housing quality improvements","authors":"Bo Hu, Nicola Brimblecombe, Javiera Cartagena-Farias, Wagner Silva-Ribeiro","doi":"10.1016/j.healthpol.2025.105246","DOIUrl":"10.1016/j.healthpol.2025.105246","url":null,"abstract":"<div><div>Good quality housing is vitally important to public health. However, its economic consequences for the long-term care sector and implications for health policy have not been thoroughly examined. This study investigates the impacts of housing improvements on future costs of long-term care in England. Using data from two national surveys, the English Longitudinal Study of Ageing (ELSA) and the Health Survey for England (HSE), we combined a Markov model with a macrosimulation model to make projections of long-term care costs under a series of housing intervention scenarios. We project that, without housing interventions, formal care costs will increase from £22.4 billion to £40.8 billion and unpaid/informal care costs will increase from £55.2 billion to £90.8 billion between 2022 and 2042. In a scenario where all housing problems are remedied, formal and unpaid care costs in 2042 are projected to be £2.8 billion and £7.1 billion lower than the no intervention scenario, respectively. There are substantial synergies between health and housing policies. Well-designed housing improvement programmes delay the progression of long-term care needs, resulting in lower long-term care costs. The cumulative savings of long-term care costs over time can pay back the investment needed for housing improvements.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105246"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The appropriate use of day surgery has been shown to provide the same or better outcomes for patients and to increase hospital efficiency. However, it is often underutilised, and rates can vary widely across hospitals. This study examines variation in day-surgery rates across Irish public hospitals and identifies the characteristics associated with these variations. Using patient-level administrative data on high-volume elective procedures, three-level logistic regression models are estimated which allow us to attribute variation in day-surgery rates to hospitals and surgical-teams. We find that day-surgery rates have increased in the last decade and vary substantially between hospitals for most procedures examined. Focusing on laparoscopic cholecystectomy, a key procedure targeted by policymakers, rates varied from 0% to over 90% across hospitals in 2019. We find that a substantial amount of variation in likelihood of day surgery is attributable to the surgical team (56.8%) with 37.8% attributable to the hospital. While there has undoubtedly been progress in the use of day surgery in Ireland there is still scope for improvement. A policy focus on encouraging and incentivising surgical team adoption of day surgery may be warranted, in addition to dedicated resources, and monitoring of day-surgery rate variation across hospitals.
{"title":"Variation in day surgery rates across Irish public hospitals","authors":"Aoife Brick , Brendan Walsh , Theano Kakoulidou , Harry Humes","doi":"10.1016/j.healthpol.2024.105215","DOIUrl":"10.1016/j.healthpol.2024.105215","url":null,"abstract":"<div><div>The appropriate use of day surgery has been shown to provide the same or better outcomes for patients and to increase hospital efficiency. However, it is often underutilised, and rates can vary widely across hospitals. This study examines variation in day-surgery rates across Irish public hospitals and identifies the characteristics associated with these variations. Using patient-level administrative data on high-volume elective procedures, three-level logistic regression models are estimated which allow us to attribute variation in day-surgery rates to hospitals and surgical-teams. We find that day-surgery rates have increased in the last decade and vary substantially between hospitals for most procedures examined. Focusing on laparoscopic cholecystectomy, a key procedure targeted by policymakers, rates varied from 0% to over 90% across hospitals in 2019. We find that a substantial amount of variation in likelihood of day surgery is attributable to the surgical team (56.8%) with 37.8% attributable to the hospital. While there has undoubtedly been progress in the use of day surgery in Ireland there is still scope for improvement. A policy focus on encouraging and incentivising surgical team adoption of day surgery may be warranted, in addition to dedicated resources, and monitoring of day-surgery rate variation across hospitals.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105215"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016810","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 : 2025-02-01DOI: 10.1016/j.healthpol.2024.105222
Maxime Sapin, David Ehlig, Alexander Geissler, Justus Vogel
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.
{"title":"Public reporting in five health care areas: A comparative content analysis across nine countries","authors":"Maxime Sapin, David Ehlig, Alexander Geissler, Justus Vogel","doi":"10.1016/j.healthpol.2024.105222","DOIUrl":"10.1016/j.healthpol.2024.105222","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105222"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to develop an organizational typology of Interprofessional Primary Care (IPC) teams in Quebec, Canada, by describing their organizational profiles and assessing the association between the characteristics of the populations served and the organizational profiles.
Methods
This cross-sectional study was carried out using a finite mixture model of the 2021 financial monitoring data from the Ministry of Health and Social Services of Quebec. The population consisted of all IPC teams in Quebec (N = 368). A multinomial logistic model was used to assess the association between the population characteristics and the organizational profiles.
Results
The analysis revealed that IPC teams were heterogeneous and could be classified into five distinct profiles varying in size, team composition, sector, type, and level of partnership. Pregnant women (odds ratio [OR] = 2.78, 95 % confidence interval [CI] 1.98–3.91), disadvantaged patients ([OR] = 1.62, [CI] 1.15–2.28), patients receiving homecare support ([OR] = 1.85, [CI] 1.28–2.66) and rural patients ([OR] = 0.66, [CI] 0.50–0.86)) were more likely to be associated to the medium, public, university-affiliated, practitioner-oriented, low partnered profile compared to the very small, private, regular, high-partnered profile.
Conclusion
IPC teams can be characterized into five distinct profiles that are associated with the characteristics of the populations they serve. These results may help to better evaluate if the desired effects of IPC teams have been achieved.
{"title":"Development of an organizational typology of interprofessional primary care teams in Quebec, Canada: A multivariate analysis","authors":"Maria Alejandra Rodriguez-Duarte , Pamela Fernainy , Lise Gauvin , Géraldine Layani , Marie-Eve Poitras , Mylaine Breton , Claire Godard-Sebillotte , Catherine Hudon , Janusz Kaczorowski , Yves Couturier , Anaïs Lacasse , Marie-Thérèse Lussier , Cristina Longo , Nadia Sourial","doi":"10.1016/j.healthpol.2024.105202","DOIUrl":"10.1016/j.healthpol.2024.105202","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop an organizational typology of Interprofessional Primary Care (IPC) teams in Quebec, Canada, by describing their organizational profiles and assessing the association between the characteristics of the populations served and the organizational profiles.</div></div><div><h3>Methods</h3><div>This cross-sectional study was carried out using a finite mixture model of the 2021 financial monitoring data from the Ministry of Health and Social Services of Quebec. The population consisted of all IPC teams in Quebec (<em>N</em> = 368). A multinomial logistic model was used to assess the association between the population characteristics and the organizational profiles.</div></div><div><h3>Results</h3><div>The analysis revealed that IPC teams were heterogeneous and could be classified into five distinct profiles varying in size, team composition, sector, type, and level of partnership. Pregnant women (odds ratio [OR] = 2.78, 95 % confidence interval [CI] 1.98–3.91), disadvantaged patients ([OR] = 1.62, [CI] 1.15–2.28), patients receiving homecare support ([OR] = 1.85, [CI] 1.28–2.66) and rural patients ([OR] = 0.66, [CI] 0.50–0.86)) were more likely to be associated to the medium, public, university-affiliated, practitioner-oriented, low partnered profile compared to the very small, private, regular, high-partnered profile.</div></div><div><h3>Conclusion</h3><div>IPC teams can be characterized into five distinct profiles that are associated with the characteristics of the populations they serve. These results may help to better evaluate if the desired effects of IPC teams have been achieved.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105202"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.healthpol.2024.105223
Bruce Warner , Tracey Thornley , Claire Anderson , Anthony Avery
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.
{"title":"Key stakeholder's attitudes towards the professional accountabilities and responsibilities of newly qualified Pharmacist Independent Prescribers (IPs) in England and enablers to implementation at scale?","authors":"Bruce Warner , Tracey Thornley , Claire Anderson , Anthony Avery","doi":"10.1016/j.healthpol.2024.105223","DOIUrl":"10.1016/j.healthpol.2024.105223","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To inform commissioning frameworks that will allow independent prescribing by community pharmacists to be commissioned safely and appropriately at scale.</div></div><div><h3>Design/Methodology</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105223"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.healthpol.2024.105235
Claudia Wild, Ozren Sehic, Louise Schmidt, Daniel Fabian
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.
{"title":"Public contributions to R&D of medical innovations: A framework for analysis","authors":"Claudia Wild, Ozren Sehic, Louise Schmidt, Daniel Fabian","doi":"10.1016/j.healthpol.2024.105235","DOIUrl":"10.1016/j.healthpol.2024.105235","url":null,"abstract":"<div><h3>Background and Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Discussion and conclusion</h3><div>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.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105235"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.healthpol.2024.105224
Katherine Polin , Giada Scarpetti , Pia Vracko
Countries worldwide seek to strengthen their primary healthcare systems often through introducing health promotion and disease prevention, multidisciplinary teams, group practices and community approaches to advance universal health coverage. These strategies are underpinned by scientific evidence and international standards. Slovenia's primary healthcare system reflects many of these features, with universally accessible, multidisciplinary, and integrated health services, emphasizing health promotion, disease prevention, and equity. Municipal primary healthcare centres serve as hubs within local communities. Slovenia's efforts to strengthen the delivery model are continuous and follow a controlled stepwise implementation process. This approach has strong policy support and organizational and implementation capacities.
This paper describes Slovenia's primary healthcare model and three innovations between 2011 and 2020: (1) family medicine model practices, (2) health promotion centres, and (3) mental health centres. These innovations are used both to showcase the efforts of Slovenia to enhance primary healthcare and as a lens to explore Slovenia's established primary healthcare innovation implementation approach. The three innovations have had a positive impact on health outcomes in the short- to medium-term, but mixed health system and implementation outcomes. Slovenia's experience can inspire other countries looking to sustainably integrate primary healthcare fully or effectively introduce single innovations in their primary healthcare systems.
{"title":"Innovations in primary healthcare in Slovenia 2011–2020: Exploring the stepwise process behind effective implementation","authors":"Katherine Polin , Giada Scarpetti , Pia Vracko","doi":"10.1016/j.healthpol.2024.105224","DOIUrl":"10.1016/j.healthpol.2024.105224","url":null,"abstract":"<div><div>Countries worldwide seek to strengthen their primary healthcare systems often through introducing health promotion and disease prevention, multidisciplinary teams, group practices and community approaches to advance universal health coverage. These strategies are underpinned by scientific evidence and international standards. Slovenia's primary healthcare system reflects many of these features, with universally accessible, multidisciplinary, and integrated health services, emphasizing health promotion, disease prevention, and equity. Municipal primary healthcare centres serve as hubs within local communities. Slovenia's efforts to strengthen the delivery model are continuous and follow a controlled stepwise implementation process. This approach has strong policy support and organizational and implementation capacities.</div><div>This paper describes Slovenia's primary healthcare model and three innovations between 2011 and 2020: (1) family medicine model practices, (2) health promotion centres, and (3) mental health centres. These innovations are used both to showcase the efforts of Slovenia to enhance primary healthcare and as a lens to explore Slovenia's established primary healthcare innovation implementation approach. The three innovations have had a positive impact on health outcomes in the short- to medium-term, but mixed health system and implementation outcomes. Slovenia's experience can inspire other countries looking to sustainably integrate primary healthcare fully or effectively introduce single innovations in their primary healthcare systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105224"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959281","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}
Policy strategies targeting imprudent antimicrobial use (AMU) in livestock farming have been established at the global and country levels, recognising the risks associated with antimicrobial resistance (AMR). This study evaluates the strategies addressing AMU and AMR in animal farms and the food supply chain in EU Member States using a multimethod approach. Our aim is to contribute to the debates surrounding the goals set by the EU Commission and the ‘Strategic framework for collaboration on antimicrobial resistance: Together for One Health’. We first review the policies, strategies and specific legislation in the European Union (EU) and Member States about AMU/AMR in livestock production. We then evaluate the national action plans for AMU reduction in the EU using the progressive management pathway tool from the FAO. Finally, we assess the measures that affect AMU reduction by applying a system generalised method of moments to a 8-year panel of the same countries. According to our results, efforts to reduce AMU could be focused on controlling excessive AMU in the pig sector. Further veterinary training on AMU/AMR and improvements in the performance of the veterinary sector, as well as strengthening the development of multisector and One Health collaboration and coordination, can also contribute to achieving better standards in AMU reduction in the livestock sector and, consequently, for AMR control.
{"title":"Policies and strategies to control antimicrobial resistance in livestock production: A comparative analysis of national action plans in European Union Member States","authors":"Caetano Luiz Beber , Maurizio Aragrande , Massimo Canali","doi":"10.1016/j.healthpol.2024.105238","DOIUrl":"10.1016/j.healthpol.2024.105238","url":null,"abstract":"<div><div>Policy strategies targeting imprudent antimicrobial use (AMU) in livestock farming have been established at the global and country levels, recognising the risks associated with antimicrobial resistance (AMR). This study evaluates the strategies addressing AMU and AMR in animal farms and the food supply chain in EU Member States using a multimethod approach. Our aim is to contribute to the debates surrounding the goals set by the EU Commission and the ‘Strategic framework for collaboration on antimicrobial resistance: Together for One Health’. We first review the policies, strategies and specific legislation in the European Union (EU) and Member States about AMU/AMR in livestock production. We then evaluate the national action plans for AMU reduction in the EU using the progressive management pathway tool from the FAO. Finally, we assess the measures that affect AMU reduction by applying a system generalised method of moments to a 8-year panel of the same countries. According to our results, efforts to reduce AMU could be focused on controlling excessive AMU in the pig sector. Further veterinary training on AMU/AMR and improvements in the performance of the veterinary sector, as well as strengthening the development of multisector and One Health collaboration and coordination, can also contribute to achieving better standards in AMU reduction in the livestock sector and, consequently, for AMR control.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"152 ","pages":"Article 105238"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.healthpol.2025.105251
Zachary DV Abel , Laurence SJ Roope , Raymond Duch , Sophie Cole , Philip M Clarke
Background COVID-19 vaccine hesitancy was a key barrier to ending the pandemic via mass immunisation.
Objectives Assess magnitudes and differences in socioeconomic inequality in stated COVID-19 vaccine acceptance (hesitancy) and uptake.
Methods Online surveys were conducted in 13 countries, collecting data from 15,337 and 18,189 respondents respectively. The investigation compares socioeconomic inequality in reported vaccine acceptance, measured in 2020–21 and subsequent uptake of vaccination in 2022. Inequalities are quantified using differences, ratios and the Erreygers adjusted concentration index. A regression decomposition approach is used to identify factors associated with inequality.
Results Mean uptake levels were 87 %, while acceptance was lower at 77 %. The difference between the richest and the poorest quintile was as large as 23 percentage points in acceptance and 30 p.p. in uptake, both observed in France. Acceptance and uptake were pro-rich (regressive) in most countries. Nine countries reported pro-rich inequality in acceptance, and eight in uptake. Uptake was significantly less regressive than acceptance in Australia, China, India, and USA. Australia and Colombia were the only countries where vaccination uptake was pro-poor (progressive). Age, marital status and political ideology were correlated with socioeconomic inequalities in several countries in both waves, while gender and education were associated with acceptance, and health levels with uptake.
Conclusion We found significant inequalities in vaccination acceptance and uptake across countries but inequality was generally lower in vaccine uptake than in acceptance. This suggests that inequalities can be reduced over time if adequate policies are in place to overcome hesitancy and reduce inequalities.
{"title":"Inequality in COVID-19 vaccine acceptance and uptake: A repeated cross-sectional analysis of COVID vaccine acceptance and uptake in 13 countries","authors":"Zachary DV Abel , Laurence SJ Roope , Raymond Duch , Sophie Cole , Philip M Clarke","doi":"10.1016/j.healthpol.2025.105251","DOIUrl":"10.1016/j.healthpol.2025.105251","url":null,"abstract":"<div><div>Background COVID-19 vaccine hesitancy was a key barrier to ending the pandemic via mass immunisation.</div><div>Objectives Assess magnitudes and differences in socioeconomic inequality in stated COVID-19 vaccine acceptance (hesitancy) and uptake.</div><div>Methods Online surveys were conducted in 13 countries, collecting data from 15,337 and 18,189 respondents respectively. The investigation compares socioeconomic inequality in reported vaccine acceptance, measured in 2020–21 and subsequent uptake of vaccination in 2022. Inequalities are quantified using differences, ratios and the Erreygers adjusted concentration index. A regression decomposition approach is used to identify factors associated with inequality.</div><div>Results Mean uptake levels were 87 %, while acceptance was lower at 77 %. The difference between the richest and the poorest quintile was as large as 23 percentage points in acceptance and 30 p.p. in uptake, both observed in France. Acceptance and uptake were pro-rich (regressive) in most countries. Nine countries reported pro-rich inequality in acceptance, and eight in uptake. Uptake was significantly less regressive than acceptance in Australia, China, India, and USA. Australia and Colombia were the only countries where vaccination uptake was pro-poor (progressive). Age, marital status and political ideology were correlated with socioeconomic inequalities in several countries in both waves, while gender and education were associated with acceptance, and health levels with uptake.</div><div>Conclusion We found significant inequalities in vaccination acceptance and uptake across countries but inequality was generally lower in vaccine uptake than in acceptance. This suggests that inequalities can be reduced over time if adequate policies are in place to overcome hesitancy and reduce inequalities.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"153 ","pages":"Article 105251"},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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