Health Policy最新文献_第4页

RSV prevention options for infants and older adults: A specific expanding competitive arena 婴儿和老年人 RSV 预防方案：不断扩大的特定竞争领域。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-10-20 DOI: 10.1016/j.healthpol.2024.105187

Livio Garattini , Antonio Clavenna

Respiratory Syncytial Virus (RSV) is an ubiquitous respiratory virus, which spreads like seasonal influenza throughout winter time in temperate climate countries. RSV infections are usually mild in healthy children and adults, but may be severe in premature infants, young children with congenital heart disease or chronic lung disease, immunocompromised individuals and frail elderly people.

At present, the pharmaceutical options to prevent RSV negative effects can be divided into monoclonal antibodies (mABs) and vaccines (active immunization). The two mABs licensed so far are indicated only for infants, while the first vaccines approved are mainly recommended for older adults.

The pharmaceutical competitive arena of products to prevent RSV negative effects has recently become very crowded after more than two decades with only one mAB as the unique option. Here, we try to put order in the dramatically increasing mix of very different products which have been recently launched. The aim of our effort is to provide some suggestions for European policy makers in order to limit the potentially relevant financial impact of these new expensive options on public pharmaceutical expenditures. We hope the suggested strategies might help to avoid transforming RSV from an apparently underscored health issue into a clearly overestimated health risk for the whole population in European countries. This dramatic change could be driven by a bunch of powerful multinational companies.

呼吸道合胞病毒（RSV）是一种无处不在的呼吸道病毒，它像季节性流感一样在温带气候国家的整个冬季传播。健康儿童和成人感染 RSV 后病情通常较轻，但早产儿、患有先天性心脏病或慢性肺病的幼儿、免疫力低下者和体弱老人感染 RSV 后病情可能会很严重。目前，预防 RSV 负面影响的药物可分为单克隆抗体（mABs）和疫苗（主动免疫）。目前获得许可的两种 mABs 仅适用于婴儿，而首批获批的疫苗主要推荐用于老年人。在二十多年后的今天，预防 RSV 负面影响的药品竞争领域已变得非常拥挤，只有一种 mAB 可供选择。在此，我们试图为最近推出的、急剧增加的各种不同产品建立秩序。我们努力的目的是为欧洲政策制定者提供一些建议，以限制这些新的昂贵选择对公共医药支出可能产生的相关财务影响。我们希望所建议的策略能够有助于避免 RSV 从一个明显被忽视的健康问题转变为一个明显被高估的对欧洲国家全体人口的健康风险。这种巨大的变化可能是由一群强大的跨国公司推动的。

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引用次数: 0

Social innovation management to support integrated care: Insights from an Italian revelatory case study. 支持综合护理的社会创新管理：意大利启示性案例研究的启示。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-10-19 DOI: 10.1016/j.healthpol.2024.105188

Francesca Costanza, Giada Li Calzi

This research deals with Social Innovation (SI) and integrated and connected care in the hospital care, presenting a successful experience of telemedicine's implementation within the Italian context. Nowadays integrated care and connected care are relevant concepts for delivering people-centered healthcare; though their operationalization is challenging and requires accounting for systems' complexity. In this regard, SI may be a catalyst, since it consists in a kind of innovation motivated by social needs. Extant research on SI in healthcare is scant and fragmentary, overlooking operational features and enabling conditions. Considering these gaps, the paper investigates the potential contribution of SI management to integrated and connected care. For the purpose, it offers a revelatory case study, concerning the pediatric research hospital Gaslini (Genoa, Italy), which is, to our knowledge, the first Italian public hospital to have hired a SI manager. By referring to a telemedicine pilot project, the study analyzes main features of the SI management process and its approach to promote integrated and connected care. Research data are analyzed by combining Gioia methodology and systems thinking. The resulting grounded theory model is causal loops-shaped and highlights virtuous mechanisms of SI unveiling generative voids and existing skills.

本研究涉及医院护理中的社会创新（SI）和综合互联护理，介绍了在意大利实施远程医疗的成功经验。如今，综合护理和互联护理是提供以人为本的医疗保健服务的相关概念；尽管其操作具有挑战性，需要考虑系统的复杂性。在这方面，SI 可以起到催化剂的作用，因为它是一种以社会需求为动力的创新。关于医疗保健中的社会创新的现有研究很少且零散，忽略了操作特点和有利条件。考虑到这些差距，本文研究了 SI 管理对综合互联医疗的潜在贡献。为此，本文提供了一个具有启发性的案例研究，涉及加斯利尼儿科研究医院（意大利热那亚），据我们所知，该医院是意大利第一家聘用 SI 管理员的公立医院。通过参考远程医疗试点项目，该研究分析了 SI 管理流程的主要特点及其促进整合和连接护理的方法。研究数据结合了 Gioia 方法和系统思维进行分析。由此产生的基础理论模型是因果循环型的，并强调了揭示产生性空白和现有技能的 SI 良性机制。

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引用次数: 0

Does financial incentive for diabetes management in the primary care setting reduce avoidable hospitalizations and mortality in high-income countries? A systematic review 在高收入国家，对基层医疗机构的糖尿病管理进行经济激励是否能降低可避免的住院率和死亡率？系统回顾

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-10-18 DOI: 10.1016/j.healthpol.2024.105189

Thaksha Thavam , Michael Hong , Rose Anne Devlin , Kristin K Clemens , Sisira Sarma

Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.

有效的糖尿病管理可以避免可避免的糖尿病相关住院治疗。本综述探讨了基层医疗机构糖尿病管理的经济激励措施对糖尿病相关住院、住院费用和过早死亡率的影响。为了评估证据，我们使用五个数据库对研究进行了文献检索：Medline、Embase、Scopus、CINAHL 和 Web of Science。我们按照医疗保险系统、研究质量或糖尿病人群（新诊断的糖尿病）对结果进行了审查。我们共发现了 32 篇从一般到高质量的文章：19 篇评估了糖尿病管理经济激励措施与住院治疗之间的关系，8 篇评估了住院费用，15 篇评估了死亡率。许多研究发现，糖尿病管理经济激励措施降低了住院率，而少数研究发现没有影响。在住院费用和死亡率方面也有类似的发现。不同类型的医疗保险系统得出的结果并无差别，但研究的质量确实很重要；大多数高质量的研究都报告了住院率和/或死亡率的降低。我们还发现，经济激励措施往往对新诊断的糖尿病患者有益。我们的结论是，精心设计的糖尿病管理激励措施可以减少与糖尿病相关的住院治疗，尤其是新诊断的糖尿病患者。

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引用次数: 0

German centralization strategy during COVID-19: Continuing or interrupting a trend? COVID-19 期间德国的集权战略：延续还是中断趋势？

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-10-08 DOI: 10.1016/j.healthpol.2024.105177

Ines Marina Niehaus , Andreas Lehr , André Kaiser , Helena Sophie Müller , Ludwig Kuntz

In response to the COVID-19 pandemic, many countries applied centralization strategies to the distribution of power between national government and regional/local governments over responsibility for regulatory tasks. As a result, health-policy decision-making competences were shifted from the regional level to the national level (vertical shift of decision-making competences). This centralization trend for the purpose of infection control is evident in Germany. We conducted a quantitative and qualitative analysis of health-policy regulatory measures (March 2018 to March 2020) in order to investigate whether the vertical shift in decision-making competences was already a trend in Germany before the COVID-19 pandemic and beyond infection control. Our results show that the centralization strategy observed during COVID-19 does not continue a trend. Before the COVID-19 pandemic, what was most important was the distribution of power at national level between government and non-government institutions (horizontal allocation of decision-making competences). This long-term trend strengthens the decision-making competences of government institutions and weakens non-government institutions.

为应对 COVID-19 大流行病，许多国家在国家政府与地区/地方政府之间分配监管任务的权力时采用了集中化战略。因此，卫生政策的决策权从地区一级转移到国家一级（决策权的纵向转移）。这种以感染控制为目的的中央集权趋势在德国非常明显。我们对卫生政策监管措施（2018 年 3 月至 2020 年 3 月）进行了定量和定性分析，以调查在 COVID-19 大流行之前，决策权的纵向转移在德国是否已经成为一种趋势，并且超出了感染控制的范围。我们的研究结果表明，在 COVID-19 期间观察到的集中化战略并没有延续这一趋势。在 COVID-19 大流行之前，最重要的是国家层面的权力在政府和非政府机构之间的分配（决策权的横向分配）。这一长期趋势加强了政府机构的决策能力，削弱了非政府机构的决策能力。

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引用次数: 0

Impact of local sports policies in the prevalence of cardiovascular disease: An assessment with spatial data analysis 地方体育政策对心血管疾病发病率的影响：空间数据分析评估

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-10-06 DOI: 10.1016/j.healthpol.2024.105179

Miguel Viegas , João Valente dos Santos , Manuel João Coelho e Silva

According to the World Health Organization, 17 million people die every year of cardiovascular diseases (CVD), particularly heart attacks and strokes. More than half of all deaths across the Europe are caused by CVDs. 80 % of premature deaths from these causes could be avoided by controlling the main risk factors: tobacco, unhealthy diet and physical inactivity.

Local authorities provide sport and recreation facilities to their communities. They also have a central role in forging partnerships with public and private sector to enhance the local sport delivery system.

The present paper consists of an empirical exercise about the statistical relationship between the financial effort of Portuguese municipalities in the implementation of sports policies and the prevalence of CVDs. The estimation of a Spatial Autocorrelation Model confirms the strong spatial dependence between neighbouring municipalities and validates the existence of a positive impact of local sports policies on mortality rate from cardiovascular diseases. The results raise the need to reinforce local policies to promote active living based on holistic approaches to combating heart disease and promoting healthy lifestyles in partnerships with health professionals, educators, and community leaders.

据世界卫生组织统计，每年有 1700 万人死于心血管疾病（CVD），尤其是心脏病和中风。在整个欧洲，一半以上的死亡是由心血管疾病造成的。通过控制主要的风险因素：烟草、不健康的饮食和缺乏运动，80%的过早死亡是可以避免的。地方当局为其社区提供体育和娱乐设施，在与公共和私营部门建立伙伴关系以加强地方体育服务体系方面也发挥着核心作用。本文包括一项关于葡萄牙市政当局在实施体育政策方面的财政努力与心血管疾病发病率之间统计关系的实证研究。空间自相关模型的估算证实了相邻城市之间存在很强的空间依赖性，并验证了地方体育政策对心血管疾病死亡率的积极影响。研究结果表明，有必要加强地方政策，在与卫生专业人员、教育工作者和社区领袖合作防治心脏病和推广健康生活方式的整体方法基础上，促进积极的生活方式。

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引用次数: 0

Voluntarily stopping eating and drinking (VSED): A systematic mixed-methods review focusing on the carers’ experiences 自愿停止饮食（VSED）：以照顾者的经历为重点的系统性混合方法综述。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-09-30 DOI: 10.1016/j.healthpol.2024.105174

Christina Mensger , Yang Jiao , Maximiliane Jansky , Christian Banse , Friedemann Nauck , Monika Nothacker , Henrikje Stanze

Background

Voluntary stopping of eating and drinking (VSED) is a way to end one's life prematurely. We synthesized the empirical data on VSED.

Methods

In this systematic mixed-methods review, we searched MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT for English and German articles published between January 1, 2013 and November 12, 2021. We included quantitative and qualitative research examining the experiences, attitudes, and knowledge of people confronted with VSED. We inductively analyzed the data after quantitative data transformation. We assessed quality and confidence using the Mixed-Methods Appraisal Tool and GRADE-CERQual approach, respectively. This study was registered in PROSPERO (CRD42022283743).

Findings

We identified 22 eligible articles, comprising 16 studies. The participants were healthcare professionals and relatives, but not individuals undertaking VSED. We present here our findings on the challenges of accompanying VSED, positive experiences with VSED, and the identified needs. Support during VSED is needed at multiple levels (medical care, family relief, course planning), and the willingness to accompany VSED is very high among healthcare professionals. However, there are several problems, the most obvious being the lack of knowledge and expertise regarding VSED, placing a great burden on families and professionals. The confidence in the review findings ranged from moderate to low.

Interpretation

Evidence-based guidance, in-depth knowledge, and training of healthcare professionals can greatly reduce the burden and fear among individuals accompanying VSED.

背景：自愿停止进食和饮水（VSED）是提前结束生命的一种方式。我们综合了有关 VSED 的经验数据：在这项系统性混合方法综述中，我们检索了 MEDLINE、CINAHL、PsycINFO、Google Scholar 和 BELIT 在 2013 年 1 月 1 日至 2021 年 11 月 12 日期间发表的英文和德文文章。我们收录了对面临 VSED 的人们的经历、态度和知识进行研究的定量和定性研究。我们对定量数据转换后的数据进行了归纳分析。我们分别使用混合方法评估工具和 GRADE-CERQual 方法对研究质量和可信度进行了评估。本研究已在 PROSPERO（CRD42022283743）上注册：我们确定了 22 篇符合条件的文章，包括 16 项研究。参与者包括医疗保健专业人员和亲属，但不包括进行 VSED 的个人。我们在此介绍我们在 VSED 陪同过程中遇到的挑战、VSED 的积极经验以及已确定的需求方面的研究结果。VSED 期间需要多层次的支持（医疗护理、家庭救济、课程规划），医护专业人员陪同 VSED 的意愿非常高。然而，也存在一些问题，最明显的是缺乏有关 VSED 的知识和专业技能，这给家庭和专业人员带来了沉重的负担。综述结果的可信度从中度到低度不等：以证据为基础的指导、深入的知识以及对医护专业人员的培训可以大大减轻 VSED 患者的负担和恐惧。

{"title":"Voluntarily stopping eating and drinking (VSED): A systematic mixed-methods review focusing on the carers’ experiences","authors":"Christina Mensger , Yang Jiao , Maximiliane Jansky , Christian Banse , Friedemann Nauck , Monika Nothacker , Henrikje Stanze","doi":"10.1016/j.healthpol.2024.105174","DOIUrl":"10.1016/j.healthpol.2024.105174","url":null,"abstract":"<div><h3>Background</h3><div>Voluntary stopping of eating and drinking (VSED) is a way to end one's life prematurely. We synthesized the empirical data on VSED.</div></div><div><h3>Methods</h3><div>In this systematic mixed-methods review, we searched MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT for English and German articles published between January 1, 2013 and November 12, 2021. We included quantitative and qualitative research examining the experiences, attitudes, and knowledge of people confronted with VSED. We inductively analyzed the data after quantitative data transformation. We assessed quality and confidence using the Mixed-Methods Appraisal Tool and GRADE-CERQual approach, respectively. This study was registered in PROSPERO (CRD42022283743).</div></div><div><h3>Findings</h3><div>We identified 22 eligible articles, comprising 16 studies. The participants were healthcare professionals and relatives, but not individuals undertaking VSED. We present here our findings on the challenges of accompanying VSED, positive experiences with VSED, and the identified needs. Support during VSED is needed at multiple levels (medical care, family relief, course planning), and the willingness to accompany VSED is very high among healthcare professionals. However, there are several problems, the most obvious being the lack of knowledge and expertise regarding VSED, placing a great burden on families and professionals. The confidence in the review findings ranged from moderate to low.</div></div><div><h3>Interpretation</h3><div>Evidence-based guidance, in-depth knowledge, and training of healthcare professionals can greatly reduce the burden and fear among individuals accompanying VSED.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105174"},"PeriodicalIF":3.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395429","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}

引用次数: 0

The long-run effect of COVID-19 on hospital emergency department attendances:evidence from statistical analysis of hospital data from England COVID-19 对医院急诊室就诊人数的长期影响：英格兰医院数据统计分析的证据

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-09-30 DOI: 10.1016/j.healthpol.2024.105168

Nikita Jacob, Rita Santos, Peter Sivey

During the COVID-19 pandemic, hospital emergency departments worldwide experienced a pronounced fall in utilisation of emergency care, with a decrease of up to 40% in many countries. Evidence suggests the cause of these changes include both population fear of COVID-19 and the effects of lockdowns and the interaction of these two effects. We analyse a sub-sample of national data on Accident and Emergency (A&E) attendances in England over an extended period from April 2019 to March 2022 for different patient groups, including by age, mental/physical health status, acuity, and common clinical groupings. Our results showed that all patient groups experienced substantial declines in attendances during the first two waves of the pandemic, including high acuity and cardiovascular patients. Mental health patients were the only exception, with a smaller decline in attendances. Our findings suggest that policymakers should recognise the potential harmful effects of lockdowns, public messaging, and changes in health care provision on all patients during health emergencies.

在 COVID-19 大流行期间，全球医院急诊科的急诊使用率明显下降，许多国家的降幅高达 40%。有证据表明，造成这些变化的原因包括人们对 COVID-19 的恐惧、封锁的影响以及这两种影响的相互作用。我们分析了英格兰从 2019 年 4 月到 2022 年 3 月这一较长时期内不同患者群体的全国事故和急诊（A&E）就诊数据子样本，包括按年龄、精神/身体健康状况、严重程度和常见临床分组进行的分析。我们的研究结果表明，在大流行的前两波中，所有患者群体的就诊人次都出现了大幅下降，其中包括重症患者和心血管病患者。精神疾病患者是唯一的例外，就诊人次下降幅度较小。我们的研究结果表明，政策制定者应该认识到在卫生紧急情况下，封锁、公共信息发布和医疗服务的改变对所有患者可能产生的有害影响。

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引用次数: 0

How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering 法国全科医生如何应对日益增长的医疗需求和医生短缺问题。面板数据调查与分层聚类。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-09-29 DOI: 10.1016/j.healthpol.2024.105175

Bérengère Davin-Casalena , Dimitri Scronias , Yann Videau , Pierre Verger

Background

General practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages.

Objectives

To investigate how GPs cope with doctor shortage issues.

Materials and methods

Two cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics.

Results

87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas.

Conclusion

These results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

背景：全科医生（GP全科医生（GPs）面临着患者需求和医生短缺的量变和质变：调查全科医生如何应对医生短缺问题：分别于 2019 年和 2022 年对 1530 名全科医生进行了两次横向调查，了解他们对医生短缺、工作时间（WHW）和适应行为的看法。通过层次聚类，确定了具有不同适应模式的特征。多重泊松或逻辑回归模型研究了全科医生的情况与专业特征之间的关联：87.4%的全科医生至少采用了一种适应方式来控制患者的医疗需求。24%的全科医生采用了任务转移，而在2019年至2022年期间，他们的平均全科医生工作时间减少了3.6小时。研究发现了四种全科医生的情况。"低适应性/低工作量 "和 "低适应性/高工作量"（各占样本的 25%）报告了 2.4 项适应性措施：在前一组中，75.5% 的人拒绝成为新患者的首选医生（对比 5.1%）。"高度适应/改变诊疗"（30.7%）和 "高度适应/缩短诊疗"（18.9%）分别报告了 4.8 和 6.1 项适应措施。他们更有可能在医疗服务不足的地区执业：这些结果使人们对全科医生在法国医疗系统中的守门人角色产生了质疑。此外，医疗服务欠缺地区的全科医生人数明显减少，这可能会加剧全科医生在全国范围内的分布不均。鼓励医疗保健人员之间的纵向整合，同时加强合作和任务分工，可能是改善全科医生相对短缺的一条途径。

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引用次数: 0

Understanding the evolution of competing institutional logics in the marketization of care: A stage model analysis of Australia's National Disability Insurance Scheme 了解护理市场化过程中相互竞争的制度逻辑的演变：对澳大利亚国家伤残保险计划的阶段模型分析。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-09-29 DOI: 10.1016/j.healthpol.2024.105173

Fanny Salignac , Ralf Barkemeyer , Elizabeth Franklin-Johnson , Tulin Dzhengiz

This study explores the marketization of healthcare through a stage model analysis, focusing on Australia's National Disability Insurance Scheme (NDIS). By employing mixed methods, including sentiment and frequency analysis as well as qualitative content analysis of policy documents and media coverage, we trace the NDIS's evolution and the interplay of competing social welfare and market logics over time. Our findings underline that the evolution and interplay between competing institutional logics follow a stage model of institutional change, detailing pre-emergence, orientation, contestation, consolidation, and normalization phases. Additionally, we observe a shift in dominant institutional logics across different stages, demonstrating the critical role of media and public sentiment in shaping discourse about the marketization of care, which intertwines with policy decision-making. Our findings emphasize the importance of adaptive engagement and communication strategies by policymakers to avoid marginalizing vulnerable groups as institutional logics evolve, especially in the latter stages of the process when a dominant logic has emerged. The study highlights the complex dynamics of institutional change and offers insights for both researchers and practitioners in the healthcare sector, shedding light on the coevolution of competing logics in the policy development and implementation process.

本研究通过阶段模型分析探讨医疗保健的市场化，重点关注澳大利亚的国家伤残保险计划（NDIS）。通过采用混合方法，包括情感和频率分析以及对政策文件和媒体报道的定性内容分析，我们追溯了国家残疾保险计划的演变过程，以及随着时间推移社会福利和市场逻辑之间相互竞争的相互作用。我们的研究结果强调，相互竞争的制度逻辑之间的演变和相互作用遵循了制度变革的阶段模型，详细描述了萌芽前、定向、竞争、巩固和正常化阶段。此外，我们还观察到主导性制度逻辑在不同阶段的转变，这表明媒体和公众情绪在形成有关护理市场化的讨论方面起着至关重要的作用，这种讨论与政策决策交织在一起。我们的研究结果强调了政策制定者采取适应性参与和沟通策略的重要性，以避免弱势群体随着制度逻辑的演变而被边缘化，尤其是在这一过程的后期，当主导逻辑出现时。本研究强调了制度变迁的复杂动态，为医疗保健领域的研究人员和从业人员提供了启示，揭示了政策制定和实施过程中相互竞争的逻辑的共同演变。

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引用次数: 0

Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework 识别患有罕见疾病的老年人在健康方面面临的不平等：系统文献综述及伦理范围和资源分配框架建议。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2024-09-26 DOI: 10.1016/j.healthpol.2024.105176

Jean Pierre Uwitonze , Lize Duminy , Carl Rudolf Blankart

Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.

近年来，医疗保健中的年龄歧视问题受到越来越多的关注，但关于它如何影响罕见病患者的文献仍然很少。罕见病患者在使用医疗系统时已经面临重重障碍，而年龄歧视有可能加剧现有的健康不平等。我们对有关罕见病人群健康不平等问题的同行评议文献和灰色文献进行了系统性回顾，试图找出那些报告了有关这些人群公平或不公平待遇的主要或次要数据，或讨论了相关监管、道德或哲学问题的出版物。我们的目的是了解这些人群在健康方面的不公平是如何产生的，从社会角度来看它们是如何合理的，它们是如何在法律法规中体现出来的，以及它们对医疗保健的获取和健康结果有什么影响。我们从 63 篇出版物中检索了信息，并将其归纳为五个类别：伦理讨论、社会偏好、法规、医疗服务的获取和健康结果。综合这些类别的见解，我们制定了 "伦理范围和资源分配框架"，该框架解释了公平问题的出现及其在医疗系统中的表现形式。通过更好地了解健康不公平的根本原因，尤其是老年人的健康不公平，该框架可以为健康决策提供信息，改善罕见病患者获得护理的机会和健康结果。

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引用次数: 0