Pub Date : 2025-12-02DOI: 10.1016/j.healthpol.2025.105509
Iman Nurjaman S.Kep., Ners., M.Kep., CWCCA., CSI
{"title":"Beyond income: The overlooked role of institutional trust and digital access in vaccine equity","authors":"Iman Nurjaman S.Kep., Ners., M.Kep., CWCCA., CSI","doi":"10.1016/j.healthpol.2025.105509","DOIUrl":"10.1016/j.healthpol.2025.105509","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105509"},"PeriodicalIF":3.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694433","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 : 2025-12-02DOI: 10.1016/j.healthpol.2025.105521
Nicole Sutton , Nelson Ma , Jin Sug Yang , Michael Woods , Rachael L. Lewis , Deborah Parker
Background
Public reporting systems are increasingly used to promote transparency and accountability in the delivery and quality of long-term care (LTC). Australia’s Star Ratings system includes resident experience measures, offering an opportunity to assess their added informational value relative to more commonly used quality indicators.
Objective
To examine whether resident experience ratings capture distinct aspects of quality in residential LTC homes, this study investigates their association with regulatory compliance, staffing, and clinical quality ratings.
Methods
A pooled panel with a two-period change analysis was used, drawing on 2023–2024 Star Ratings data from 4,957 home-quarter observations across 2,642 unique Australian residential LTC homes. Multivariate analyses assessed associations between resident experience ratings and ratings for compliance, staffing, and clinical quality, adjusting for home-specific characteristics.
Results
After controlling for home-specific characteristics, the residents’ experience rating exhibits a positive but modest association with compliance and clinical quality ratings, but no significant association with staffing ratings. However, annual changes in residents’ experience ratings were not significantly associated with corresponding changes in other rating categories.
Conclusions
Resident experience ratings provide distinct insights into care quality that are not strongly reflected in ratings for compliance, clinical or staffing. Their inclusion in national quality frameworks strengthens the person-centredness and comprehensiveness of LTC quality measurement.
{"title":"Associations between residents’ experience and compliance, staffing and clinical quality Star Ratings for Australian residential long-term care homes","authors":"Nicole Sutton , Nelson Ma , Jin Sug Yang , Michael Woods , Rachael L. Lewis , Deborah Parker","doi":"10.1016/j.healthpol.2025.105521","DOIUrl":"10.1016/j.healthpol.2025.105521","url":null,"abstract":"<div><h3>Background</h3><div>Public reporting systems are increasingly used to promote transparency and accountability in the delivery and quality of long-term care (LTC). Australia’s Star Ratings system includes resident experience measures, offering an opportunity to assess their added informational value relative to more commonly used quality indicators.</div></div><div><h3>Objective</h3><div>To examine whether resident experience ratings capture distinct aspects of quality in residential LTC homes, this study investigates their association with regulatory compliance, staffing, and clinical quality ratings.</div></div><div><h3>Methods</h3><div>A pooled panel with a two-period change analysis was used, drawing on 2023–2024 Star Ratings data from 4,957 home-quarter observations across 2,642 unique Australian residential LTC homes. Multivariate analyses assessed associations between resident experience ratings and ratings for compliance, staffing, and clinical quality, adjusting for home-specific characteristics.</div></div><div><h3>Results</h3><div>After controlling for home-specific characteristics, the residents’ experience rating exhibits a positive but modest association with compliance and clinical quality ratings, but no significant association with staffing ratings. However, annual changes in residents’ experience ratings were not significantly associated with corresponding changes in other rating categories.</div></div><div><h3>Conclusions</h3><div>Resident experience ratings provide distinct insights into care quality that are not strongly reflected in ratings for compliance, clinical or staffing. Their inclusion in national quality frameworks strengthens the person-centredness and comprehensiveness of LTC quality measurement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105521"},"PeriodicalIF":3.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702823","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}
Patients with advanced cancer often encounter significant challenges during the transition from oncology to palliative care, particularly due to hospital discharges that lack clear communication and follow-up plans. This discontinuity in care may be addressed through various regulatory strategies designed to facilitate smooth transitions.
Objective
To investigate the regulatory landscape governing transitions from oncology to palliative care across eight European countries.
Methods
A grey literature review followed by a comparative analysis of identified documents was carried out.
Results
A total of 20 professional guidelines, strategies, and regulations in England, Germany, the Netherlands, Portugal, and Spain were identified. Identified documents provided inconsistent guidance regarding the promotion of care continuity. Notably, several essential components for ensuring effective transitions were identified across countries: the formulation of collaborative protocols between various levels and types of care, the establishment of clear transition and referral criteria, early identification of palliative care needs, synchronization of patient information across care levels, involvement of family members in the care process, implementation of a comprehensive four-dimensional patient assessment, and regular evaluation and revision of care plans. Certain elements, such as the role of primary care professionals in identifying palliative care patients, realistic discharge timelines, effective communication with patients and families, and approaches to advance care planning and shared decision-making, were inconsistently identified across different countries.
Conclusions
To enhance continuity of care for patients transitioning from oncology to palliative care at different levels, it is imperative to develop targeted guidance that incorporates all pertinent elements of care coordination.
{"title":"How are transitions from oncology to palliative care regulated across Europe? A grey literature review in eight countries: Pal-Cycles project","authors":"Eduardo Garralda , Tamara Radojičić , Sheila Payne , Rachel Hooley , Csilla Busa , Ian Koper , Wojciech Leppert , Carla Reigada , Flavia Hurducas , Holger Brunsch , Alazne Belar , Carlos Centeno , Jeroen Hasselaar , María Arantzamendi","doi":"10.1016/j.healthpol.2025.105522","DOIUrl":"10.1016/j.healthpol.2025.105522","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced cancer often encounter significant challenges during the transition from oncology to palliative care, particularly due to hospital discharges that lack clear communication and follow-up plans. This discontinuity in care may be addressed through various regulatory strategies designed to facilitate smooth transitions.</div></div><div><h3>Objective</h3><div>To investigate the regulatory landscape governing transitions from oncology to palliative care across eight European countries.</div></div><div><h3>Methods</h3><div>A grey literature review followed by a comparative analysis of identified documents was carried out.</div></div><div><h3>Results</h3><div>A total of 20 professional guidelines, strategies, and regulations in England, Germany, the Netherlands, Portugal, and Spain were identified. Identified documents provided inconsistent guidance regarding the promotion of care continuity. Notably, several essential components for ensuring effective transitions were identified across countries: the formulation of collaborative protocols between various levels and types of care, the establishment of clear transition and referral criteria, early identification of palliative care needs, synchronization of patient information across care levels, involvement of family members in the care process, implementation of a comprehensive four-dimensional patient assessment, and regular evaluation and revision of care plans. Certain elements, such as the role of primary care professionals in identifying palliative care patients, realistic discharge timelines, effective communication with patients and families, and approaches to advance care planning and shared decision-making, were inconsistently identified across different countries.</div></div><div><h3>Conclusions</h3><div>To enhance continuity of care for patients transitioning from oncology to palliative care at different levels, it is imperative to develop targeted guidance that incorporates all pertinent elements of care coordination.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105522"},"PeriodicalIF":3.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748014","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 : 2025-12-01DOI: 10.1016/j.healthpol.2025.105505
Niamh Humphries , Holly R Hanlon , Mike O’Callaghan , John-Paul Byrne , Laura Cullen , Andrew W Murphy , Susan M Smith , Éidín Ní Shé
Background
General practice in Ireland has changed significantly with increased participation of women in the workforce; a move from single-handed to group practices and an increased prioritisation of work life balance.
Objective
This paper explores how GP ways of working have changed. By presenting qualitative data from GPs in Ireland, we present GP perspectives on part and full time working and highlight the need to capture new ways of working by GPs (via research and routine data), and use it to inform GP workforce planning.
Method
To provide an in-depth exploration of GP working life, the study employed a qualitative method of remote ethnography which involved recruiting 20 GPs in Ireland, conducting two online interviews with each GP and conducting an eight-week discussion via Threema (instant messaging application). Data collection was conducted from October 2024 to July 2025. Research ethics permission was granted by the institutional ethics committee.
Results
GPs discussed heavy workloads and high work intensity, long working hours and a heavy burden of administrative work. They explained how reduced working hours and job crafting were used to reduce the intensity of their working week, achieve work-life balance and reduce their stress levels.
Conclusion
Participant GPs reported reducing the number of clinical sessions worked in order to protect their wellbeing and achieve work-life balance. These new ways of working must be evaluated using research and routine data collection to capture the work-as-done by GPs (rather than the work-as-imagined) in order to inform policy and GP workforce planning.
{"title":"Changing Working Patterns in Irish general practice: Findings from a Qualitative Remote Ethnographic Study","authors":"Niamh Humphries , Holly R Hanlon , Mike O’Callaghan , John-Paul Byrne , Laura Cullen , Andrew W Murphy , Susan M Smith , Éidín Ní Shé","doi":"10.1016/j.healthpol.2025.105505","DOIUrl":"10.1016/j.healthpol.2025.105505","url":null,"abstract":"<div><h3>Background</h3><div>General practice in Ireland has changed significantly with increased participation of women in the workforce; a move from single-handed to group practices and an increased prioritisation of work life balance.</div></div><div><h3>Objective</h3><div>This paper explores how GP ways of working have changed. By presenting qualitative data from GPs in Ireland, we present GP perspectives on part and full time working and highlight the need to capture new ways of working by GPs (via research and routine data), and use it to inform GP workforce planning.</div></div><div><h3>Method</h3><div>To provide an in-depth exploration of GP working life, the study employed a qualitative method of remote ethnography which involved recruiting 20 GPs in Ireland, conducting two online interviews with each GP and conducting an eight-week discussion via Threema (instant messaging application). Data collection was conducted from October 2024 to July 2025. Research ethics permission was granted by the institutional ethics committee.</div></div><div><h3>Results</h3><div>GPs discussed heavy workloads and high work intensity, long working hours and a heavy burden of administrative work. They explained how reduced working hours and job crafting were used to reduce the intensity of their working week, achieve work-life balance and reduce their stress levels.</div></div><div><h3>Conclusion</h3><div>Participant GPs reported reducing the number of clinical sessions worked in order to protect their wellbeing and achieve work-life balance. These new ways of working must be evaluated using research and routine data collection to capture the work-as-done by GPs (rather than the work-as-imagined) in order to inform policy and GP workforce planning.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105505"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745694","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}
European healthcare systems are facing shortages of physicians, which increases pressure on the recruitment and retention of young doctors.
Objective
This article aims to compare the solutions implemented for young doctors in Poland and the United Kingdom and to identify transferrable solutions between the systems.
Methods
A comparative analysis of public policies was conducted in April 2025 and was updated in August 2025 based on the five pillars of the WHO 2023–2030 framework and the healthcare labour market. The analysis comprised documents of the governments and international health organisations, legal acts, scientific and grey literature and additional consultations with national experts.
Results
In Poland, the remuneration of medical doctors (including interns and residents), as well as admission limits and number of institutions educating doctors, significantly increased. However, a comprehensive, long-term resource planning strategy is still lacking.
In the United Kingdom, the National Health Service Long Term Workforce Plan and 10 Point Plan were implemented to improve resident working conditions, complemented by wellbeing and flexible work organisation programs.
Conclusions
The policies for young doctors in Poland and the UK show differences in scale, consistency, and sustainability, but the comparison reveals a similar need for a long-term integrated strategy. Key issues include expanding training tailored to supervisory capabilities; replacing fragmented workplace-based incentive packages; making flexibility, mentoring and psychological safety permanent features of young doctors' work; and adapting curricula to digital, team-based care.
{"title":"From recruitment to retention of young doctors: A comparative analysis of policies in Poland and the United Kingdom","authors":"Kamila Michalska , Alejandro Gonzalez-Aquines , Lynn McVey , Gaynor Clark , Alicja Domagała","doi":"10.1016/j.healthpol.2025.105513","DOIUrl":"10.1016/j.healthpol.2025.105513","url":null,"abstract":"<div><h3>Background</h3><div>European healthcare systems are facing shortages of physicians, which increases pressure on the recruitment and retention of young doctors.</div></div><div><h3>Objective</h3><div>This article aims to compare the solutions implemented for young doctors in Poland and the United Kingdom and to identify transferrable solutions between the systems.</div></div><div><h3>Methods</h3><div>A comparative analysis of public policies was conducted in April 2025 and was updated in August 2025 based on the five pillars of the WHO 2023–2030 framework and the healthcare labour market. The analysis comprised documents of the governments and international health organisations, legal acts, scientific and grey literature and additional consultations with national experts.</div></div><div><h3>Results</h3><div>In Poland, the remuneration of medical doctors (including interns and residents), as well as admission limits and number of institutions educating doctors, significantly increased. However, a comprehensive, long-term resource planning strategy is still lacking.</div><div>In the United Kingdom, the National Health Service Long Term Workforce Plan and 10 Point Plan were implemented to improve resident working conditions, complemented by wellbeing and flexible work organisation programs.</div></div><div><h3>Conclusions</h3><div>The policies for young doctors in Poland and the UK show differences in scale, consistency, and sustainability, but the comparison reveals a similar need for a long-term integrated strategy. Key issues include expanding training tailored to supervisory capabilities; replacing fragmented workplace-based incentive packages; making flexibility, mentoring and psychological safety permanent features of young doctors' work; and adapting curricula to digital, team-based care.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105513"},"PeriodicalIF":3.4,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694496","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}
Many health systems need substantial capital investment to advance people-centred, integrated care, but public capital budgets are often constrained. Estonia strategically leveraged EU grants to enable provider-network transformation alongside broader service-delivery reforms.
Reform content
After EU accession, Estonia leveraged EU grants to finance coordinated programmes of investment aligned with national strategies. Across 121 projects, €652.8 million was invested, of which €463.8 million came from EU funds. Investments supported optimisation of the acute hospital network, expansion of nursing/long-term care, establishment of multidisciplinary primary health-care (PHC) centres, and upgrades to digital infrastructure and emergency preparedness. Project selection was determined by functional development plans, reform-related eligibility criteria and co-financing rules, with the Estonian Health Insurance Fund (EHIF) engaged to assess long-term budget impact.
Expected results
Overall, this multi-phase investment programme was designed to modernise infrastructure, rationalise acute capacity, expand PHC scope and strengthen continuity of care and preparedness. Observed system changes include: fewer acute beds and more nursing beds; modernised regional hospitals; and substantial PHC and digital upgrades. However, uptake of extended PHC services was limited in practice, highlighting the need to combine capital and organisational change.
Conclusions
Estonia’s experience shows that EU grant funds - though modest relative to total health spending - can spur reconfiguration when embedded in clear strategies, conditional access to capital, inclusive stakeholder engagement, and purchaser alignment. Future sustainability will depend on securing predictable domestic capital and ensuring that infrastructure investments are matched by service-delivery and workforce changes to realise intended benefits.
{"title":"The role of EU funds in capital investment for health-care: a case study of Estonia's approach to provider network transformation 2004-2024","authors":"Triin Habicht , Kaija Kasekamp , Yulia Litvinova , Mark Hellowell","doi":"10.1016/j.healthpol.2025.105506","DOIUrl":"10.1016/j.healthpol.2025.105506","url":null,"abstract":"<div><h3>Background</h3><div>Many health systems need substantial capital investment to advance people-centred, integrated care, but public capital budgets are often constrained. Estonia strategically leveraged EU grants to enable provider-network transformation alongside broader service-delivery reforms.</div></div><div><h3>Reform content</h3><div>After EU accession, Estonia leveraged EU grants to finance coordinated programmes of investment aligned with national strategies. Across 121 projects, €652.8 million was invested, of which €463.8 million came from EU funds. Investments supported optimisation of the acute hospital network, expansion of nursing/long-term care, establishment of multidisciplinary primary health-care (PHC) centres, and upgrades to digital infrastructure and emergency preparedness. Project selection was determined by functional development plans, reform-related eligibility criteria and co-financing rules, with the Estonian Health Insurance Fund (EHIF) engaged to assess long-term budget impact.</div></div><div><h3>Expected results</h3><div>Overall, this multi-phase investment programme was designed to modernise infrastructure, rationalise acute capacity, expand PHC scope and strengthen continuity of care and preparedness. Observed system changes include: fewer acute beds and more nursing beds; modernised regional hospitals; and substantial PHC and digital upgrades. However, uptake of extended PHC services was limited in practice, highlighting the need to combine capital and organisational change.</div></div><div><h3>Conclusions</h3><div>Estonia’s experience shows that EU grant funds - though modest relative to total health spending - can spur reconfiguration when embedded in clear strategies, conditional access to capital, inclusive stakeholder engagement, and purchaser alignment. Future sustainability will depend on securing predictable domestic capital and ensuring that infrastructure investments are matched by service-delivery and workforce changes to realise intended benefits.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105506"},"PeriodicalIF":3.4,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694434","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 : 2025-11-28DOI: 10.1016/j.healthpol.2025.105507
Pilar Contreras-Montiel , Nicolás Armijo , Macarena Vera , Oscar Arteaga , Pamela Góngora-Salazar , Carlos Balmaceda , Manuel A. Espinoza
Background
Health Benefit Packages (HBPs) are essential for advancing universal health coverage (UHC) globally. In Chile, a fragmented and segmented health system includes multiple HBPs. Understanding their characteristics is crucial to inform policy debates on whether to maintain multiple HBPs or move toward a unified national plan.
Objective
To characterize Chile’s HBPs by examining their foundations, mechanisms for defining and updating covered services, and their interactions with health system functions and outcomes.
Methods
We conducted a document review informed by methodological approaches from rapid reviews. Primary sources included laws, decrees, regulations, and technical norms governing HBPs in Chile, complemented by information from institutional websites and selected grey literature. Data were systematized using a conceptual matrix with three domains and twelve dimensions capturing the main elements of any HBP.
Results
Seven HBPs were identified, including the "Explicit Health Guarantees Plan" and the "Ricarte Soto Law", the "High-Cost Oncological Drugs Fund", and the essential HBP for the public, private and the armed forces and security forces system. Significant variability was found across eight of the twelve dimensions, particularly regarding health technology assessment mechanism. Similarities were observed in principles, laws, healthcare provisions, and regulatory dimensions.
Conclusions
Maintaining multiple HBPs may hinder equitable access to health services. We recommend that Chile advance toward harmonizing or unifying the set of services into a universal HBP, supported by a robust HTA mechanism to ensure transparency and fairness. This approach could enhance the effectiveness of the health system and help achieve UHC.
{"title":"Fragmentation of Health Benefits Plans in Chile: Findings from a comparative policy analysis and implications for advancing Universal Health Coverage","authors":"Pilar Contreras-Montiel , Nicolás Armijo , Macarena Vera , Oscar Arteaga , Pamela Góngora-Salazar , Carlos Balmaceda , Manuel A. Espinoza","doi":"10.1016/j.healthpol.2025.105507","DOIUrl":"10.1016/j.healthpol.2025.105507","url":null,"abstract":"<div><h3>Background</h3><div>Health Benefit Packages (HBPs) are essential for advancing universal health coverage (UHC) globally. In Chile, a fragmented and segmented health system includes multiple HBPs. Understanding their characteristics is crucial to inform policy debates on whether to maintain multiple HBPs or move toward a unified national plan.</div></div><div><h3>Objective</h3><div>To characterize Chile’s HBPs by examining their foundations, mechanisms for defining and updating covered services, and their interactions with health system functions and outcomes.</div></div><div><h3>Methods</h3><div>We conducted a document review informed by methodological approaches from rapid reviews. Primary sources included laws, decrees, regulations, and technical norms governing HBPs in Chile, complemented by information from institutional websites and selected grey literature. Data were systematized using a conceptual matrix with three domains and twelve dimensions capturing the main elements of any HBP.</div></div><div><h3>Results</h3><div><strong>S</strong>even HBPs were identified, including the \"Explicit Health Guarantees Plan\" and the \"Ricarte Soto Law\", the \"High-Cost Oncological Drugs Fund\", and the essential HBP for the public, private and the armed forces and security forces system. Significant variability was found across eight of the twelve dimensions, particularly regarding health technology assessment mechanism. Similarities were observed in principles, laws, healthcare provisions, and regulatory dimensions.</div></div><div><h3>Conclusions</h3><div>Maintaining multiple HBPs may hinder equitable access to health services. We recommend that Chile advance toward harmonizing or unifying the set of services into a universal HBP, supported by a robust HTA mechanism to ensure transparency and fairness. This approach could enhance the effectiveness of the health system and help achieve UHC.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105507"},"PeriodicalIF":3.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727342","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 : 2025-11-27DOI: 10.1016/j.healthpol.2025.105504
Jebağı Canberk Aydın, Emre Atilgan, Aysu Zekioğlu, Işıl Usta Kara
Background
Health workforce migration is a global phenomenon with far-reaching implications for health systems. Turkey has experienced an unprecedented rise in physician emigration over the past decade, yet the relationship between migration intentions and realised mobility remains insufficiently explored, particularly under overlapping economic, political, and health system crises.
Objective
To examine the divergence between physician emigration intentions and realised migration from Turkey to OECD countries (2012–2022), and to assess how the 2017–2018 structural crisis coincided with shifts in migration dynamics.
Methods
Data on Good Standing Certificate applications from the Turkish Medical Association (intentions) were combined with OECD Health Workforce Migration data (realised flows). An interrupted time-series design and structural break analysis were applied to detect significant changes associated with the crisis period.
Results
The intention–action ratio increased from 0.77:1 in 2012 to 4.16:1 in 2022, with a notable structural break at 2017–2018. The interrupted time-series estimate indicated a crisis-related rise of +1.6 ratio points (p < 0.001). Certificate applications grew from 59 to 2685, while OECD inflows rose from 77 to 645, illustrating intensifying migration friction.
Conclusions
Periods of crisis appear to amplify emigration intentions while constraining their realisation, widening the intention–action gap. This pattern has implications beyond Turkey, highlighting the need for friction-sensitive forecasting, evidence-based retention strategies in source countries, and ethically balanced recruitment in destination countries.
{"title":"Understanding the intention–action gap in physician migration during crises: Interrupted time-series evidence from Turkey","authors":"Jebağı Canberk Aydın, Emre Atilgan, Aysu Zekioğlu, Işıl Usta Kara","doi":"10.1016/j.healthpol.2025.105504","DOIUrl":"10.1016/j.healthpol.2025.105504","url":null,"abstract":"<div><h3>Background</h3><div>Health workforce migration is a global phenomenon with far-reaching implications for health systems. Turkey has experienced an unprecedented rise in physician emigration over the past decade, yet the relationship between migration intentions and realised mobility remains insufficiently explored, particularly under overlapping economic, political, and health system crises.</div></div><div><h3>Objective</h3><div>To examine the divergence between physician emigration intentions and realised migration from Turkey to OECD countries (2012–2022), and to assess how the 2017–2018 structural crisis coincided with shifts in migration dynamics.</div></div><div><h3>Methods</h3><div>Data on Good Standing Certificate applications from the Turkish Medical Association (intentions) were combined with OECD Health Workforce Migration data (realised flows). An interrupted time-series design and structural break analysis were applied to detect significant changes associated with the crisis period.</div></div><div><h3>Results</h3><div>The intention–action ratio increased from 0.77:1 in 2012 to 4.16:1 in 2022, with a notable structural break at 2017–2018. The interrupted time-series estimate indicated a crisis-related rise of +1.6 ratio points (<em>p</em> < 0.001). Certificate applications grew from 59 to 2685, while OECD inflows rose from 77 to 645, illustrating intensifying migration friction.</div></div><div><h3>Conclusions</h3><div>Periods of crisis appear to amplify emigration intentions while constraining their realisation, widening the intention–action gap. This pattern has implications beyond Turkey, highlighting the need for friction-sensitive forecasting, evidence-based retention strategies in source countries, and ethically balanced recruitment in destination countries.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105504"},"PeriodicalIF":3.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688749","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 : 2025-11-27DOI: 10.1016/j.healthpol.2025.105508
Lindsey M Warkentin, Lisa Tjosvold, Ken Bond
Background
The continued use of low-value health care consumes system resources and creates unnecessary risk. There are numerous policy levers available to improve appropriateness of care, but a supporting tool is needed to allow for characteristic and evidence comparison.
Objective
Develop an inventory which catalogues policy levers which support the reduction of low-value care, alongside their effectiveness evidence and implementation factors.
Methods
Information on relevant levers was identified through searches in Medline, Cochrane Library, and Google Scholar, with additional targeted searches. An Excel-based inventory was developed with a list of levers, their descriptions, effectiveness outcomes, and implementation considerations. Filters were developed to help identify levers based on key characteristics. The inventory was refined through presentations to and feedback from key stakeholders.
Results
The inventory includes 53 levers which may influence clinician or patient behaviour, service provision, fiscal policies, and populations or organizations. Levers were often used across a variety of settings, care providers, and clinical indications, though some levers addressed specific low-value care contexts. Fiscal policy levers or those influencing service provision were more restrictive, while clinician and patient behaviour levers and those aimed at populations or organizations were less restrictive. Evidence was identified for 40 levers, with 9 levers considered high impact (> 5 % change to behaviour, utilization, or cost) or consistently supported (> 10 studies, the majority reporting desired effects).
Conclusion
This inventory can support health systems in addressing low-value care, through the ability to compare policy levers and select those applicable to the particular context.
{"title":"An inventory of policy levers to reduce low value care: Results of a rapid scoping review","authors":"Lindsey M Warkentin, Lisa Tjosvold, Ken Bond","doi":"10.1016/j.healthpol.2025.105508","DOIUrl":"10.1016/j.healthpol.2025.105508","url":null,"abstract":"<div><h3>Background</h3><div>The continued use of low-value health care consumes system resources and creates unnecessary risk. There are numerous policy levers available to improve appropriateness of care, but a supporting tool is needed to allow for characteristic and evidence comparison.</div></div><div><h3>Objective</h3><div>Develop an inventory which catalogues policy levers which support the reduction of low-value care, alongside their effectiveness evidence and implementation factors.</div></div><div><h3>Methods</h3><div>Information on relevant levers was identified through searches in Medline, Cochrane Library, and Google Scholar, with additional targeted searches. An Excel-based inventory was developed with a list of levers, their descriptions, effectiveness outcomes, and implementation considerations. Filters were developed to help identify levers based on key characteristics. The inventory was refined through presentations to and feedback from key stakeholders.</div></div><div><h3>Results</h3><div>The inventory includes 53 levers which may influence clinician or patient behaviour, service provision, fiscal policies, and populations or organizations. Levers were often used across a variety of settings, care providers, and clinical indications, though some levers addressed specific low-value care contexts. Fiscal policy levers or those influencing service provision were more restrictive, while clinician and patient behaviour levers and those aimed at populations or organizations were less restrictive. Evidence was identified for 40 levers, with 9 levers considered high impact (> 5 % change to behaviour, utilization, or cost) or consistently supported (> 10 studies, the majority reporting desired effects).</div></div><div><h3>Conclusion</h3><div>This inventory can support health systems in addressing low-value care, through the ability to compare policy levers and select those applicable to the particular context.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105508"},"PeriodicalIF":3.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670979","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 : 2025-11-27DOI: 10.1016/j.healthpol.2025.105510
Abrar Ahmad Chughtai , Elizabeth Kpozehouen , Holly Seale , Smita Shah , Guy B. Marks , C Raina MacIntyre
Background
As climate change intensifies the frequency and severity of bushfires, exposure to bushfire smoke is emerging as a significant public health concern, associated with numerous adverse health outcomes, including exacerbation of chronic obstructive pulmonary disease, asthma, cardiovascular diseases, and respiratory infections.
Objective
This study examined policies related to the use of masks and respirators as protective measures against smoke exposure.
Methods
Policies and guidelines of health departments, emergency and fire services, and other relevant organisations of selected countries were reviewed. Guidelines were sourced from organizational websites, PubMed, and Google Scholar using specific keywords.
Result
There is variability in policies regarding mask and respirator use during bushfires. Health departments generally recommend using P2/ N95 respirators to protect the public from particulate exposure arising bushfire smoke, while emergency and fire services generally recommend surgical or cloth masks. Few guidelines provided detailed instructions on the proper use of respirators, including fit testing, or fit checking procedures. Most guidelines emphasised monitoring air quality and avoiding bushfire smoke, particularly for high-risk groups. There is no guidance provided on the length of time a mask should be used in any guideline.
Conclusion
The inconsistent recommendations from health organisations and countries regarding mask and respirator use during bushfires highlights the lack of high-quality evidence in this area. Health, emergency and fire services, and other relevant organisations should provide clear guidance around types of facemasks, the length of time a facemask should be used and on proper use of respirators use, including training and fit checking.
{"title":"Facemask and respirator use for bushfire smoke protection: A cross-country comparison of public health policies in Australia, Canada, India, and the United States","authors":"Abrar Ahmad Chughtai , Elizabeth Kpozehouen , Holly Seale , Smita Shah , Guy B. Marks , C Raina MacIntyre","doi":"10.1016/j.healthpol.2025.105510","DOIUrl":"10.1016/j.healthpol.2025.105510","url":null,"abstract":"<div><h3>Background</h3><div>As climate change intensifies the frequency and severity of bushfires, exposure to bushfire smoke is emerging as a significant public health concern, associated with numerous adverse health outcomes, including exacerbation of chronic obstructive pulmonary disease, asthma, cardiovascular diseases, and respiratory infections.</div></div><div><h3>Objective</h3><div>This study examined policies related to the use of masks and respirators as protective measures against smoke exposure.</div></div><div><h3>Methods</h3><div>Policies and guidelines of health departments, emergency and fire services, and other relevant organisations of selected countries were reviewed. Guidelines were sourced from organizational websites, PubMed, and Google Scholar using specific keywords.</div></div><div><h3>Result</h3><div>There is variability in policies regarding mask and respirator use during bushfires. Health departments generally recommend using P2/ N95 respirators to protect the public from particulate exposure arising bushfire smoke, while emergency and fire services generally recommend surgical or cloth masks. Few guidelines provided detailed instructions on the proper use of respirators, including fit testing, or fit checking procedures. Most guidelines emphasised monitoring air quality and avoiding bushfire smoke, particularly for high-risk groups. There is no guidance provided on the length of time a mask should be used in any guideline.</div></div><div><h3>Conclusion</h3><div>The inconsistent recommendations from health organisations and countries regarding mask and respirator use during bushfires highlights the lack of high-quality evidence in this area. Health, emergency and fire services, and other relevant organisations should provide clear guidance around types of facemasks, the length of time a facemask should be used and on proper use of respirators use, including training and fit checking.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"164 ","pages":"Article 105510"},"PeriodicalIF":3.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694431","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}
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