Health Policy最新文献_第5页

Facemask and respirator use for bushfire smoke protection: A cross-country comparison of public health policies in Australia, Canada, India, and the United States 面罩和呼吸器用于森林火灾烟雾防护：澳大利亚、加拿大、印度和美国公共卫生政策的跨国比较

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-27 DOI: 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.

随着气候变化加剧了森林大火的频率和严重程度，接触森林大火烟雾正在成为一个重大的公共卫生问题，与许多不良健康后果相关，包括慢性阻塞性肺病、哮喘、心血管疾病和呼吸道感染的加剧。目的本研究探讨了使用口罩和呼吸器作为烟雾暴露防护措施的相关政策。方法对选定国家的卫生部门、应急和消防部门以及其他相关组织的政策和准则进行审查。指南来源于组织网站、PubMed和谷歌Scholar，使用了特定的关键词。结果森林火灾期间口罩和呼吸器的使用政策存在差异。卫生部门通常建议使用P2/ N95呼吸器来保护公众免受森林大火烟雾产生的颗粒暴露，而紧急和消防部门通常建议使用外科口罩或布口罩。很少有指南提供关于正确使用呼吸器的详细说明，包括适合测试或适合检查程序。大多数指导方针强调监测空气质量和避免森林大火烟雾，特别是对高危人群。在任何指南中都没有提供口罩使用时间长度的指导。卫生组织和国家关于森林火灾期间口罩和呼吸器使用的不一致的建议突出了该领域缺乏高质量的证据。卫生、急救和消防部门以及其他相关机构应就口罩的种类、使用口罩的时间长短和正确使用呼吸器提供明确的指导，包括培训和健康检查。

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引用次数: 0

Romania’s 2025 guide for health workforce attraction and retention: Bridging global strategies and local realities 罗马尼亚《2025年卫生人力吸引和留住指南：衔接全球战略和地方现实》。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-27 DOI: 10.1016/j.healthpol.2025.105511

Teodor Cristian Blidaru , Alina-Ioana Forray , Tomas Zapata , Cris Scotter , Yana Andersen , Khamis Al-alawy , Ioana Novac , Rareș Vrîncianu , Alexandru Rafila , Alexandru Florin Rogobete , Dragoș Nicolae Garofil

Background

Romania's health system faces a challenge of health workforce maldistribution, especially in rural and non-university urban areas. A national policy reform was launched in 2024–2025, supported by the National Recovery and Resilience Plan and WHO technical assistance. The reform's objective was to equip and empower local authorities to improve the recruitment, retention, and motivation of health professionals in their communities.

Reform content

The reform involves the development and nationwide dissemination of the “Solutions for Human Resources in Health: Guide of Local Actions”. Developed through a participatory, evidence-based process with stakeholders, this guide is a practical toolkit for local authorities and hospital managers. It consolidates underused legal frameworks and curates national and international best practices examples across four main pillars: Education, Incentives, Regulation, and Support.

Expected Results

The primary expected outcome is an improvement in the geographical distribution of the health workforce, resulting in better-staffed facilities in underserved regions. A key secondary outcome is the boost in local authorities' administrative capacity and proactive involvement in the health workforce management, which fosters greater ownership and a more sustainable, decentralized approach to addressing staffing challenges. These outcomes will become measurable over the medium-to-long term as local authorities implement the guide's provisions.

Conclusions

The collaborative, evidence-based process used for the guide exemplifies a best practice model for stakeholder-driven policy development. The Romanian experience provides a transferable framework for countries with decentralized health systems to empower local actors in addressing health workforce maldistribution, though long-term success depends on local implementation and political will.

背景：罗马尼亚的卫生系统面临着卫生人力分布不均的挑战，特别是在农村和非大学城市地区。在国家恢复和复原力计划和世卫组织技术援助的支持下，于2024-2025年启动了一项国家政策改革。改革的目标是使地方当局有能力改进其社区卫生专业人员的招聘、保留和激励工作。改革内容：改革涉及制定和在全国范围内传播《卫生人力资源解决办法：地方行动指南》。该指南是通过与利益攸关方的参与性循证进程制定的，是地方当局和医院管理人员的实用工具包。它整合了未充分利用的法律框架，并在教育、激励、监管和支持四个主要支柱上汇集了国家和国际最佳实践实例。预期结果：主要预期结果是改善卫生人力的地理分布，从而在服务不足的地区改善设施人员配备。一个关键的次要成果是地方当局的行政能力得到提高，并积极参与卫生人力管理，从而促进更大的自主权，并采取更可持续、更分散的办法来应对人员配备方面的挑战。随着地方当局实施指南的规定，这些成果将在中长期内变得可衡量。结论：指南所采用的以证据为基础的协作过程体现了利益相关者驱动的政策制定的最佳实践模式。罗马尼亚的经验为拥有分散式卫生系统的国家提供了一个可转让的框架，以增强当地行为体解决卫生人力分配不当问题的能力，尽管长期成功取决于当地的实施和政治意愿。

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引用次数: 0

Cultural competence teaching in public health: a rapid review to support implementation 公共卫生文化能力教学：快速回顾以支持实施。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-27 DOI: 10.1016/j.healthpol.2025.105512

Martina Paric , Pablo Rodriguez Feria , María del Carmen Calle , Gloria Lagos , Matt Commers , Katarzyna Czabanowska

Background

Efforts to strengthen the public health workforce increasingly emphasize cultural competence as essential for addressing health disparities. While widely recognized, approaches to teaching this competency in public health remain fragmented. With the shift towards competency-based education that is aligned with workforce needs, clarity on how to integrate cultural competence teaching is needed.

Objective

To understand what factors support and inhibit cultural competence teaching within the public health education sector.

Methods

A rapid review was conducted using the Cochrane Rapid Review Methods Guidance and the databases Medline (Pubmed), Embase (Ovid), and Ebsco host. Blinded screening of title and abstract was performed, with additional citation searches. Relevant data was collected, and qualitative findings were synthesised using thematic analysis. Critical appraisal was performed on all included articles. The review was registered to PROSPERO 2025 CRD420251016703.

Results

17 articles were included. Analysis identified 6 major themes and 27 subthemes. 3 themes focus on the context in which cultural competence is taught: leveraging connections to communities, overall institutional readiness of public health schools, and having the aim to develop culturally competent graduates. The remaining 3 themes focused on content: providing an overview of various teaching practices, educational content, and developing an environment for continuous cultural learning. One cross-cutting code that emerged, referred to the need for standardization across public health and other health and allied health programmes.

Conclusions

This review provides decision-makers in public health schools with insights to advance cultural competence teaching. Closer collaboration with stakeholders and public health professionals is encouraged.

背景：加强公共卫生人力的努力日益强调文化能力对于解决卫生差距至关重要。虽然得到广泛认可，但在公共卫生领域教授这一能力的方法仍然是零散的。随着向符合劳动力需求的能力教育的转变，需要明确如何整合文化能力教学。目的：了解公共卫生教育部门文化能力教学的支持和抑制因素。方法：使用Cochrane快速回顾方法指南和Medline （Pubmed）、Embase （Ovid）和Ebsco主机数据库进行快速回顾。对标题和摘要进行盲法筛选，并进行额外的引文检索。收集了相关数据，并利用专题分析对定性结果进行了综合。对所有纳入的文章进行了批判性评价。该审查注册号为PROSPERO 2025 CRD420251016703。结果：纳入17篇文献。分析确定了6个主要主题和27个次要主题。3个主题侧重于文化能力教学的背景：利用与社区的联系，公共卫生学校的整体制度准备，并以培养具有文化能力的毕业生为目标。其余3个主题侧重于内容：提供各种教学实践的概述，教育内容，以及为持续的文化学习创造环境。出现了一项横切准则，其中提到需要在公共卫生和其他卫生及相关卫生规划之间实现标准化。结论：本综述为公共卫生学校决策者提供了促进文化能力教学的见解。鼓励与利益攸关方和公共卫生专业人员密切合作。

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引用次数: 0

The impact of pre-admission care on hospital mortality: Results of an instrumental variable analysis from Italy 入院前护理对医院死亡率的影响：来自意大利的工具变量分析结果。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-20 DOI: 10.1016/j.healthpol.2025.105483

Francesco Moscone , Elisa Tosetti , Giorgio Vittadini

Background

With healthcare spending projected to increase in the coming decades, the relationship between expenditure and health outcomes demands urgent attention.

Objective

This paper investigates the impact of health care spending on hospital mortality. We use data on 96,778 patients admitted for acute myocardial infarction (AMI) in the Lombardy region, Italy, in the years from 2007 to 2022 and combine them with information on expenditure on pharmaceuticals and outpatient visits made in the 12 months prior to hospital admission.

Methods

We adopt an instrumental variables approach to evaluate the causal impact of the total cost for pre-admission prescriptions and outpatient visits on hospital patient’s mortality.

Results

We find that pre-admission healthcare, particularly pharmaceutical spending, has a significant impact on reducing mortality rates within hospitals, with a 10 % increase in pharmaceutical spending leading to a reduction in mortality by around 3.0 percentage points, although this result varies depending on the age group and the type of infarction.

Conclusions

The findings suggest that prioritizing pharmaceutical management can significantly reduce hospital mortality, highlighting a key area for healthcare optimization.

背景：随着医疗保健支出预计将在未来几十年增加，支出与健康结果之间的关系需要迫切关注。目的：探讨医疗保健支出对医院死亡率的影响。我们使用了意大利伦巴第地区2007年至2022年间入院的96778例急性心肌梗死（AMI）患者的数据，并将其与入院前12个月内的药品支出和门诊就诊信息相结合。方法：采用工具变量法评估住院前处方总费用和门诊总费用对住院患者死亡率的因果影响。结果：我们发现，入院前医疗保健，特别是药品支出，对降低医院内的死亡率有显著影响，药品支出每增加10%，死亡率就会降低约3.0个百分点，尽管这一结果因年龄组和梗塞类型而异。结论：优化药品管理可显著降低医院死亡率，这是医疗优化的一个关键领域。

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引用次数: 0

Impact of COVID-19 on primary care consultation mode in England: An interrupted time series analysis COVID-19对英格兰初级保健咨询模式的影响：中断时间序列分析

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-19 DOI: 10.1016/j.healthpol.2025.105502

Nicoletta Mesiano , Rita Santos

Background

The COVID-19 pandemic significantly disrupted healthcare delivery worldwide, and general practice in England was no exception. The adoption of remote consultations in primary care increased sharply during the pandemic. However, there is no evidence that the adoption of remote consultation will continue in the long term.

Objective

Analyse the long-term effects on primary care face-to-face and telephone consultations in England after the change towards remote consultation during COVID-19 pandemic.

Method

We use Interrupted Time Series analysis to understand the long-term effects on primary care face-to-face and telephone consultations in England at both national and regional levels.

Results

There was a shift in consultation patterns during and after the pandemic. Face-to-face consultations experienced a significant and immediate decline following the introduction of restrictions. However, they gradually increased and returned to pre-pandemic levels after restrictions were lifted, indicating that most healthcare needs still require in-person contact. Telephone consultations rose sharply during the pandemic. Although their use declined after restrictions eased in July 2021, they remained above pre-pandemic levels.

Conclusion

The COVID-19 pandemic profoundly changed how general practice consultations are delivered in England, prompting a rapid shift to remote consultation methods. While telephone consultations surged when face-to-face contact was restricted, this increase was not sustained in the long term. Although remote consultations remained above pre-pandemic levels, they did not fully replace in-person visits. This suggests a dual use of resources rather than a substitution. Policy efforts should focus on balancing and supporting both remote and face-to-face consultation models.

背景：COVID-19大流行严重扰乱了全球医疗保健服务，英格兰的一般做法也不例外。在大流行期间，在初级保健中采用远程会诊的情况急剧增加。然而，没有证据表明远程会诊的采用将长期持续下去。目的：分析新冠肺炎大流行期间英国基层医疗面对面和电话会诊向远程会诊转变后的远期效果。方法：我们使用中断时间序列分析来了解英格兰国家和地区一级初级保健面对面和电话咨询的长期影响。结果：在大流行期间和之后，协商模式发生了变化。在实行限制措施后，面对面协商立即大幅减少。然而，在取消限制后，它们逐渐增加并恢复到大流行前的水平，这表明大多数卫生保健需求仍然需要面对面接触。大流行期间电话咨询急剧增加。尽管在2021年7月限制措施放松后，它们的使用量有所下降，但仍高于大流行前的水平。结论：2019冠状病毒病大流行深刻改变了英国全科医生会诊的提供方式，促使其迅速转向远程会诊方式。虽然电话咨询在面对面接触受到限制时激增，但这种增长并没有长期持续下去。尽管远程咨询仍高于大流行前的水平，但它们并没有完全取代亲自就诊。这表明资源的双重使用，而不是替代。政策应注重平衡和支持远程咨询和面对面咨询两种模式。

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引用次数: 0

Pricing matters: A retrospective national study of pricing reform impact on hip fracture procedures in Israel 定价问题：以色列定价改革对髋部骨折手术影响的回顾性全国研究

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-19 DOI: 10.1016/j.healthpol.2025.105503

Gideon Leibner , Meir Liebergall , Shuli Brammli-Greenberg

Background

This study examines the effects of a 2015 national reform in the Israeli healthcare system in the pricing structure for hip fracture procedures, where hospitals are reimbursed at a fixed rate based on the relevant Procedure-Related Group (PRG). The reform increased reimbursement rates for urgent hip-replacements, shifting the relative financial incentives between procedures.

Objective

To estimate the impact of the PRG tariff change on procedure mix and patients’ likelihood of undergoing hip replacement.

Methods

Utilizing a longitudinal retrospective case study approach, this national, multicenter, population-based study analyzed data from all 88,585 publicly funded urgent hip surgical procedures carried out in Israel from 2007 to 2018. The empirical strategy included a descriptive analysis of trends, Interrupted Time Series (ITS) and Projection-Based Adaptation of DID (Projected-DID).

Results

Among 88,585 urgent hip surgeries, 68.2% occurred before and 31.8% after the reform. Internal hip fixation (86.5%) remained most common, but total hip arthroplasty (THA) rose from 10.5% in 2007 to 32.2% in 2018, accompanied by a corresponding decline in hemiarthroplasty (HA). ITS analysis showed accelerated THA adoption post-reform (slope-change OR 1.06/quarter), with immediate declines in HA and IHF. The projected-DID estimates indicated the reform more than doubled the probability of THA, while moderating trends in HA and IHF. Overall, higher reimbursement increased likelihood of joint replacement, shifting from HA to THA.

Conclusions

Our study joins the extensive literature showing that compensation mechanisms are powerful tools for policymakers and payers to influence clinical decisions and shift practice at both hospital and departmental levels.

本研究考察了2015年以色列医疗保健系统对髋部骨折手术定价结构的国家改革的影响，其中医院根据相关手术相关组（PRG）以固定费率报销。这项改革提高了紧急髋关节置换术的报销率，改变了不同手术之间的相对财政激励。目的评估PRG价格变化对手术组合和患者接受髋关节置换术可能性的影响。方法采用纵向回顾性病例研究方法，这项全国性、多中心、基于人群的研究分析了2007年至2018年以色列所有88,585例公共资助的紧急髋关节手术的数据。实证策略包括趋势的描述性分析、中断时间序列（ITS）和基于预测的DID适应（Projected-DID）。结果88,585例髋关节急诊手术中，改革前和改革后分别占68.2%和31.8%。髋关节内固定（86.5%）仍然是最常见的，但全髋关节置换术（THA）从2007年的10.5%上升到2018年的32.2%，伴有半髋关节置换术（HA）的相应下降。ITS分析显示改革后THA采用加速（斜率变化OR 1.06/季度），HA和IHF立即下降。预测的did估计表明，改革使THA的可能性增加了一倍以上，同时减缓了HA和IHF的趋势。总体而言，较高的报销增加了关节置换术的可能性，从HA转移到THA。结论：我们的研究与大量文献一起表明，补偿机制是政策制定者和支付者影响临床决策和改变医院和部门实践的有力工具。

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引用次数: 0

Multi-Sector collaboration to promote healthy ageing: A comparative case study of national policy responses in the Western Pacific Region 促进健康老龄化的多部门合作：西太平洋区域国家政策对策的比较案例研究

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-19 DOI: 10.1016/j.healthpol.2025.105501

Tao Yang , Aaron Hagedorn , Wenqian Xu , Siwon Lee , Mikiko Kanda , Sunghun Yun , Honglin Chen

This study investigates how national policies in nine Western Pacific countries—China, Japan, South Korea, Australia, New Zealand, Singapore, Malaysia, Vietnam, and Cambodia—promote healthy ageing through multi-sector collaboration. The objective is to identify common patterns and country-specific features in the governance and organization of collaborative efforts.

Using comparative case study analysis based on government documents, official reports, academic literature, and authoritative websites, the analysis reveals a growing policy emphasis on cross-sector collaboration in healthy ageing. Three distinct models of collaborative governance were identified, each characterized by different sectoral roles and coordination mechanisms.

These findings contribute to a better understanding of how multi-sector approaches are structured and implemented in diverse policy contexts to support healthy ageing. The study offers practical insights for policymakers aiming to strengthen intersectoral collaboration and align national strategies with international frameworks such as the UN Decade of Healthy Ageing (2021–2030) and the WHO Regional Action Plan for Healthy Ageing in the Western Pacific Region.

本研究调查了九个西太平洋国家（中国、日本、韩国、澳大利亚、新西兰、新加坡、马来西亚、越南和柬埔寨）的国家政策如何通过多部门合作促进健康老龄化。目标是确定协作工作的治理和组织中的共同模式和国别特点。通过基于政府文件、官方报告、学术文献和权威网站的比较案例分析，分析表明，在健康老龄化方面，政策越来越强调跨部门合作。确定了三种不同的协作治理模式，每种模式都具有不同的部门作用和协调机制。这些发现有助于更好地了解如何在不同政策背景下构建和实施多部门方法，以支持健康老龄化。该研究为旨在加强部门间合作并使国家战略与联合国健康老龄化十年（2021-2030年）和世卫组织西太平洋区域健康老龄化区域行动计划等国际框架保持一致的政策制定者提供了实际见解。

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引用次数: 0

Health workforce resilience in the age of polycrisis: A framework to support health workforce policy and planning 多重危机时代卫生人力复原力：支持卫生人力政策和规划的框架。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-17 DOI: 10.1016/j.healthpol.2025.105500

Olivier Onvlee , Eelco Jacobs , Noor Tromp , Ajay Bailey , Marjolein Dieleman

Background

Many countries face prolonged health workforce crises, marked by shortages, maldistribution, skills mix imbalances and attrition. When workforces are overstretched, they become more vulnerable to external shocks and chronic strains, including infectious disease outbreaks, climate-related effects and political instability. This is particularly concerning as an emerging global “polycrisis” means such external pressures increasingly interact and amplify one another in unpredictable ways. Strengthening health workforce resilience must therefore become a priority for policy and planning.

Objective

To introduce a resilience lens for health workforce policy and planning.

Methods

This conceptual paper synthesises literature from health workforce and systems research, resilience, and complex adaptive systems theory, complemented by practical insights from workforce planning and governance.

Results

The paper introduces the Health Workforce Resilience framework, which illustrates how the multilevel nature of health workforce resilience connects individual health workers, teams and organisations, and the national health workforce level. It shows how shocks and long-term pressures ripple through these interconnected levels, affecting the capacity, composition, and performance of the workforce. Impacts and responses at one level can amplify or dampen effects at others. The framework highlights two critical interfaces: the workforce–community interface, capturing how societal, economic, and security conditions shape workforce motivation, performance, and retention, and the workforce–governance interface, reflecting how institutional arrangements, policies, and decision-making processes enable or constrain workforce system responses.

Conclusions

Adopting a resilience lens underscores the need to view workforce planning as a systems approach that emphasises anticipatory, needs-based planning and integrates political, social, and contextual realities to strengthen workforce resilience under pressure.

背景：许多国家面临长期的卫生人力危机，其特点是短缺、分配不均、技能组合失衡和人员流失。当劳动力过度紧张时，他们更容易受到外部冲击和慢性压力的影响，包括传染病爆发、气候相关影响和政治不稳定。这尤其令人担忧，因为新兴的全球“多重危机”意味着这些外部压力越来越多地以不可预测的方式相互作用和放大。因此，加强卫生人力复原力必须成为政策和规划的优先事项。目的：为卫生人力政策和规划引入弹性视角。方法：这篇概念性论文综合了来自卫生人力和系统研究、弹性和复杂适应系统理论的文献，并辅以人力规划和治理的实践见解。结果：本文介绍了卫生人力弹性框架，该框架说明了卫生人力弹性的多层次性质如何将卫生工作者个人、团队和组织以及国家卫生人力层面联系起来。它显示了冲击和长期压力如何在这些相互关联的层面上波动，影响劳动力的能力、构成和表现。一个层面的影响和反应可以放大或抑制其他层面的影响。该框架强调了两个关键接口：劳动力-社区接口，捕捉社会、经济和安全条件如何塑造劳动力动机、绩效和保留，以及劳动力-治理接口，反映制度安排、政策和决策过程如何使或限制劳动力系统的反应。结论：采用弹性视角强调需要将劳动力规划视为一种系统方法，强调预期的、基于需求的规划，并整合政治、社会和背景现实，以增强压力下的劳动力弹性。

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引用次数: 0

How health workers experience health system reform: A qualitative study from Finland 卫生工作者如何体验卫生系统改革：来自芬兰的定性研究

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-15 DOI: 10.1016/j.healthpol.2025.105499

Laura Kihlström , Marjaana Viita-aho , Ilmo Keskimäki , Liina-Kaisa Tynkkynen

Background

Health system reforms have been ubiquitous in high-income countries during the past decades, yet research on how reform implementation is experienced by the health and care workforce (HCWF) remains scant. This is a critical omission, given that the recruitment and retention of the HCWF is recognized as one of the key challenges of health systems globally, and one which health system reforms often set out to solve.

Objective

To study how the implementation of a large-scale health system reform in Finland has been experienced by the HCWF in primary health care.

Methods

Qualitative interviews mainly with physicians, registered nurses, and licensed practical nurses (n=48) were conducted in regions’ three primary health care (PHC) centers in Jan 2024-Nov 2024. Interviewees were identified through snowball and purposive sampling. The data were analyzed through an iterative process consisting of both deductive and inductive elements.

Results

The results point to misalignment between the reform’s intended policy objectives and on-the-ground experiences of the HCWF in PHC in Finland. This has led to a sense of demoralization among the HCWF and impacts how they interpret the legitimacy and legacy of the reform. The data also bring forward factors which strengthen the engagement of the HCWF in PHC which is crucial for overall system change and reform implementation.

Conclusions

Our findings have critical implications for the implementation and leadership of health system reforms in PHC. HCWF involvement can be a win-win situation for the system and the workforce, and failure to involve them can further deepen the issue of HCWF shortages in PHC.

在过去的几十年里，卫生系统改革在高收入国家已经无处不在，但关于卫生和保健工作人员（HCWF）如何体验改革实施的研究仍然很少。这是一个重大遗漏，因为招募和保留卫生保健工作人员被认为是全球卫生系统面临的主要挑战之一，也是卫生系统改革往往着手解决的问题。目的研究芬兰卫生中心在初级卫生保健方面实施大规模卫生体制改革的经验。方法于2024年1月~ 2024年11月，对各地区3个初级卫生保健中心的医师、注册护士和执业护士（n=48）进行定性访谈。通过滚雪球和有目的的抽样来确定受访者。数据是通过一个由演绎和归纳元素组成的迭代过程来分析的。结果结果表明，改革的预期政策目标与芬兰初级卫生保健HCWF的实际经验之间存在不一致。这导致了HCWF的一种士气低落的感觉，并影响了他们如何解释改革的合法性和遗产。数据还提出了加强HCWF参与初级卫生保健的因素，这对整个系统变革和改革实施至关重要。结论研究结果对基层医疗卫生体制改革的实施和领导具有重要意义。医护人员的参与对医疗系统和医护人员来说是一个双赢的局面，如果医护人员不参与进来，可能会进一步加深初级保健医护人员短缺的问题。

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引用次数: 0

Spatial equity of physiotherapy accessibility in Aotearoa New Zealand in relation to Māori and Pacific ethnicity, socioeconomic deprivation, and rurality 新西兰奥特罗阿地区物理治疗可及性的空间公平性与Māori、太平洋族裔、社会经济剥夺和乡村性的关系

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-11-09 DOI: 10.1016/j.healthpol.2025.105498

Miranda Buhler , Tayyab Shah , Meredith Perry , Marc Tennant , Estie Kruger , Stephan Milosavljevic

Background

In Aotearoa New Zealand (NZ), physiotherapists are legislated first-contact practitioners yet physiotherapy services outside of limited public services have low subsidy rates or are entirely user-pays. The distribution of geographic accessibility of physiotherapy relative to population health need in this context is not known.

Objective

To examine NZ physiotherapy spatial accessibility at a high acuity level in relation to demographic indicators of health need (Māori or Pacific ethnicity, socioeconomic deprivation, rurality).

Methods

Using the distance-based 3-step floating catchment area (3SFCA) geospatial analysis methodology, location data for 5582 physiotherapists (92 % of the registered physiotherapists at March 2022) were integrated with 2018 NZ Census data to generate 'accessibility scores' (weighted practitioner: population ratio) for each Statistical Area 2. Population demographic characteristics were cross tabulated with accessibility scores and thematically mapped. Trends in relationships were explored statistically.

Results

Specific locations of inequity where health need is high, yet accessibility of physiotherapy is low (<0.94 to 9.06 per 10,000 population) were identified. Low physiotherapy accessibility was statistically associated with high proportion population Māori ethnicity and more rural location.

Conclusions

The methods can be built on to generate intelligence for developing and evaluating strategies to eliminate modifiable spatial inequities in physiotherapy care.

背景：在新西兰（NZ），物理治疗师是法律规定的第一次接触从业人员，但有限的公共服务之外的物理治疗服务补贴率低或完全由用户支付。在这种情况下，物理治疗相对于人口健康需求的地理可及性分布尚不清楚。目的：研究新西兰物理治疗的空间可及性与健康需求的人口指标（Māori或太平洋族裔、社会经济剥夺、乡村性）的关系。方法：采用基于距离的三步浮动集水区（3SFCA）地理空间分析方法，将5582名物理治疗师（占2022年3月注册物理治疗师的92%）的位置数据与2018年新西兰人口普查数据相结合，为每个统计区域2生成“可达性分数”（加权从业者：人口比例）。人口统计特征与可达性得分交叉表，并进行主题映射。从统计学上探讨了人际关系的趋势。结论：这些方法可以为制定和评估消除物理治疗护理中可改变的空间不平等策略提供情报。

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引用次数: 0