Health Policy最新文献

{"title":"Different systems, same challenges: a comparative analysis of long-term care resilience in Norway, Finland, the Netherlands, Romania, Spain, Italy and Australia","authors":"Martijn Felder ,&nbsp;Roland Bal ,&nbsp;Eline Ree ,&nbsp;Maren Sogstad ,&nbsp;Sharon Stoddart ,&nbsp;Louise A. Ellis ,&nbsp;Florin Tibu ,&nbsp;Federico Vola ,&nbsp;Paola Cantarelli ,&nbsp;Juana María Delgado-Saborit ,&nbsp;Estefania Aparicio ,&nbsp;Mari Lahti ,&nbsp;Eila Kankaanpää ,&nbsp;Siri Wiig ,&nbsp;Iris Wallenburg ,&nbsp;Hilda Bø Lyng","doi":"10.1016/j.healthpol.2025.105484","DOIUrl":"10.1016/j.healthpol.2025.105484","url":null,"abstract":"<div><h3>Background</h3><div>Welfare states face multiple challenges in the sustainable organization of their long-term care (LTC) systems due to aging populations and structural workforce shortages. In this context, the need emerges to facilitate cross-country exchange of policy responses to strengthen LTC resilience.</div></div><div><h3>Objectives</h3><div>In this paper, we provide comparative insight into the LTC systems of Norway, Finland, the Netherlands, Romania, Spain, Italy, and Australia. We identify key challenges in organizing LTC in these systems and compare strategies implemented to enhance LTC resilience.</div></div><div><h3>Methods</h3><div>Our qualitative cross-country analysis is based on the Consolidated Framework for Implementation Research and adapted for LTC contexts. Data was derived from OECD databases and complemented with country specific publicly available data sources.</div></div><div><h3>Results</h3><div>We show that participating countries face similar workforce challenges and adopt comparable strategies such as aging-in-place policies, technological innovation, service integration, and task shifting. Subtle yet crucial differences can however be observed in the broader systemic conditions in place to support LTC employment, and in the trade-offs being made between care quality and accessibility. The differences highlight the crucial role of LTC organizations and particularly middle managers in translating workforce strategies into situated interventions that strengthen both organizational resilience and individual well-being.</div></div><div><h3>Conclusions</h3><div>To enhance LTC resilience in both the short and long term, translational challenges include strengthening the connections to informal carers; stabilizing ehealth technologies to support ageing-in-place; and balancing individual workers’ ambitions and needs with organizational goals to keep healthcare accessible, responsive and of good quality.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105484"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520884","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}

{"title":"The challenge of the first 1000 days. The dynamics of early-life health inequalities in a universal healthcare system: Evidence from Italy.","authors":"Paolo Berta, Gilberto Turati","doi":"10.1016/j.healthpol.2025.105390","DOIUrl":"10.1016/j.healthpol.2025.105390","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Research in context: &lt;/strong&gt;(1) What is already known about the topic? Low birth weight (LBW) is a key marker of early-life health disadvantage, associated with increased mortality, delayed development, and long-term socioeconomic challenges. Health disparities related to LBW are predictive of future health outcomes and life trajectories. Although universal healthcare systems can mitigate such inequalities, their effectiveness varies across health domains and population subgroups. (2) What does this study add to the literature? This study examines how LBW-related health disparities evolve during early childhood within the universal healthcare system of Lombardy, Italy. Using robust statistical approaches, including twin fixed-effect models, the study shows that initial disadvantages in hospitalization rates and severity substantially decrease within the first 1000 days of life, particularly for nervous and digestive system conditions. However, disparities persist in respiratory diseases, indicating uneven mitigation across health domains. The study contributes new evidence on how universal healthcare can promote health equity in early life, while highlighting residual areas of concern. (3) What are the policy implications? The findings suggest that universal healthcare systems can significantly reduce health inequalities linked to LBW, but targeted interventions are necessary to address persistent disparities-especially in respiratory health. Policymakers should consider strengthening prenatal and neonatal care and designing condition-specific strategies that extend beyond infancy. Tailored support for LBW infants can further improve long-term outcomes and enhance the overall effectiveness of universal healthcare in promoting equitable health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early-life health inequalities can shape long-term health outcomes. This study examines disparities in hospitalization rates and severity between low- and normal-birth-weight children aged 0-3 years in Lombardy, Italy, under a universal public healthcare system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the evolution of early-life health inequalities in hospitalization rates and severity between low- and normal-birth-weight children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective longitudinal study leveraging a unique administrative dataset that integrates birth records and hospital discharge data for a large cohort of children in Lombardy. This approach allows for a robust analysis of hospitalization probabilities, total reimbursement costs, and hospital length of stay over the critical first 1000 days of life. Subgroup analyses focus on nervous, digestive, and respiratory diseases. Twin birth data are used to strengthen causal inference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Low-birth-weight children experience higher hospitalization rates and greater severity in the first year of life, but disparities substantially decline over time, with no significant diffe","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"105390"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812690","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}

{"title":"A population-based exploration of immigrants undergoing general surgery procedures in British Columbia: Do immigrants present for emergency surgeries more than non-immigrants?","authors":"Michael Guo, Nicolas Mourad, Ahmer Karimuddin, Jason M Sutherland","doi":"10.1016/j.healthpol.2025.105410","DOIUrl":"10.1016/j.healthpol.2025.105410","url":null,"abstract":"<p><strong>Background: </strong>Canada's growing immigrant population faces language and cultural barriers that hinder timely access to healthcare. The balance between elective and emergency general surgery (EGS) reflects immigrant's access to healthcare since many EGS cases are avoidable through treatment as elective procedures.</p><p><strong>Objective: </strong>This study examines whether immigrants are more likely to undergo EGS than non-immigrants and measures whether language proficiency or access to primary care plays a role in disparity in access to care.</p><p><strong>Methods: </strong>All general surgery procedures performed in British Columbia, Canada between 2013 and 2021 were identified using a population-based longitudinal administrative data that linked immigration data with physician billing and hospital data. The primary outcome was whether patients' surgery was elective or EGS and the primary exposure was immigrant status. The odds of EGS between immigrants and non-immigrants was estimated adjusting for patient and system-level differences. The analysis compared immigrants with and without English proficiency on arrival to Canada.</p><p><strong>Results: </strong>Of 237,054 general surgery procedures, 30.7 % were EGS and 15.2 % involved immigrants. Immigrants had slightly higher odds of undergoing emergency general surgery (EGS) than non-immigrants. Immigrants not fluent in English had 16 % higher odds of EGS (OR: 1.16, 95 %CI 1.03-1.32). Immigrants with fewer GP contacts were more likely to undergo EGS (45.5 % versus 42.2 %, p < 0.01).</p><p><strong>Conclusions: </strong>Immigrants with language barriers and who accessed primary care less often were more likely to require EGS. These findings highlight the need for system-level interventions to reduce immigrants' reliance on emergency surgical care.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"105410"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805273","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}

{"title":"Understanding physician prescription behaviors: a systematic review and meta-analysis of macro, meso, and micro-level influences.","authors":"Giaele Moretti, Francesca Ferrè, Alma Martelli, Paola Cantarelli","doi":"10.1016/j.healthpol.2025.105415","DOIUrl":"10.1016/j.healthpol.2025.105415","url":null,"abstract":"<p><strong>Background: </strong>Prescription is a complex act that reflects the physician's expertise and authority. While some factors affecting prescription decisions have been studied, empirical findings often conflict, leaving our understanding of prescription behaviors limited and fragmented.</p><p><strong>Objective: </strong>To assess the factors influencing physicians' drug prescribing habits by applying Strong Structuration Theory. Factors are categorized at: physician, practice, patient, industry, and system level.</p><p><strong>Methods: </strong>Pubmed, Scopus, and ISI Web of Science were searched from inception to June 2025. Peer-reviewed studies were included if they were published in English, empirical, and assessed at least one factor influencing physicians' prescribing behaviors. Studies reporting the effect of covariates on prescriptions using Odds Ratios were included in the meta-analysis.</p><p><strong>Results: </strong>146 studies were selected for the review. At the macro-level, physicians were more likely to prescribe after being exposed to marketing activities by pharmaceutical industries, and for privately insured patients. Meso-level factors, such as practice ownership and setting, showed conflicting results, with no significant effect observed in the meta-analysis. Micro-level influences were the most prevalent in literature. Patient requests had a significant positive effect on prescriptions. Physician-level influences were inconsistent across most variables, except gender, where male physicians were more likely to prescribe. This effect was not confirmed by the meta-analysis, which showed heterogeneity across studies.</p><p><strong>Conclusion: </strong>This study highlights the complexity of prescribing behaviors and the challenges in designing effective micro-level policies. Policymakers should therefore consider the multiple influences on prescribing to design targeted interventions that promote high-quality prescribing practices.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"161 ","pages":"105415"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812691","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}

{"title":"Mortality risk factors in Catalonia’s long-term care system: A population-based survival analysis","authors":"Albert Prades-Colomé","doi":"10.1016/j.healthpol.2025.105482","DOIUrl":"10.1016/j.healthpol.2025.105482","url":null,"abstract":"<div><h3>Background</h3><div>As populations age, understanding the health impact of long-term care systems is critical for shaping effective policy.</div></div><div><h3>Objective</h3><div>This study investigates the association between long-term care benefits and mortality risk among older adults in Catalonia, Spain, using comprehensive administrative data from July 2015 to December 2024.</div></div><div><h3>Methods</h3><div>The analysis focuses on applicants of long-term care benefits in Catalonia aged 50+, categorizing them by severity of their needs (Grades I–III) and type of benefit received: home care, residential care, a combination of both or no benefit. It applies survival analysis techniques—including Kaplan-Meier estimators and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Individuals with long-term care needs receiving benefits have significantly lower mortality hazards. Notably, individuals transitioning from home to residential care exhibit the most favourable hazard ratios, suggesting that responsive care pathways are associated with better survival outcomes, potentially due to a most accurate matching of care to needs. Residential care alone is associated to higher mortality risk than home care in the population with the highest grades of long-term care needs. Individuals with recognized long-term care needs who do not receive any benefits face significantly higher risks. Mortality risk also varies by sex, age, and clinical profile, with higher hazards observed among men, older individuals, and those with previous haematological, neoplastic, or respiratory conditions.</div></div><div><h3>Conclusion</h3><div>These findings underscore the association between formal long-term care systems and lower mortality risk and emphasize the importance of timely, adaptive care pathways in mitigating health decline among ageing populations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105482"},"PeriodicalIF":3.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469093","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}

{"title":"The effectiveness of pharmaceutical tenders as a cost containment mechanism: analysis through the Synthetic Control Method. The case of Andalusia (Spain)","authors":"Pedro Atienza Montero ,&nbsp;Luis Ángel Hierro Recio ,&nbsp;Antonio José Garzón Gordón","doi":"10.1016/j.healthpol.2025.105481","DOIUrl":"10.1016/j.healthpol.2025.105481","url":null,"abstract":"<div><h3>Background</h3><div>Outpatient pharmaceutical tenders are not a widespread measure. In Spain, the sub-central government of the Andalusian region is the only Spanish health administration to have applied them.</div></div><div><h3>Objective</h3><div>This work aims to evaluate the effectiveness of this measure in reducing public pharmaceutical expenditure during the period it was in force –from June 2012 to December 2020.</div></div><div><h3>Methods</h3><div>We use the Synthetic Control Method (SCM), which estimates a counterfactual (synthetic) value for our variable of interest (outpatient pharmaceutical expenditure per capita) based on a set of predictor variables from a combination of units from the potential control group (in this case, the rest of the regions in Spain).</div></div><div><h3>Results</h3><div>The results of the SCM show no evidence that the pharmaceutical tender implemented in Andalusia reduced pharmaceutical spending. Statistical tests show that the null hypothesis of no differential effect of the measure on pharmaceutical spending during the period in which it was in force cannot be rejected. These results are robust to various robustness tests.</div></div><div><h3>Conclusions</h3><div>Public tenders for outpatient pharmaceuticals in Andalusia did not prove effective as a mechanism for controlling public expenditure during the period it was in force and failed to lead to a reduction in expenditure when compared to the rest of the regions in Spain, which did not apply it.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105481"},"PeriodicalIF":3.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432957","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}

{"title":"Association between socioeconomic disadvantage and low-value care in acute care hospitals in Japan: Cross-sectional study","authors":"So Sato ,&nbsp;Hideo Yasunaga ,&nbsp;Yuichiro Matsuo ,&nbsp;Hiroki Matsui ,&nbsp;Kiyohide Fushimi ,&nbsp;Atsushi Miyawaki","doi":"10.1016/j.healthpol.2025.105479","DOIUrl":"10.1016/j.healthpol.2025.105479","url":null,"abstract":"<div><h3>Background</h3><div>Low-value care offers little clinical benefit and contributes to inefficient healthcare utilization. Although socioeconomic disparities in healthcare access are well documented, data on low-value care among disadvantaged inpatients remain limited.</div></div><div><h3>Objective</h3><div>To examine the association between neighborhood-level socioeconomic status (SES) and the proportion of low-value care services in Japanese inpatient settings using the area deprivation index (ADI) as a proxy for SES.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study using a nationwide inpatient database from 920 hospitals in Japan between April 2022 and March 2023. Hospitalizations of patients aged ≥18 years receiving one of 12 selected low-value care services were included. The outcome was whether a service provided during hospitalization was classified as low-value based on established algorithms. Patients from deprived areas (top 10 % ADI) were compared with those from non-deprived areas, adjusting for patient case-mix and hospital fixed effects.</div></div><div><h3>Results</h3><div>Among 524,705 hospitalizations (42.3 % female; mean age, 69.9 ± 15.5 years), 33,271 (6.3 %) were classified as low-value care. After adjustment, patients from deprived areas had a higher proportion of low-value care than those from non-deprived areas (6.6 % vs. 6.3 %; adjusted difference, +0.2 percentage points; 95 % CI, 0.03 to 0.5; <em>P</em> = 0.02). Subgroup analyses showed stronger associations among patients aged ≥65, females, and those treated in non-academic hospitals. Results remained consistent after accounting for hospital fixed effects.</div></div><div><h3>Conclusions</h3><div>Patients from disadvantaged areas are slightly more likely to receive low-value inpatient care than are those from non-disadvantaged areas. Older adults, women, and patients treated in non-academic hospitals appeared more affected.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105479"},"PeriodicalIF":3.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439437","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}

{"title":"Backlogs, waiting times and waiting lists of elective surgeries across OECD countries","authors":"Luigi Siciliani ,&nbsp;Gaetan Lafortune ,&nbsp;Marie-Clémence Canaud ,&nbsp;Chekwube Madichie","doi":"10.1016/j.healthpol.2025.105478","DOIUrl":"10.1016/j.healthpol.2025.105478","url":null,"abstract":"<div><h3>Background</h3><div>Many OECD countries suspended elective (non-emergency) care during the pandemic to divert efforts towards COVID-19 patients, which generated a backlog of patients.</div></div><div><h3>Objective</h3><div>This study measures the extent to which waiting times and volume changed over time before and after COVID-19 in OECD countries (between 2016-2023). We test whether COVID-19 had a different effect on the waiting time of the patients on the list versus the wait of patients treated, two common measures of waiting times. It discusses how waiting times and volume can be used as measures of health system resilience for elective care.</div></div><div><h3>Methods</h3><div>The study uses data on a selection of high-volume elective surgeries and OECD countries that report waiting times for patients on the list or from addition to the list to treatment. We use regression methods to quantify the extent to which waiting times increased and volumes decreased after the pandemic across OECD countries.</div></div><div><h3>Results</h3><div>We find that the wait on the list increased on average by 27-30% in the first three years. In contrast, the wait to treatment increased only to a small extent and the effect was not statistically significant. Volume reduced on average by 19% and 10% in the first two years. There were heterogeneous effects across countries, but these do not appear to be systematically related to health spending, physicians and acute beds.</div></div><div><h3>Conclusion</h3><div>Measures of health system resilience for elective care should monitor both the wait on the list and the wait to treatment, in addition to volumes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105478"},"PeriodicalIF":3.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469092","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}

{"title":"A scoping literature review of rehabilitation policy recommendations during the COVID-19 pandemic in the WHO European Region","authors":"Callum Thomas ,&nbsp;Justine Gosling ,&nbsp;Ruth E Ashton ,&nbsp;Rebecca Owen ,&nbsp;Mark A Faghy","doi":"10.1016/j.healthpol.2025.105477","DOIUrl":"10.1016/j.healthpol.2025.105477","url":null,"abstract":"<div><h3>Background</h3><div>As with other frontline healthcare services, the delivery of rehabilitation services has been greatly affected by the COVID-19 pandemic with many services suspended, despite WHO’s mandate that rehabilitation is an essential service.</div></div><div><h3>Objective</h3><div>This review aimed to provide an overview of policy responses that were taken across the WHO European Region to identify systems and processes that helped to inform and shape decisions pertaining to rehabilitation during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A scoping literature search was conducted according to PRISMA-ScR guidelines and prospectively registered on Prospero (ID: CRD42024550641). Cinahl, Cochrane, PubMed and Scopus databases were searched from inception to February 2024. Eligibility criteria for selecting publications: Published work that includes any policy documents that informed rehabilitation during the COVID-19 pandemic in any of the 53 World Health Organisation European member states. Search results were extracted using the PESTLE heading framework in Microsoft Excel.</div></div><div><h3>Results</h3><div>Seven publications comprising seven policy documents from Italy (N=2), England (N=2) and the United Kingdom (N=3) were included in this review. Five key areas were identified in response to COVID-19 and rehabilitation: 1) government direction, 2) funding, 3) education, 4) telerehabilitation, and 5) social distancing and isolation.</div></div><div><h3>Conclusions</h3><div>Our study's findings demonstrate a dearth of published government policy documentation referring to rehabilitation in response to the COVID-19 pandemic. This lack of published documents indicates that rehabilitation is not considered an essential health service during emergency response. Research should investigate the systems and processes of key decision-makers to inform future rehabilitation pandemic preparations.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105477"},"PeriodicalIF":3.4,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469091","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}

{"title":"Healthcare utilization and costs for cardiovascular diseases across different levels of bundled payment adoption in general practice: A data linkage study","authors":"J.T. Dros ,&nbsp;C.E. van Dijk ,&nbsp;R.A. Verheij ,&nbsp;I. Bos ,&nbsp;B.R. Meijboom","doi":"10.1016/j.healthpol.2025.105476","DOIUrl":"10.1016/j.healthpol.2025.105476","url":null,"abstract":"<div><h3>Background</h3><div>Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands.</div></div><div><h3>Objective</h3><div>This study assesses changes in healthcare utilization patterns and costs for CVD between 2014 and 2019, while investigating the potential association with bundled payment adoption.</div></div><div><h3>Method</h3><div>We studied patients at very high risk for CVD with routinely recorded nationwide healthcare data, using an observational study design. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2014 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs.</div></div><div><h3>Results</h3><div>The odds of medical specialist involvement declined over time for the 152,591 unique patients included in our study. Practices with a higher level of bundled payments had lower odds of medical specialist involvement. Medical specialist costs did also significantly decrease between 2014 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments.</div></div><div><h3>Conclusion</h3><div>Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do suggest that due to bundled payments more patients are actively monitored.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105476"},"PeriodicalIF":3.4,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446598","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}