Health Policy最新文献_第7页

Mortality risk factors in Catalonia’s long-term care system: A population-based survival analysis 加泰罗尼亚长期护理系统的死亡率危险因素：基于人群的生存分析

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-30 DOI: 10.1016/j.healthpol.2025.105482

Albert Prades-Colomé

Background

As populations age, understanding the health impact of long-term care systems is critical for shaping effective policy.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

随着人口老龄化，了解长期护理系统对健康的影响对于制定有效政策至关重要。目的本研究利用2015年7月至2024年12月的综合行政数据，调查西班牙加泰罗尼亚老年人长期护理福利与死亡风险之间的关系。方法分析的重点是加泰罗尼亚50岁以上的长期护理福利申请人，根据他们的需求严重程度（I-III级）和所获得的福利类型对他们进行分类：家庭护理，住宿护理，两者结合或没有福利。它应用生存分析技术，包括Kaplan-Meier估计和Cox比例风险模型。结果有长期护理需要的患者死亡率显著降低。值得注意的是，从家庭过渡到住宿护理的个体表现出最有利的风险比，这表明响应性护理途径与更好的生存结果相关，可能是由于护理与需求的最准确匹配。在长期护理需求等级最高的人群中，单独的住宿护理比家庭护理具有更高的死亡率风险。有长期护理需要但没有得到任何福利的个人面临着明显更高的风险。死亡风险也因性别、年龄和临床情况而异，在男性、老年人和既往有血液病、肿瘤或呼吸系统疾病的人群中观察到更高的风险。这些发现强调了正规长期护理系统与降低死亡风险之间的关联，并强调了及时、适应性护理途径在缓解老龄化人群健康下降方面的重要性。

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引用次数: 0

The effectiveness of pharmaceutical tenders as a cost containment mechanism: analysis through the Synthetic Control Method. The case of Andalusia (Spain) 医药招标作为成本控制机制的有效性：基于综合控制方法的分析。安达卢西亚（西班牙）案。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-30 DOI: 10.1016/j.healthpol.2025.105481

Pedro Atienza Montero , Luis Ángel Hierro Recio , Antonio José Garzón Gordón

Background

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.

Objective

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.

Methods

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).

Results

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.

Conclusions

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.

背景：门诊药品招标不是一项广泛的措施。在西班牙，安达卢西亚地区的次中央政府是西班牙唯一实施这些措施的卫生行政部门。目的：本工作旨在评估该措施在2012年6月至2020年12月期间减少公共医药支出的有效性。方法：我们使用综合控制方法（SCM），该方法基于一组来自潜在对照组（在这种情况下，西班牙其他地区）的单位组合的预测变量，估计我们感兴趣的变量（人均门诊药物支出）的反事实（合成）值。结果：SCM的结果显示没有证据表明，在安达卢西亚实施的药品招标减少了药品支出。统计检验表明，在该措施生效期间，该措施对药品支出没有差异效应的原假设不能被拒绝。这些结果对各种稳健性测试具有稳健性。结论：安达卢西亚门诊药品的公开招标在其生效期间并没有被证明是有效的控制公共支出的机制，与西班牙其他地区相比，未能导致支出的减少，这些地区没有应用它。

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引用次数: 0

Association between socioeconomic disadvantage and low-value care in acute care hospitals in Japan: Cross-sectional study 日本急症医院社会经济劣势与低价值护理之间的关系：横断面研究

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-28 DOI: 10.1016/j.healthpol.2025.105479

So Sato , Hideo Yasunaga , Yuichiro Matsuo , Hiroki Matsui , Kiyohide Fushimi , Atsushi Miyawaki

Background

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.

Objective

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.

Methods

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.

Results

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; P = 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.

Conclusions

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.

背景：低价值护理提供很少的临床效益，并导致低效率的医疗保健利用。尽管在医疗保健获取方面的社会经济差异有充分的记录，但关于弱势住院患者的低价值护理的数据仍然有限。目的：以区域剥夺指数（ADI）为指标，探讨社区社会经济地位（SES）与日本住院机构低价值护理服务比例之间的关系。方法：我们在2022年4月至2023年3月期间使用日本920家医院的全国住院患者数据库进行了一项横断面研究。年龄≥18岁的住院患者接受了12种选定的低价值护理服务之一。结果是根据已建立的算法，住院期间提供的服务是否被归类为低价值。将来自贫困地区的患者（ADI前10%）与来自非贫困地区的患者进行比较，并根据患者病例组合和医院固定效果进行调整。结果：524,705例住院患者（42.3%为女性，平均年龄69.9±15.5岁）中，33,271例（6.3%）被归为低价值护理。调整后，来自贫困地区的患者接受低价值护理的比例高于来自非贫困地区的患者（6.6%对6.3%；调整后差异为+0.2个百分点；95% CI, 0.03 ~ 0.5; P = 0.02）。亚组分析显示，年龄≥65岁的患者、女性和在非学术医院治疗的患者之间存在更强的相关性。考虑到医院固定效应后，结果保持一致。结论：贫困地区患者接受低价值住院治疗的可能性略高于非贫困地区患者。老年人、女性和在非学术医院接受治疗的患者似乎更容易受到影响。

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引用次数: 0

Backlogs, waiting times and waiting lists of elective surgeries across OECD countries 经合组织国家选择性手术的积压、等待时间和等待名单

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-28 DOI: 10.1016/j.healthpol.2025.105478

Luigi Siciliani , Gaetan Lafortune , Marie-Clémence Canaud , Chekwube Madichie

Background

Many OECD countries suspended elective (non-emergency) care during the pandemic to divert efforts towards COVID-19 patients, which generated a backlog of patients.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

许多经合组织国家在大流行期间暂停了选择性（非紧急）护理，以将精力转移到COVID-19患者身上，这导致患者积压。本研究测量了经合组织国家（2016-2023年）COVID-19前后等待时间和数量随时间变化的程度。我们测试了COVID-19对名单上患者的等待时间和治疗患者的等待时间是否有不同的影响，这是两种常见的等待时间衡量标准。它讨论了如何等待时间和数量可以作为卫生系统弹性选择性护理的措施。方法：本研究使用了大量选择性手术和经合组织国家的数据，这些国家报告了名单上患者的等待时间或从加入名单到治疗的等待时间。我们使用回归方法来量化经合组织国家大流行后等待时间增加和数量减少的程度。结果我们发现，在前三年，名单上的等待人数平均增加了27-30%。相比之下，等待治疗的时间只增加了很小的程度，效果没有统计学意义。头两年，运输量平均下降了19%和10%。各国之间存在异质性影响，但这些影响似乎与卫生支出、医生和急症床位没有系统关系。结论卫生系统选择性护理弹性措施应监测名单上的等待和等待治疗，除了数量。

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引用次数: 0

A scoping literature review of rehabilitation policy recommendations during the COVID-19 pandemic in the WHO European Region 世卫组织欧洲区域2019冠状病毒病大流行期间康复政策建议的范围文献综述

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-27 DOI: 10.1016/j.healthpol.2025.105477

Callum Thomas , Justine Gosling , Ruth E Ashton , Rebecca Owen , Mark A Faghy

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

与其他一线卫生保健服务一样，康复服务的提供受到COVID-19大流行的极大影响，尽管世卫组织规定康复是一项基本服务，但许多服务已暂停。本综述旨在概述整个世卫组织欧洲区域采取的政策应对措施，以确定在2019冠状病毒病大流行期间帮助告知和制定康复相关决策的系统和流程。方法根据PRISMA-ScR指南进行范围文献检索，并在Prospero （ID: CRD42024550641）进行前瞻性注册。检索了Cinahl、Cochrane、PubMed和Scopus数据库，检索时间从成立到2024年2月。选择出版物的资格标准：已发表的作品，包括在世界卫生组织欧洲53个成员国中的任何一个国家在COVID-19大流行期间为康复提供信息的任何政策文件。在Microsoft Excel中使用PESTLE标题框架提取搜索结果。结果共纳入意大利（N=2）、英国（N=2）和英国（N=3）的7篇出版物，包括7份政策文件。确定了应对COVID-19和康复的五个关键领域：1)政府指导，2)资金，3)教育，4)远程康复，5)保持社会距离和隔离。我们的研究结果表明，在应对COVID-19大流行的过程中，缺乏公开的政府政策文件。缺乏公开的文件表明，在应急期间，康复不被视为一项基本的保健服务。研究应调查关键决策者的系统和程序，以便为今后的大流行康复准备工作提供信息。

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引用次数: 0

Healthcare utilization and costs for cardiovascular diseases across different levels of bundled payment adoption in general practice: A data linkage study 在一般实践中采用不同级别捆绑支付的心血管疾病的医疗保健利用和成本：数据链接研究。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-27 DOI: 10.1016/j.healthpol.2025.105476

J.T. Dros , C.E. van Dijk , R.A. Verheij , I. Bos , B.R. Meijboom

Background

Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands.

Objective

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.

Method

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.

Results

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.

Conclusion

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.

背景：在荷兰，心血管疾病（CVD）患者的捆绑支付旨在提高初级保健的利用。目的：本研究评估了2014年至2019年间心血管疾病医疗保健利用模式和成本的变化，同时调查了捆绑支付采用的潜在关联。方法：我们采用观察性研究设计，对全国常规记录的心血管疾病高危患者进行研究。进行了多水平logistic和gamma回归，以评估2014年至2019年期间的医疗保健利用模式，以及捆绑支付对接受医疗专家护理的可能性和相关成本高度的影响。结果：在我们的研究中包括的152,591名独特患者中，医学专家参与的几率随着时间的推移而下降。捆绑支付水平较高的做法，医疗专家参与的几率较低。2014年至2019年期间，医疗专家费用也显著下降，在捆绑支付水平最高的实践中，患者的医疗专家费用显著降低。然而，当包括一般医疗费用时，每位患者的医疗保健费用在一段时间内保持不变，并通过使用捆绑支付进行分层。结论：我们的研究结果表明，捆绑支付与专业医疗保健使用之间存在关联，可能促进向初级保健的过渡。虽然我们没有发现节省成本的证据，但我们的发现确实表明，由于捆绑支付，更多的患者得到了积极的监测。

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引用次数: 0

Physician and relatives’ role change after shifting to an opt-out organ donation system in the Netherlands: A before and after ethnographic study 在荷兰，医生和亲属在转移到选择退出器官捐赠系统后的角色变化：一项人种学研究的前后

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-22 DOI: 10.1016/j.healthpol.2025.105473

Niek Kok , Myrthe van de Meulenhof , Wilson F. Abdo , Jelle L.P. van Gurp , Gert Olthuis

Background

In 2020, the Netherlands adopted an opt-out registration system for organ donation meaning that consent for donation is presumed except when someone actively objects against this. This change in organ donation default policy may change the division of roles between relatives and physicians during conversations.

Objectives

To compare role performance of relatives and physicians in organ donation conversations in the opt-in and opt-out systems.

Methods

We applied an institutional ethnographic approach to compare cases from the former opt-in system in which there was ‘no registration’ to the ‘presumed consent cases’ in the opt-out system.

Results

We audio-recorded six no registration conversations from the opt-in period, and compared these with eight presumed consent conversations from the opt-out period, and conducted sixteen interviews with physicians conducting the conversations. The data show the effect of the system transition on the role division between relatives and physicians in donation conversations. In the opt-in system, physicians and relatives together aimed for a yet to be taken decision, while in the opt-out system, the physicians started the conversation with the registered choice. Ethical deliberation about organ donation is therefore pushed to the background the role of the physician is more tilted to providing relevant factual information and implementing the patient’s choice.

Conclusions

The change to opt-out did likely alleviates the burdensome role of relatives to make morally charged donation choices for their relatives, since organ donation conversations about patients presumed to consent commence with a clear picture of what the potential donor’s wish is.

2020年，荷兰采用了器官捐赠选择退出登记制度，这意味着除非有人积极反对，否则推定同意捐赠。器官捐赠默认政策的这一变化可能会改变亲属和医生在谈话中的角色划分。目的比较选择加入和选择退出制度下亲属和医生在器官捐献对话中的角色表现。方法我们采用了一种制度人种学方法来比较前选择加入系统中“没有登记”的案例与选择退出系统中“假定同意案例”的案例。结果我们录音了选择加入期间的6次未注册对话，并将其与选择退出期间的8次推定同意对话进行了比较，并对进行对话的医生进行了16次访谈。数据显示了制度变迁对亲属和医生在捐赠对话中的角色划分的影响。在选择加入系统中，医生和家属共同针对尚未做出的决定，而在选择退出系统中，医生开始与注册选择对话。因此，关于器官捐赠的伦理考虑被推到后台，医生的角色更倾向于提供相关的事实信息和执行患者的选择。选择退出的改变很可能减轻了亲属为他们的亲属做出道德上的捐赠选择的负担，因为关于假定患者同意的器官捐赠对话始于对潜在捐赠者愿望的清晰描述。

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引用次数: 0

Conceptualising the primary health care workforce: A meta-narrative-inspired review of stakeholder perspectives in Denmark 初级卫生保健工作人员的概念化：对丹麦利益相关者观点的元叙述启发的审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-21 DOI: 10.1016/j.healthpol.2025.105474

Andreas Nielsen Hald , Ulrika Enemark , Martin Limbikani Mwale , Viola Burau

Background

Primary healthcare (PHC) systems across Europe are under increasing pressure. In response, research has focused on how to develop and support PHC workforces. However, studies often neglect how stakeholders conceptualise the PHC workforce, even though this may influence reform processes. Denmark offers a relevant case due to the involvement of many stakeholders and longstanding tensions over workforce organisation.

Objective

To examine the literature on how stakeholders in Denmark conceptualise the PHC workforce and how conflicting narratives influence policy contestation.

Methods

We conducted a meta-narrative-inspired literature review, following RAMESES guidelines. The review included 49 sources (1980–2025), drawing on peer-reviewed articles, organisational documents, professional journals, policy texts, and political news. Documents were screened, appraised, and synthesised using an iterative narrative analysis. We identified dominant stakeholders, primary narratives, and key areas of policy contestation relevant to the PHC workforce.

Results

Across 45 years of reform and policy debate, three primary narratives have structured stakeholder perspectives: a medical narrative emerging in the mid-1960s, a health economics narrative gaining prominence during the 1990s, and a community narrative growing since the early 2010s. These narratives compete across and within stakeholder groups, most visibly in debates over governance, task-shifting, and whether recipients are framed as patients or citizens.

Conclusions

Stakeholders in Denmark conceptualise the PHC workforce differently depending on the narratives they invoke and the reform context in which they act. Reforms are more likely to gain traction when engaging these perspectives. Narrative-informed approaches can help anticipate resistance and support more effective PHC workforce development.

整个欧洲的初级卫生保健（PHC）系统正面临越来越大的压力。作为回应，研究的重点是如何发展和支持初级保健工作人员。然而，研究往往忽视了利益相关者如何概念化初级保健劳动力，尽管这可能会影响改革进程。丹麦提供了一个相关的案例，由于许多利益相关者的参与和长期紧张的劳动力组织。目的研究丹麦利益相关者如何概念化初级保健人力资源的文献，以及相互冲突的叙述如何影响政策争论。方法：我们按照RAMESES的指导方针进行了一项元叙事启发的文献综述。该综述包括49个来源（1980-2025），参考了同行评议的文章、组织文件、专业期刊、政策文本和政治新闻。使用迭代叙事分析对文件进行筛选、评估和综合。我们确定了与PHC劳动力相关的主要利益相关者、主要叙述和政策争论的关键领域。在45年的改革和政策辩论中，三种主要叙事构成了利益相关者的观点：20世纪60年代中期出现的医学叙事，20世纪90年代崭露头角的卫生经济学叙事，以及自2010年代初以来不断增长的社区叙事。这些说法在利益相关者群体之间和内部相互竞争，最明显的是关于治理、任务转移以及接受者是被定义为患者还是公民的辩论。丹麦的利益相关者根据他们援引的叙述和他们采取行动的改革背景，对初级保健劳动力有不同的概念。当这些观点参与进来时，改革更有可能获得动力。基于叙述的方法可以帮助预测阻力并支持更有效的初级保健劳动力发展。

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引用次数: 0

Exploring financial challenges of students and early-career professionals working in the healthcare sector: A scoping review 探索在医疗保健部门工作的学生和早期职业专业人员的财务挑战：范围审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-21 DOI: 10.1016/j.healthpol.2025.105475

Samin Huq , Yoonjung Choi , Paul Künzle , Mfonobong Timothy , Cornelia Santoso , Stephanie Hwang , Sherly Meilianti

Background

The global healthcare workforce is facing a substantial shortage and an uneven distribution of qualified professionals, which restricts access to essential healthcare services. This shortage may be mitigated through more effective support of healthcare workers in training. Therefore, an overview of existing economic barriers for this demographic is necessary.

Objective

To review the existing literature on financial challenges of students and early-career professionals in the healthcare sector.

Methods

Following the PRISMA-ScR guidelines, articles published between January 2008 and February 2024 were identified using PubMed and Scopus. A total of 17,268 articles were screened by reviewing their titles and abstracts followed by a detailed review of full texts with cross-validation. Themes were identified, clustered, and analyzed.

Results

This scoping review included 167 articles focusing on the themes debt (36.5%, n=61) and loans (10.2 %, n=17) and their influence on career pathways, the role of employment for career satisfaction, summarizing findings concerning salary (29.9%, n=50), finances (25.1%, n=42), funding (10.8%, n=18), and savings (10.2%, n=17), and obstacles toward a sustainable lifestyle, which included results considering career choice (34.1%, n=57), migration (7.2%, n=12), gender disparity (6.0%, n=10), and working conditions (2.4%, n=4).

Conclusions

Efforts to close the healthcare workforce gap require greater investment in training, compensation, and support for junior healthcare workers. Students and early-career professionals warrant particular attention to build a sustainable, resilient, and reliable healthcare workforce.

背景全球医疗保健人员面临着严重短缺和合格专业人员分布不均的问题，这限制了获得基本医疗保健服务的机会。这一短缺可以通过更有效地支持保健工作者的培训来缓解。因此，有必要对这一人口的现有经济障碍进行概述。目的回顾现有的关于医疗保健行业学生和早期职业专业人员财务挑战的文献。方法根据PRISMA-ScR指南，使用PubMed和Scopus对2008年1月至2024年2月间发表的文章进行鉴定。共筛选了17,268篇文章，方法是对标题和摘要进行审查，然后对全文进行交叉验证的详细审查。主题被识别、聚类和分析。结果本研究纳入167篇文章，重点关注债务（36.5%,n=61）和贷款（10.2%,n=17）及其对职业道路的影响、就业对职业满意度的作用，总结了有关工资（29.9%,n=50）、财务（25.1%,n=42）、资金（10.8%,n=18）和储蓄（10.2%,n=17）的研究结果，以及可持续生活方式的障碍，其中包括考虑职业选择（34.1%,n=57）、移民（7.2%,n=12）、性别差异（6.0%,n=10）的研究结果。工作条件（2.4%,n=4）。结论要缩小卫生保健人力资源差距，需要加大对初级卫生保健工作者的培训、薪酬和支持方面的投资。学生和早期职业专业人士需要特别关注建立可持续、有弹性和可靠的医疗保健队伍。

{"title":"Exploring financial challenges of students and early-career professionals working in the healthcare sector: A scoping review","authors":"Samin Huq , Yoonjung Choi , Paul Künzle , Mfonobong Timothy , Cornelia Santoso , Stephanie Hwang , Sherly Meilianti","doi":"10.1016/j.healthpol.2025.105475","DOIUrl":"10.1016/j.healthpol.2025.105475","url":null,"abstract":"<div><h3>Background</h3><div>The global healthcare workforce is facing a substantial shortage and an uneven distribution of qualified professionals, which restricts access to essential healthcare services. This shortage may be mitigated through more effective support of healthcare workers in training. Therefore, an overview of existing economic barriers for this demographic is necessary.</div></div><div><h3>Objective</h3><div>To review the existing literature on financial challenges of students and early-career professionals in the healthcare sector.</div></div><div><h3>Methods</h3><div>Following the PRISMA-ScR guidelines, articles published between January 2008 and February 2024 were identified using PubMed and Scopus. A total of 17,268 articles were screened by reviewing their titles and abstracts followed by a detailed review of full texts with cross-validation. Themes were identified, clustered, and analyzed.</div></div><div><h3>Results</h3><div>This scoping review included 167 articles focusing on the themes debt (36.5%, <em>n</em>=61) and loans (10.2 %, <em>n</em>=17) and their influence on career pathways, the role of employment for career satisfaction, summarizing findings concerning salary (29.9%, <em>n</em>=50), finances (25.1%, <em>n</em>=42), funding (10.8%, <em>n</em>=18), and savings (10.2%, <em>n</em>=17), and obstacles toward a sustainable lifestyle, which included results considering career choice (34.1%, <em>n</em>=57), migration (7.2%, <em>n</em>=12), gender disparity (6.0%, <em>n</em>=10), and working conditions (2.4%, <em>n</em>=4).</div></div><div><h3>Conclusions</h3><div>Efforts to close the healthcare workforce gap require greater investment in training, compensation, and support for junior healthcare workers. Students and early-career professionals warrant particular attention to build a sustainable, resilient, and reliable healthcare workforce.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105475"},"PeriodicalIF":3.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520885","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}

引用次数: 0

Exploring barriers to nutritional support for oncology patients in regional and rural settings: A scoping review through the lens of Levesque’s accessibility framework 探索区域和农村环境中肿瘤患者营养支持的障碍：通过Levesque可及性框架的视角进行范围审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-17 DOI: 10.1016/j.healthpol.2025.105455

Annemarie De Leo , Christelle Schofield , Emily Jeffery , Emily Mountford , Elle Cotton , Joshua Lewis , Jonathan Hodgson , Mary A. Kennedy

Background

Integrating supportive cancer services into routine cancer care is challenging, especially in regional and rural settings where accessibility to healthcare is a known issue. This scoping review aimed to describe and map barriers to nutrition services from the perspectives of people living with cancer and health service providers. Exploring the applicability of Levesque’s Accessibility Framework in identifying and prioritising service gaps was a secondary aim.

Methods

Electronic database searches were conducted in Allied and Contemporary Medicine, CINAHL, Informit, Medline and SPORTDiscus between May-July 2023. Studies reporting on perceived barriers to nutrition services from the perspectives of health service providers and people living with cancer in regional and rural settings were included. We categorised these into demand or supply determinants, which were mapped across the ten dimensions of Leveque’s Accessibility Framework.

Results

Eight studies were included in this review. Thirty-seven barriers were identified and mapped across the ten dimensions described within Levesque’s Accessibility Framework. The most frequently reported barriers related to: Availability and Accommodation of regional health services, Approachability of regional health services and Ability of patients to engage.

Conclusion

This review identified the most commonly reported barriers to nutrition services for people living with cancer in regional and rural settings. Levesque’s Accessibility Framework demonstrates value in categorising barriers to accessibility, which can be used to identify service gaps and inform future policy-setting agendas.

背景：将支持性癌症服务纳入常规癌症治疗具有挑战性，特别是在地区和农村环境中，在那里获得医疗保健是一个已知的问题。这项范围审查旨在从癌症患者和卫生服务提供者的角度描述和绘制营养服务的障碍。探索Levesque的无障碍框架在识别和优先考虑服务差距方面的适用性是第二个目标。方法于2023年5 - 7月在Allied and Contemporary Medicine、CINAHL、Informit、Medline和SPORTDiscus等电子数据库进行检索。从保健服务提供者和区域和农村环境中的癌症患者的角度报告了对营养服务的感知障碍的研究。我们将这些因素分类为需求或供应决定因素，并将其映射到Leveque无障碍框架的十个维度上。结果本综述共纳入8项研究。在Levesque的无障碍框架中，我们确定了37个障碍，并在十个维度上进行了映射。最常报告的障碍涉及：区域卫生服务的可获得性和可提供性、区域卫生服务的可获得性和患者参与的能力。本综述确定了区域和农村地区癌症患者获得营养服务最常见的障碍。Levesque的无障碍框架展示了对无障碍障碍进行分类的价值，可用于识别服务差距并为未来的政策制定议程提供信息。

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引用次数: 0