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Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.

The work is devoted to the study of the problem of personal data protection in health care. Today, the world is dominated by a global socio-cultural process of informatization, which is based on the priority of collecting, accumulating, creating, processing, storing, exchanging and using information in any form. The growing demand for information technologies allowed modern science to characterize the new stage of society's development as an «information society». At the same time, the number of violations of the functioning of information carriers and information about a person is constantly increasing. It was emphasized that the sphere of healthcare and medicine was not an exception in the process of informatization of all spheres of human activity, which contributed and optimized the functioning and development of such spheres. The modern trend towards a rapid increase in the amount of data circulating in the information space has not escaped the sphere of health care, which has a high degree of vulnerability due to the sensitivity of data on the state of health of a person and a citizen. Nowadays, with the development of the information society, it is quite easy to identify a specific person and obtain confidential personal information about him. Therefore, issues of protection from third parties of personal data contained in centralized databases of medical information systems remain relevant. Reforms in health care, such as the introduction of electronic systems and changes in legislation, indeed generate a lot of scientific research in the field of personal data protection. This important aspect, after maintaining the confidentiality of medical information and the protection of personal data, is key to ensuring trust in the health care system. Research in this area may include evaluating the effectiveness of data protection measures, analyzing the risks of using electronic medical information processing systems, developing and improving data encryption and authentication methods, as well as studying legal aspects of personal data protection in health care. These studies help understand potential threats and identify best practices for ensuring the security and privacy of health information, which contributes to improving the quality of health care and increasing public confidence in the health care system. [ABSTRACT FROM AUTHOR]

AbstractThis paper examines the evolution and current challenges of the Brazilian Psychosocial Care Centers for Alcohol and other Drugs (CAPS-ADs), central to Brazil’s mental health reform. Established within the broader Psychosocial Care Network (RAPS) in 2002, CAPS-AD represents a shift from hospital-centric to community-based care for mental health and substance dependency. Synthesizing 39 peer-reviewed articles, the study explores CAPS-AD’s operational characteristics, effectiveness and limitations. The model is distinguished by its interdisciplinary approach, open-door policy, and focus on social reintegration, providing continuous access to specialized care. Key features include singular therapeutic plans, harm reduction strategies and integration with primary care. The CAPS-AD III modality, offering 24-hour care, highlights the model’s adaptability. Despite its strengths, the CAPS-ADs face challenges such as user dissatisfaction with rigid therapeutic activities, limited autonomy and inadequate participation in care planning. Structural deficiencies, particularly in resource-limited regions and the persistence of traditional biomedical approaches further hinder quality care. Additional barriers include insufficient attention to gender-specific needs, age-appropriate care and the stigmatization of substance users and professionals. Addressing these challenges through structural reforms, enhanced training, and a more integrated, personalized, and stigma-free approach is essential to fully realize the potential of CAPS-AD and advance equitable mental health care in Brazil. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that overall sleep quality among Chinese nurses is relatively low, with a sleep disorder prevalence rate of approximately 66.4%. Against the backdrop of healthcare reforms, China has been striving to improve the mental health and sleep quality of nurses. Stress mindset can influence how individuals respond to stress, but there is limited research on how stress mindset affects nurses' sleep quality. This study aims to explore the impact of stress mindset on sleep quality among nurses, as well as the mediating roles of stress overload and anxiety in this relationship. Methods: The study was conducted online using a questionnaire from February 18 to February 22, 2024. It utilized the Stress Mindset Measure (SMM), the Stress Overload Scale-Short (SOS-S), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Pittsburgh Sleep Quality Index (PSQI) to survey 441 nurses in three regions of China: Chongqing, Hunan, and Shandong (M = 34.39, SD = 7.82, 95.7% female). A chain mediation model was employed to examine the mediating roles of stress overload and anxiety in the relationship between stress mindset and sleep quality. Results: The participants' average sleep quality score was 7.18 ± 3.47. Nurses' stress mindset was significantly negatively correlated with both stress overload and anxiety, and significantly positively correlated with sleep quality. Stress overload was significantly positively correlated with anxiety and significantly negatively correlated with sleep quality. Anxiety was also significantly negatively correlated with sleep quality. The direct effect of nurses' stress mindset on sleep quality was significant (effect size = -0.10, 95% CI: -0.19 to -0.01), as were the indirect effects through stress overload (effect size = -0.05, 95% CI: -0.11 to -0.01) and anxiety (effect size = -0.09, 95% CI: -0.13 to -0.05), along with their chain mediation effect (effect size = -0.10, 95% CI: -0.14 to -0.06). Conclusion: Our study demonstrates that a higher level of nurses' stress mindset is associated with better sleep quality, with stress overload and anxiety mediating this relationship. A positive stress mindset helps nurses cope more effectively with professional challenges and reduces anxiety, leading to improved sleep quality. Healthcare institutions should therefore prioritize fostering positive stress mindsets in nurses, encouraging regular psychological training and workshops to support the development of effective coping strategies. [ABSTRACT FROM AUTHOR]

We aimed to synthesize existing research to elucidate the underlying factors and causes responsible for the high prevalence of unwanted cardiopulmonary resuscitation (CPR) occurring outside a hospital setting in Japan despite patients' Do Not Attempt Resuscitation (DNAR) orders. We conducted a narrative review by searching PubMed, EMBASE, and Scopus for English literature, and Google Scholar for Japanese literature. The key factors we identified included lack of documentation of resuscitation preferences, variation in the perception of other life‐sustaining measures associated with DNAR, non‐inclusion of the patient in discussions of goals of care, unlegislated and unstandardized DNAR orders, emergency medical service activation by the family or facility, the Fire Service Act that mandates life‐saving measures irrespective of the presence of advance directives, fire department protocols and CPR decision‐making, and death pronouncement authorization limited to physicians. This study identified the multifaceted factors and the potential triggers for unwanted CPR despite DNAR orders. These findings underscore the urgent need for comprehensive interventions encompassing educational initiatives, ethical considerations, systemic reforms, and legal adjustments to prevent future unwanted CPRs in Japan. Geriatr Gerontol Int 2024; 24: 1093–1098. [ABSTRACT FROM AUTHOR]

Research on families with disabled children has highlighted how such families experience frustration in their encounters with health and welfare services. However, less attention has been given to how these encounters are linked to social class. This article explores whether levels of cultural capital and family resources influence communication with professionals among parents of disabled children. To this end, I draw upon a longitudinal qualitative dataset of fieldwork and interview data from families in Norway. The findings show that middle-class parents could utilize experts, keep communication smooth, and persist in trying to secure services for their children without any real sense of achievement to a higher degree than working-class parents. However, neither working-class nor middle-class parents thrived in navigating these bureaucracies. This study has clear implications for policy and professionals in acknowledging how levels of cultural capital and other family resources influence the ability to endure and navigate welfare institutions. Points of interest: To understand the situation of families with disabled children it is important to find out under which circumstances these families try to obtain public services for their children. The paper examines the significance of social class on how parents with disabled children manage welfare services for their children in Norway. The research uses interviews with parents and practitioners and observation of meetings. All parents fight for services for their children and find it frustrating. Working-class and middle-class parents differ in how they communicate with professionals and how they deal with frustration. [ABSTRACT FROM AUTHOR]

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing—the largest healthcare workforce with diverse roles—operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health. [ABSTRACT FROM AUTHOR]

Community-based organizations (CBOs) serving older ethnic minority adults, especially older immigrants, are vital to satisfy their complex social, health, and behavioral health needs. This study uses organizational theories and a case study approach to examine how the organizational responses to the multifaceted impact of the COVID-19 pandemic and progress beyond the pandemic-related responses. Four CBOs serving older Chinese immigrants in New York City were examined. Results indicate that driven by unmet psychosocial needs of older Chinese immigrants and public health measures, CBOs modified practice protocols and established (or strengthened) collaborative relationships with medical providers and other CBOs. COVID-19 responses include CBOs' transformations in organizational structures (e.g. collaboration) and operational activities (e.g. telehealth). Successful transformations of CBOs were primarily due to prior adaptiveness to integrated care reform and assured needed resources before the pandemic; the transformation reflected orderly organizational progress rather than a temporary management strategy. PRACTICE POINT: CBOs modified practice protocols, established (or strengthened) collaborative relationships, and increased service coordination to address the unmet psychosocial needs of older Chinese immigrants and public health measures. Amidst evolving pandemic-related challenges, community-based organizations (CBOs) fostered collaborative partnerships and provided integrated care services, playing a crucial role in addressing the mental health needs of older immigrants during the COVID-19 pandemic. Organizational theories explain CBOs' adaptive behaviors during the pandemic, as they provided essential services to vulnerable older immigrants while navigating normative and coercive pressures to meet evolving needs and secure funding. [ABSTRACT FROM AUTHOR]

Background: Implementation issues often impede the realisation of the potential benefits of technology in disability care organisations for people with disabilities. Therefore, we conducted a longitudinal study to gain insights into the barriers and facilitators to implementation. Methods: From 2019 to 2022, data were collected using questionnaires and interviews during 28 implementation projects in 26 disability care organisations. Results: Barriers and facilitators were identified using 9 themes and 26 subthemes. The main themes identified were finances, disability care organisations, internal collaborations, external collaborations, technology, care staff, project teams, people with disabilities, and context. Most factors mentioned as barriers in one organisation were mentioned as facilitators in others. This suggests that barriers can be resolved to improve implementation. Conclusion: A large number of barriers and facilitators spanning the organisation suggests that the implementation of technology should be considered an organisational reform. Acting upon them is crucial for the successful implementation of technology. [ABSTRACT FROM AUTHOR]

Background: We investigated the implementation process of an Integrated Community Approach (ICA) applied in four low socio-economic status neighbourhoods in Maastricht, the Netherlands. The ICA is a Population Health Management initiative and aims to improve population health, quality of care, professional's satisfaction and decrease costs of care. This study addresses the facilitators and barriers for implementing the ICA from a stakeholder perspective, including steering group members, professionals and citizens. Methods: We conducted a mixed-methods study using a triangulation of methods to investigate the implementation from 1 December 2016 to 31 December 2020. The Consolidated Framework for Implementation Research guided data collection and data-analysis for evaluating the implementation process. In total, 77 interviews, 97 observations, seven focus groups, 65 collected documents and two surveys with open-ended questions were conducted. Results: Facilitators for implementation were the use of citizen science to bring residents' needs into sharp focus, the integration of the ideology of Positive Health into the working routines of the professionals and leadership at the steering group level to overcome barriers in the ICA. The existing accounting and financial infrastructure obstructed combining budgets at neighbourhood level. Conclusions: Engaging citizens and professionals at an early stage is an important facilitator for implementation. The use of a shared vision on health also worked as a facilitator since it created a shared language among professionals, which is important in Population Health Management initiatives where multiple professionals are expected to collaborate. Trial Registration: NTR 6543; registration date, 25 July 2017. [ABSTRACT FROM AUTHOR]

During the Hu Jintao era, policy intellectuals participated in public debates, openly criticizing existing government policies. During the Xi Jinping era, despite regime efforts to tame intellectuals, some critical voices have retained influence over policymaking processes. What adaptation strategies have they utilized to circumvent the regime's control over public speech? This article points to two strategies. First, policy intellectuals formed shifting collaborations with both state and nonstate actors. Second, they utilized collaborations with state actors to enter consultative forums. The article finds that policy intellectuals not only formed Beijing-based alliances but also cultivated closer cooperation with local officials. By "going local" in this way, they bypassed Beijing's tightening political environment. This article focuses on two important policy intellectuals in the healthcare arena who have gone local. It also includes a comparison between these two policy intellectuals and seven of their prominent peers who did not go local, as well as with intellectuals from another policy arena: education. [ABSTRACT FROM AUTHOR]

Whether charitable fundraising might play a part in funding Britain's ostensibly tax‐funded NHS has been a longstanding dilemma, which until recently has received only occasional scholarly attention. In 1946, Aneurin Bevan argued that one of the main goals of the reformed health care system was to liberate health care from the 'caprice of private charity'. Seven decades later, NHS Charities Together's Urgent Covid‐19 Appeal became a powerful societal rallying cry in the health emergency of the pandemic and raised £150 million in the process. This paper draws together findings from new archival research, a witness seminar with key actors in the NHS charity sector, and qualitative research based on interviews with NHS charity staff and trustees (N = 13), all conducted between 2021 and 2023. We investigate the way in which national appeals have been proposed, debated and implemented at different times in the NHS's history. We trace the recurrence of conflicting ideas about the acceptability of national fundraising for the NHS, about whether public loyalties are to their local services or the national 'brand' and about the introduction of national appeals into a complex ecology of local NHS charities. The history of charitable fundraising for the NHS is, we argue, neither a simple story of spontaneous public generosity, nor often of formal policy reform, but is an artefact of more complex dynamics between a changing cast of local and national actors over the last 75 years. [ABSTRACT FROM AUTHOR]

Scholars and advocates are at odds about how to achieve higher levels of child safety and permanency. Calls for change include the recent upEND focus on eradication of child welfare services to a radical refocusing of the present system towards prevention/early intervention. To clarify the implications of reform over abolition, we seek to portray a future in which the abolition of child welfare has occurred, in juxtaposition to maintaining four core elements of established child maltreatment programmes around the world: (1) receiving and responding to community signals about the risk to children; (2) assessment of need coupled with a proportionate response; (3) rights protections to ensure fairness when placement outside the family is required; and (4) procedures for accountability and quality improvement. For each of these functions, we outline abolitionist advocates' positions and implications for children and parents. Across these elements, we delineate how assigning these responsibilities to communities, as suggested by upEND, would likely (1) exaggerate racial and economic inequities and (2) create structural barriers that would increase harm to children. We suggest several evidence‐informed enhancements to practice, research and policy that would mitigate these inequities while also increasing safety and permanency. [ABSTRACT FROM AUTHOR]

In this study, using Taiwan's National Health Insurance (NHI) as an example of a single-payer system, we examined the extent of pharmaceutical procurement profits (PPP) and evaluated their impact on the financial performance of healthcare institutions. We extracted data from financial statements and healthcare service declarations of NHI-contracted hospitals from 2015 to 2021. Financial data concerning PPP, health service profits (HSP), and total operating profits (TOP) from each hospital were analyzed. The impact of PPP on hospitals with positive and negative HSP was further investigated. The total PPP across all hospitals studied gradually increased from NT$30.6 billion in 2015 to NT$47.0 billion in 2021. In 2021, 28.1% of all hospitals reported a deficit in HSP. PPP appeared to have a significantly positive impact on the financial performance of these hospitals. It not only enhanced positive profits, but also helped mitigate or completely offset the negative profits from HSP. The effect of PPP seems to be more pronounced for hospitals with larger HSP values, suggesting that larger hospitals benefit more from PPP in absolute terms. Average PPP increased during the study period, increasingly affecting hospitals' financial stability across all strata. The gap between TOP and HSP in medical centers has gradually widened, suggesting an increase in non-health service profits. In this study, we propose a payment policy reform that fosters sustainability of the healthcare and financing system under universal health coverage and corrects the potential distortions caused by PPP. [ABSTRACT FROM AUTHOR]

An outdated and burdensome fee-for-service (FFS) reimbursement system has significantly compromised primary care delivery in the US for decades, leading to a dire shortage of primary care workers. Support for primary care must increase from all public and private payers with well-designed value-based primary care payment. Patient care enabled by value-based payment is typically described or "labeled" as value-based care and commonly viewed as distinctly different from other models of care delivery. Unfortunately, labels tend to put individuals in camps that can make the differences seem greater than they are in practice. Achieving the aims of value-based care, aligned with the quintuple aims of health care, is common across many delivery models. The shrinking primary care workforce is too fragile to be fragmented across competing camps. Seeing the alignment across otherwise separate disciplines, such as lifestyle medicine and value-based care, is essential. In this article, we point to the opportunities that arise when we widen the lens to look beyond these labels and make the case that a variety of models and perspectives can meld together in practice to produce the kind of high-quality primary care physicians, care teams, and patients are seeking. [ABSTRACT FROM AUTHOR]

Introduction: Due to high volatility in the healthcare market and financing of healthcare services, outsourcing has been developed as an efficient method to facilitate financing and providing quality services to clients. The purpose of this paper was to determine the challenges and issues healthcare centers confront during the process of outsourcing while proposing some solutions to overcome the challenges to optimally facilitate the process of outsourcing. Methods: We reviewed papers in multiple databases including PubMed, Scopus and ProQuest, and carried out a qualitative thematic analysis to obtain the major challenges and solutions regarding the process of outsourcing in the healthcare units. Results: Several inter-organizational and intra-organizational challenges exist within the process of outsourcing, while organizational reforms and adopting new initiatives and resources are considered major solutions to resolve challenges within the process of outsourcing in healthcare centers. Main conclusions: A successful experience of outsourcing depends on precise strategic situational analysis before the implementation of such policy. Meanwhile, early assessment and feedback after the implementation of outsourcing in healthcare centers contribute to the successful implementation of such policy in healthcare centers. [ABSTRACT FROM AUTHOR]

With the aging population, the financial burdens associated with chronic diseases continue to escalate. Among various management strategies, family physician contracting stands out as a significant initiative aimed at addressing this challenge, officially introduced in China in 2016. However, current research has given relatively little attention to the economic benefits of family physician contracting in developing countries. This paper evaluates the economic effect of family physician contracting by employing microdata of patients with chronic diseases at the Yuyuantan Community Health Service Center, Haidian District, Beijing, from January 2019 to May 2021. This research contributes to the theoretical discourse in healthcare services by introducing a modified Anderson model. The empirical findings demonstrated that family physician contracting effectively reduced healthcare costs for patients with chronic diseases. Notably, the effect of family physician contracting on healthcare costs was more pronounced among patients with chronic diseases aged less than 65 years. At the same time, it is inferred that expediting the reform of the health insurance payment system, coupled with the promotion of family physician contracting services, would enhance the wellbeing of patients with chronic diseases. This research offers valuable insights into the ongoing and future development of family physician contracting in developing countries. [ABSTRACT FROM AUTHOR]

Background: The mismatch of medical resources is a significant issue in global healthcare, undermining both service accessibility and system efficiency. In China, despite the implementation of the "Healthy China" strategy, persistent mismatches remain due to factors such as industrialization, urbanization, and population aging. This study empirically evaluates the impact of Public Hospital Reform (PHR) on mitigating these mismatches. Methods: A Difference-in-Differences (DD) approach is applied to panel data from 300 cities spanning 2010 to 2021, using the phased implementation of PHR as a quasi-natural experiment. This allows for a comparative analysis of changes in resource allocation between cities that adopted the reform and those that did not. Quantile regression assesses the effects of PHR across varying levels of resource mismatch, while mechanism tests investigate how PHR influences mismatches through cost reduction and supply expansion. Results: PHR is found to reduce medical resource mismatches by 13.9%, primarily driven by cost reductions and increased resource supply. The effects are more pronounced at both lower and higher levels of mismatch, with a limited impact at mid-levels. Furthermore, the reform's effectiveness diminishes as it is extended to more cities, suggesting a potential saturation effect. Conclusions: This study demonstrates that PHR significantly alleviates medical resource mismatches in China. The findings underscore the need to focus on cost control and resource supply in future healthcare reforms, providing key insights for policymakers in developing countries facing similar healthcare resource challenges. [ABSTRACT FROM AUTHOR]

Background: Tanzania has been promoting community participation in health, either directly or through health facility governing committees (HFGCs), as part of its wider, ongoing health system reforms since the 1990s. Although some studies have assessed the functioning of the HFGCs, little is known about community knowledge and involvement in their activities. Methods: A cross-sectional survey assessing community awareness and participation in HFGCs was conducted between July and October 2022, involving two rural districts of Tanzania, which were selected based on their performance: Handeni, showing low performance and Mbarali, high performance. A total of 1,184 household heads living in the catchment areas of diverse facilities were involved. Frequencies and percentages were calculated overall and by district. The Chi-squared test was applied to assess statistically significant differences in knowledge, awareness, and participation between the districts. Results: The results revealed that 85.3% of the participants were unaware of the presence of the HFGCs and 91.7% did not know their roles. Additionally, 87% had neither heard nor seen any announcement about the selection of committee members. Only 14.5% considered that HFGCs were accountable to the community. While 96.7% of the respondents said they had never received any feedback from the HFGCs, only 8.1% reported that HFGCs were collecting views from the community. Regarding participation, 79.9% believed that the community had not been supporting their activities; however, 44.7% believed that the committees were important in improving health service delivery. Feedback and support were more common in Handeni. Conclusion: The level of community awareness of and participation in HFGCs was very low in both districts. The Ministry of Health and the President's Office of Regional Administration and Local Government should implement an action plan to raise community awareness of the role of the HFGCs and their significance in promoting social accountability within the Tanzanian health system. [ABSTRACT FROM AUTHOR]

Background: In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams. Method: Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis. Results: Peer workers found their experience in the workplace was influenced by their colleagues and the organisation's understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy. Conclusion: This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co‐designed and systems‐level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems‐based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co‐design and person‐centred care. This study assessed the acceptability of GMB as a method for co‐design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems‐level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co‐design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence‐based, person‐centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co‐designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field. [ABSTRACT FROM AUTHOR]

Background: Multiple state and national health care organizations have invested in activities to screen for and address the health-related social needs (HRSNs) of their patients. However, patient perspectives concerning HRSN screening discussions and facilitated referrals to supports are largely unexplored. The main objectives of this study were to explore the ways in which Massachusetts Medicaid (MassHealth) members engage with their health care clinicians to discuss HRSNs, to identify common needs discussed, and to describe whether members feel these needs are being addressed by health care clinicians and staff. Methods: The study team performed a cross-sectional, qualitative research study that included in-depth, open-ended interviews with 44 adult MassHealth members. Interviews were conducted between June and October 2022. Interviews were recorded, transcribed, and systematically coded for analysis, and common themes were reported. The data collected for this study were part of a larger independent evaluation of MassHealth's 2017-2022 Section 1115 Demonstration that granted authority from CMS to implement health care delivery system reforms in Massachusetts. Results: In this qualitative study of Medicaid members, some reportedly felt comfortable freely discussing all of their clinical and social needs with their health care clinicians, while others noted feelings of apprehension. Several members recalled being asked about their HRSNs in various clinical or community settings, while others did not. The majority of members endorsed having an unmet HRSN, including housing, nutrition, financial, or transportation issues, and many barriers to addressing these HRSNs were discussed. Finally, many members cited a preference for discussing HRSNs with community-based care coordinators and social workers at the community partner organizations rather than with their health care clinicians. Community-based care coordinators were lauded as essential facilitators in making the connection to necessary resources to help address HRSNs. Conclusions: Study results highlight an opportunity to increase the effectiveness of HRSN screening and referral practices within the health care setting through relationship building between Medicaid members and diverse interdisciplinary care teams that include staff such as community health workers. Continued investment in cross-sector partnerships, screening workflows, and patient-clinician relationships may contribute to establishing an environment in which members can comfortably discuss HRSNs and connect with needed services to improve their health. [ABSTRACT FROM AUTHOR]

Background: Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016–2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa. Methods: We used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD program-related policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42 life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro. Results: Our findings show that CHW programme reform provides opportunities and challenges for supporting enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies and accompanied by gendered transformative approaches to improving literacy. Conclusions: This study shows how CHW programme reform provides opportunities and challenges for health system strengthening that can both positively and negatively impact the functioning of routine health interventions. By working together, CHW programmes and routine health interventions have the opportunity to leverage mutually beneficial support for CHWs, which can enhance overall systems functioning by enhancing CHW performance. [ABSTRACT FROM AUTHOR]

Background: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. Methods: Through a search of national legal databases 7 documents were selected and subjected to content analysis. Results: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. Conclusion: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated. Key points: • In the context of insufficient healthcare resources experienced by all healthcare systems, the idea of ​​applying the personal responsibility of the patient as a criterion for the allocation of resources (PRCAR) is appealing. • If striving for a common European vision on PRCAR, then each European country's view on the subject would be of key importance, and studies in this direction are necessary. • Our manuscript offers an in-depth expert analysis of the presence of PRCAR in public health law and social regulation in Bulgaria, which is one of the more recent EU member states but experiences the same developmental trends as other European healthcare systems. • As PRCAR is still an under-researched concept, our results will be of particular interest to other public health researchers. [ABSTRACT FROM AUTHOR]

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda. [ABSTRACT FROM AUTHOR]

Background Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. Objectives To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. Methods A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. Results Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. Conclusion The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care. [ABSTRACT FROM AUTHOR]

The concept of performance has gradually become established in health policies. Presented as necessary and positive, it is often reduced to efficiency, which results in policies and management styles aimed at optimisation. While they are supposed to guarantee the sustainability of our healthcare systems, these practices have made them fragile. Insights from the life sciences help us understand why. Indeed, biologists observe that living beings do not prioritise optimisation but robustness. To cope with fluctuations, a robust organisation operates with redundancies, apparent waste, heterogeneity, organised fluctuations, slowness, and hesitation. It functions sub‐optimally. This article offers a theoretical reflection and management directions for more robust healthcare systems. [ABSTRACT FROM AUTHOR]

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse‐patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re‐centres shared work—a joint responsibility between society and nursing—as necessary for the common good. [ABSTRACT FROM AUTHOR]

Introduction: The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019–2021, where it engaged 182 participants in generating community action and research knowledge. Objective: Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems‐level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. Methods: The project invited a diverse range of self‐identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems‐level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high‐level actions and a vision for transformational change. Results: Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer‐work approaches. Conclusion: Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. Public Contribution: Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports. [ABSTRACT FROM AUTHOR]

The Special Issue on Digital Health commemorates the 40th Anniversary of the Takemi Program in International Health at Harvard University, examining the potential and obstacles of digital health. The articles investigate the influence of digital technologies on health systems worldwide, with a specific focus on low- and middle-income countries. Various topics are explored, such as internet-based health information access, digitally supported health workers, healthcare delivery at home, transportation and logistics management innovations, and utilizing data to enhance health system performance. The papers present detailed case studies, evaluations, and frameworks for comprehending and planning digital health interventions, including studies on chronic disease management in rural South Korea, addressing gender-based violence in rural Nigeria, analyzing the Maharashtra ambulance service in India, and discussing digital transformation in the health product supply chain. Additionally, the text examines the role of digital health within Taiwan's national health insurance system and the utilization of digital health data for Palestine refugees, shedding light on the readiness, obstacles, and possibilities for integrating digital technology into healthcare systems across diverse regions. [Extracted from the article]

The health care industry is experiencing a transformative shift from traditional fee-for-service models to value-based care (VBC), emphasizing improved patient outcomes, enhanced quality, and reduced costs. While Centers for Medicare & Medicaid Services Innovation Center models focus on financial and quality outcomes, a critical opportunity for reform lies in organizational culture. VBC signifies a cultural and systemic evolution aligned with the quintuple aim of enhancing equitable patient outcomes, improving quality, reducing costs, and prioritizing provider well-being. Cultural impacts play a pivotal role in this transformation. [ABSTRACT FROM AUTHOR]

In the first year of the COVID pandemic, 2020, in the US, the disproportionate deaths of nursing-facility residents, mostly indigent older women, were primarily due to abandonment by the Trump administration and the states, here defined as an Eldercide. The Eldercide that occurred in most of the 15,477 and others, aiming to transform the public-health system that had long failed the residents and their bereaved families. This essay provides an overview of the residents' situations during the pandemic, their social characteristics, and their psychological needs. Members of government, like the populace, suffer from compound ageism, learned starting young. The bias is accompanied by a range of emotions toward residents – from indifference to avoidance and, since COVID, an erroneous sense of futility about keeping residents alive. Experts have long known what policies would be necessary to transform the industry and the public-health system, but politics, corruption, and the influence of the industry's lobby may interfere, even in the wake of the catastrophe. [ABSTRACT FROM AUTHOR]

Background Inclusion of patients in healthcare service and system planning is an increasingly important tool to improve healthcare systems worldwide. In 2012, a focused healthcare reform was initiated in Austria to strengthen the primary care sector which is still underway in 2023. Objective The aim of this study was to assess the perceptions, desires, and needs of patients in terms of primary care as a necessary building block of the Austrian healthcare reform. Methods This study was designed as an exploratory qualitative study using semi-structured interviews between the years 2013 and 2018. Interviews with patients focused on positive and negative experiences with regard to general practice (GP) consultations and perceptions of the primary care system in general, as well as desires for improvement. Qualitative content analysis was used to analyse the material using the software atlas.ti. Results Altogether, 41 interviews were conducted with seven categories identified. These categories include organization and time management around consultation, access, and availability including opening hours, human and professional aspects of consultation, infrastructure and hygiene of the waiting room, healthcare system factors, as well as non-clinical/administrative staff. Conclusions Appreciating and responding to patients' perceptions and needs, healthcare reform in Austria should include improvements regarding consultation/waiting time, coordination, and navigation in Primary Care. Successful healthcare reform has to include the patient voice. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare in Egypt has undergone significant reforms since the 1990s, including the pioneering Family Health Program (FHP). However, limited evaluation exists regarding the FHP's impact on enhancing the delivery of primary healthcare services. The primary objective of this study was to analyze and understand the efficiency and effectiveness of the FHP in altering the delivery of primary healthcare in Egypt. We aimed to outline the fundamental characteristics of the primary healthcare system, compare them between the conventional and the newly reformed FHP centers, and gauge the awareness level of these variances among key decision-makers, focusing specifically on Cairo, Egypt. Methods: This cross-sectional study employed a mixed methods approach to evaluate and compare the quality of care between conventional clinics and FHP clinics in Cairo using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) tool. The study population consisted of healthcare providers and municipal health authorities in Cairo. A purposive sampling method was used to select 19 FHP clinics and 12 conventional clinics, representing 75% of the total government primary care clinics in Cairo. Surveys were conducted among healthcare providers at these clinics, and interviews were conducted with 8 carefully selected municipal health authorities in supervisory roles. Descriptive statistics were used to summarize the survey responses. The chi-square (y2) test was employed to examine variations in scores between FHP and conventional clinics, with significance attributed to differences at the P < 0.05 level. Cronbach's alpha was used to assess the reliability of the scales used within each primary care dimension. Results: FHP clinics scored significantly higher on continuity of care (4.17 ± 0.37 vs. 3.68 ± 0.51, P = 0.05), family-centered approach (4.28 ± 0.59 vs. 2.97 ± 0.44, P = 0.01), and provider competency (4.29 ± 0.39 vs. 3.42 ± 0.99, P = 0.01) compared to conventional clinics. FHP clinics were more likely to offer domestic violence services (2.76 ± 1.49 vs. 1.80 ± 1.74, P = 0.02), tuberculosis treatment (2.73 ± 2.11 vs. 0.12 ± 0.34, P = 0.029), and prenatal care (4.75 ± 0.00 vs. 4.01 ± 1.56, P = 0.014). Conclusion: While FHP clinics demonstrate benefits in continuity, family-focus, and provider competency, quality improvements are still required in both conventional and FHP clinics to achieve comprehensive, continuous, integrated, and patient-centered primary healthcare aligned with community needs. Further evaluations are warranted given the continued expansion of the FHP program. [ABSTRACT FROM AUTHOR]

Objective: To assess whether prostate biopsy rates have altered with the July 2018 change in Australian Medicare Benefits Schedule (MBS) rebates supporting multiparametric magnetic resonance imaging (mpMRI) for diagnosing prostate cancer. Methods: Biopsy data (both trans-rectal and trans-perineal) were obtained from the Victorian Agency for Health Information from July 2016 to June 2022. The data were stratified by financial year, age group and hospital type (public vs private). Comparison was made between rates pre and post the mpMRI MBS code change. Results: There was an 11.9% increase in the number of biopsies performed per year compared to the pre-MBS change period. There is a significant decreasing trend (P < 0.001–4) in number of biopsies in the 40–49, 50–59 and 60–69-year-old age groups with a significant increasing trend (P < 0.001) in the 70–79 and 80–89-year-old age groups. There was a 32.9% reduction in the mean number of biopsies performed per year in public hospitals, compared with an 18.3% increase in private. Conclusion: Contrary to expectations, and proposed funding, there has been an increase in the number of prostate biopsies since MRI became more easily available. This change will put increased pressure on the health budget and the large increase in biopsies in elderly patients was not anticipated when the changes were proposed. A review of the criteria is suggested. What is known about the topic? Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in the diagnosis of prostate cancer. In 2018, it was included in the Medicare Benefits Schedule with the expectation that the number of prostate biopsies performed would decrease. What does this paper add? By 2022, biopsies increased nearly 12% with over a 50% increase in the 80–89 age group – those least likely to benefit from curative treatment. What are the implications for practitioners? The criteria for funding mpMRI and the performance of prostate biopsies should be altered to enable better use of resources. [ABSTRACT FROM AUTHOR]

The article explores project management methodologies and tools for new pharmacy practitioners, including their applicability in a healthcare environment. Topics discussed include the life cycle of a project, team composition and roles, project management methodologies, and the need for problem investigation.

Background: British Columbia, Canada, is experiencing an overdose crisis that has pushed drug liberalization policies to the forefront of the response. This study examines police officers' perceptions of enforcement and drug liberalization policies, including support for decriminalization and regulation or 'safer supply', in this context. Methods: Qualitative interview data were collected in September-November 2020 from active police officers involved in drug law enforcement in British Columbia, prior to decriminalization reforms being introduced in the province. We conducted a thematic analysis of this data with a focus on police officer views towards drug enforcement and drug liberalization policies. Results: Policing and reforms amid the overdose crisis has shaped officer perceptions and actions towards illegal drugs and drug policies. Although officers saw overdose as a health issue, these views coincided with a strong emphasis on supply-side policing, such as drug trafficking investigations. Policing continues to be entrenched in the overdose crisis, which has impacted the way police officers view drugs and drug use, particularly, their belief that current interventions to disrupt the illegal drug market are not working. Conclusion: This study advances knowledge on the motivations for promoting drug enforcement, and enacting drug policies, in the context of an overdose crisis. [ABSTRACT FROM AUTHOR]

"The Future of Mental Health, Disability and Criminal Law" is a book that pays tribute to Prof Bernadette McSherry and explores topics such as mental disability law, criminal law, and human rights. It is a collection of essays that cover various aspects of these areas, highlighting Prof McSherry's contributions. The book discusses the challenges in creating mental disability law, balancing domestic and international law, and advocating for the rights of persons with disabilities. It also addresses the need for reforms in mental health laws and the importance of access to justice for individuals with mental disabilities. The book is praised for its thoughtful analysis and comprehensive coverage of important issues in the field. [Extracted from the article]

Canada and Italy do not share many of the features associated with modern welfare state development, yet both countries have experienced changes in the way health care programs are administered and funded, and in the shift in fiscal responsibility between center and sub-national governments. This article explores the relationship between federalism, decentralization and health reform in Canada and Italy. It investigates how the two countries – one federal, the other "regionalized" – have designed and adapted their health care systems to respond to similar issues of equity, cost containment and organization. [ABSTRACT FROM AUTHOR]

Context: The objective of this article is to explain the political factors determining the relatively weak performance of the Polish health care (HC) sector. This can be treated as a critical case for several reasons. First, the Poles are among the most unsatisfied patients in the European Union, with one of the lowest life expectancy levels. Second, Poland spends one of the lowest shares of gross domestic product on HC-related expenditures among OECD countries. Third, the country is facing medical personnel shortages. Methods: The analysis is based on the mixed-methods approach. The authors rely on quantitative data outsourced from a survey, which is supplemented by the semistructured, in-depth interviews with selected key HC stakeholders representing patients' advocacy groups, medical personnel organizations, and high-level decision-makers. Findings: The Polish HC system remains weak due to the postcommunist legacy in terms of organization, a short-term approach by politicians, and weak decision-making processes. Conclusions: The HC policy inertia in Poland is determined by a group of interrelated political factors that effectively block the development of any positive reform. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic raises the question of austerity's problematic social toll for health in the south of Europe. Has EU economic governance constrained health spending? If so, have these spending levels led to inequalities, which in turn shaped responses to the pandemic? EU economic governance is often dismissed as ineffective because of its poor track record of compliance. Yet austerity is blamed for negative health outcomes. This article shows that the EU fiscal rule is a determinant of health because it affects fiscal policies of European countries. First, the analysis of EU member states during 1995–2018 shows that austerity policies affect health spending and health inequalities. Euro-area countries under the EU Excessive Deficit Procedure significantly consolidated their health spending. The contractionary effect was concentrated in southern countries, contributing to rising health inequalities across the core and periphery. Finally, the analysis shows the pandemic implications of health inequalities, as periphery countries with a track record of high consolidation display more stringent (and costly) COVID-19 response models. This analysis contributes to understanding the supranational determinants of health in the EU, showing the pervasive spillover effects of the fiscal framework on national health policies. [ABSTRACT FROM AUTHOR]

Context: The extent to which health care reforms affect health remains understudied. Health care reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. The authors scrutinize this relationship between health policy outputs and population health by focusing on legislative changes implying privatization of health care delivery and finance. They ask the following question: What is the relationship between reforms that privatize health care provision and population health in terms of health outcomes and inequalities? Methods: They answer this question by relying on fixed-effects time-series cross-section models. The authors use an original dataset of health care reforms passed in 36 European countries from 1989 to 2019. Health outcomes are operationalized with measures of subjective health status, unmet health needs, and resulting health inequalities. Findings: Their results show that privatization of health care is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in greater socioeconomic inequalities. Conclusions: The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 pandemic has highlighted how the European Union (EU) impacts national health systems and people's health. In November 2020, the European Commission launched the European Health Union (EHU) to better coordinate and maximize EU member states' abilities to deal with cross-border health threats. This article scrutinizes the early institutionalization of the EHU and its implications for EU health policy as a political determinant of health (PDoH). Methods: The article explores how EU health policy may be appreciated from a PDoH perspective. It draws from EU documents and existing research to analyze the early-stage institutionalization of the EHU. The study complements this policy output–focused perspective with an outcome-based exploratory assessment of EU health policy as a PDoH focusing on three examples: joint vaccine procurement, health reforms and investments under the Recovery and Resilience Facility, and the development of a European Health Data Space. Findings: The article shows that the policy change triggered by the EHU and the potential impact on citizens' health are not necessarily congruent. Modest change can have a potentially strong impact on health outcomes and vice versa. Conclusions: The article argues that the PDoH perspective provides a useful approach that is complementary to policy output–based perspectives, allowing for a more comprehensive assessment of the EU's role in health. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The emergence of residential aged care facilities (RACFs) within the Ghanaian health-care system has raised eyebrows because, hitherto, the concept of nursing homes had largely been perceived as an anomaly. The purpose of this study is to understand this emerging phenomenon and the activities of care provided within two facilities in the nation's capital, Accra. Design/methodology/approach: The study draws on participant observations and in-depth interviews with purposively sampled 15 residents in the two facilities and eight caregivers. The data were analysed using thematic approach. Findings: The study found that the daily forms of care mostly performed for the elderly were intimate and non-intimate physical, medical, emotional and spiritual and end-of-life care. The bulk of activities of care were performed in the morning. Originality/value: The study reveals that the changing landscape of health-care facilities in Ghana to include RACFs indicates RACFs have come to stay to provide different forms of care to older persons who otherwise were cared for by the family. [ABSTRACT FROM AUTHOR]

Background: The new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalists with patients with complex needs. Aim: To explore patients' views on the changes in general practice in Scotland since the inception of the new contract. Design and setting: Qualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas). Method: In-depth semi-structured interviews with thematic analysis. Results: Patients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP–patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. Conclusion: Following the introduction of the new Scottish GP contract, patients in this study's sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this. [ABSTRACT FROM AUTHOR]