Health Policy Experts Research Articles

The occurrence of cystic echinococcosis in slaughtered livestock in Jahrom, south of Iran

Cystic echincoccosis (CE) is a major medical and veterinary concern in the world, especially in Iran. Domestic intermediate hosts are an important reservoir for the disease spread. The purpose of this study was to determine the prevalence of CE in slaughtered livestock in Jahrom, south of Iran. In this cross-sectional study, a total of 3074 animals (2325 (75.63%) goats, 423 (13.76%) sheep, and 326 (10.60%) cattle) were inspected macroscopically for CE. In this regard, a questionnaire about the age, sex, infected organ, number of cysts, and cyst fertility was accomplished for each animal. Moreover, PCR was applied by using the cytochrome c oxidase I (COX1) and NADH dehydrogenase subunit 1 (nad1) fragments of parasite mitochondrial genomes on some positive samples. Prevalence of CE in sheep, cattle, and goats was 11.34% (48/423), 11.04% (36/326), and 2.79% (65/2325), respectively. In all livestock, CE was more common in females than males. Moreover, the highest infection rate was observed in the age group of more than 72 months. Considering the fertility of cysts, the ratio of the number of fertile cysts to total cysts in sheep and goats were 83.3% (40/48) and 80% (52/65), respectively. All hydatid cysts were infertile in cattle. With regard to the location of the cyst on internal organs, the most were observed in the lungs and liver. Regarding the intensity of infection, 1–5, 6–9 and ≥ 10 cysts were detected in 78.52% (117/149), 6.71% (10/149) and 10.73% (16/149) of infected livestock, respectively. In all livestock, hydatid cyst with a diameter of 1–5 cm was the most frequent with 71.81% (107/149). All 149 cyst samples were subjected to PCR. Among them, a total of 18 samples (six samples of each animal) were prepared for sequencing. G6 was the most dominant. According to the results of present study and the relatively high prevalence of CE in slaughtered livestock in Jahrom, health policy makers, health authorities, and experts should make effective approach in this regard, and implement careful inspections.

Learning health systems in low-income and middle-income countries: exploring evidence and expert insights

IntroductionLearning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify...

Stamping the vaccine passport? Public support for lifting COVID-19 related restrictions for vaccinated citizens in France, Germany, and Sweden

During theCOVID-19pandemic,manycountries implementedrestrictionsto limit the spread of the SARS-CoV-2 virus (e.g. travel restrictions and lockdowns).One path to loosening restrictions is to do so selectively only for vaccinated individuals (e.g. by implementing vaccine passports domestically or as a prerequisite for international travel).Setting different rules based on people’s vaccination statusis howevera contentious issue among health policy experts, government officials, and the public. Our analysis focuses on the levels and correlates of public support for the lifting of restrictions for the vaccinatedin April 2021, i.e. at a time when restrictions were in place and aselective lifting of these restrictions just for the vaccinatedwas debated in Europe.We use representative quota samples of the populations of France (N = 1,752), Germany (N = 1,759), and Sweden (N = 1,754). We find that a slight plurality support lifting restrictions for the vaccinated in France and Germany but not in Sweden. Vaccine hesitancy emerges as strong predictor of opposition to such a policy. Additionally, individuals who are already vaccinated (in France and Germany) and who are higher in risk-seeking express more support for the lifting of restrictions for the vaccinated. We discuss implications for the debate on vaccine passports.

JACR Health Policy Expert Panel: Pay for Performance

Over the last decade, there have been multiple efforts to use pay-for-performance (P4P) incentives to promote quality rather than quantity of care in radiology and other fields of health care [1]. P4P programs are also increasingly prevalent at the practice level, with groups determining a proportion of a radiologist’s compensation based on various performance measures [2]. However, participation in federal P4P programs such as the Merit-Based Incentive Payment System (MIPS) by individual radiologists and radiology groups has been variable due to multiple potential trade-offs [3].

Using Health Economics to Inform Immunization Policy Across All Levels of Government.

Publicly funded immunization programs have grown in both complexity and scope, resulting in increased costs and more complex programmatic decision making. Economic evaluations can provide crucial information to support informed decision making. While very few countries have National Immunization Technical Advisory Groups that analyze economic information, many have started to develop processes for this purpose. Since these guidelines are being developed at the national level, we propose that regional jurisdictions, especially those responsible for healthcare (e.g., provinces, territories, states), need clear processes for incorporating this information into their immunization decision making and program implementation. We interviewed Canadian vaccine experts involved in provincial vaccine policy decision making to identify current practices, perceptions, and recommendations around incorporating economic analysis into that process. Based on these interviews, we make five recommendations: (1) economic evidence should be routinely incorporated into the decision making process; (2) economic experts should sit on, or be available to, regional advisory committees; (3) efforts should be made to build on regional expertise by increasing educational opportunities on economic evaluation; (4) processes should include guidelines for when economic analysis is not required; and (5) clarification on the role of regional advisory groups in economic analysis is needed in relation to national expertise. The information presented here provides a starting point for regional health policy experts and decision makers to work collaboratively with national partners to create transparent and effective approaches to incorporating economic analysis into vaccine decision making.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00347-1.

An Appraisal of Prevailing Issues in Rural Tribal Health Care System in India

Better health is one of the most important aspect of the overall development and progress of any country. In the context of India, tribals are an integral part, which are 8.6 percent of the total population of the country. Scarce public health care services in India and related issues are currently the most discussed topic with recent outbreak of Covid-19 affecting human life terribly and still persisting. Health care issue affects every individual in the society. In tribal areas health care issues become even more important because as it seems that this section of society is still comparatively in unprivileged condition and not properly exploited the benefits of development process.India's development cannot be imagined without improvement of rural and tribal health. This article highlights major issues prevailing in the rural tribal health care system of India, which arises many barriers to tribal health and the holistic development of the country. Based on the blending results of several multi-factual studies, it is known that there exist many issues prevailingin the rural tribal health care delivery system. Many issues are there which are responsible for poor and complex tribal health status among the tribes, such as, low awareness about health, different religious and cultural beliefs, unrealistic health practices, living in difficult and inaccessible areas, financial problems, various infectious diseases, nutritional deficiencies, and poor public health care facilities, etc. These issues have attracted renewed attention from physicians, health policy experts, various health agencies as well as the general public, particularly tribal societies, which are most affected by these issues. Keywords: Health Status; Health Infrastructure; Rural Health Care Services; Tribal Culture And Practices; Health Policy; Public Involvement And Awareness.

National health workforce accreditation and regulation in Palestine: a qualitative assessment

BackgroundThe Health Workforce Accreditation and Regulation (HWAR) is a set of policies and processes designed to improve the quality of health services and the performance of health professionals. Various efforts were implemented, mainly by WHO, to advance and strengthen practices and activities of HWAR. In Palestine, HWAR seems to be lagging and to require strengthening at both national policy and institutional levels, based on local evidence. HWAR is rarely investigated in Palestine and possibly also in the Eastern Mediterranean. We aimed to assess the current status of HWAR in Palestine, to identify the challenges, and to propose useful policy and technical actions for the effectiveness of HWAR. MethodsWe did a qualitative assessment with a purposive sampling strategy to identify key informants from health authorities and institutions in government institutions (Palestinian Ministry of Health and National Legislative Council), academia (universities), and private and non-governmental organisations. Ethical and administration approvals were obtained from the Helsinki Committee at the Palestinian Health Research Council. The study was implemented from mid-October to mid-November, 2019. 22 in-depth interviews were done with key personnel from leadership and policy levels, including health policy makers, experts, and academics (six female, 16 male). Open questions in the interviews covered HWAR domains: conceptual, governance and policy, technical practices, resource and capacity, and gaps and solutions. Triangulated qualitative methods (thematic and ground theory) were used for data analysis and management. FindingsWe found a lack of understanding of HWAR, and perceptions of HWAR were inconsistent. Despite the existence of a strong legal framework for HWAR and an abundance of untapped skillful health workers, graduates, and students in Palestine and abroad, the majority of participants had a negative view of HWAR, perceiving it as fragmented, poorly regulated, and poorly coordinated. The governing system for HWAR was described as having no specific body or no clear mechanisms of operation. Interviewees reported that some existing accreditation and regulatory standards are well applied but that most need to be updated, reviewed, and enforced at a larger scale. They also reported that HWAR regulatory, executive, and education stakeholders have no consensus on HWAR governance, which is driven by individual initiatives and capacity rather than a systematic evidence-based approach. Overall, the participants described HWAR practices and resources as of low quality. Benefits of a well-established HWAR system and mechanism were suggested, such as an increase in the quality of services, patient safety, trust, and satisfaction with the performance of health system, and a reduction in resource waste. Factors affecting HWAR and the challenges for its implementation were identified—eg, political instability, deficit of education and training, shortage of resources and capacities, and lack of governance and oversight. Actionable solutions at the level of the health system, institutions, and individuals were proposed, establishing a unified and effective HWAR governance structure, policy and regulations, and guidelines and standards for practices. InterpretationInterviewees emphasised the importance of HWAR as a key pillar of health system governance for improving health care and achieving universal health coverage. HWAR national policy and guidelines need substantial reform to tackle poor implementation, communication, standardisation, monitoring, and evaluation. Stakeholders, ministries, syndicates, and academic institutions should work together through an integrated national accreditation and regulation system. Interviewees suggested that system reform must be driven by a common vision, well-established guidelines, and an accreditation and regulation policy for better awareness, best practices, and effective mechanisms. FundingNone.

JACR Health Policy Expert Panel: Hospital Price Transparency.

The desire to increase health care price transparency is not new: multiple efforts have been made to do so over several decades. Most recently, in a policy that began on January 2021, CMS now requires all hospitals to publish negotiated prices for “shoppable services” including the technical component fees for 13 CMS-specified diagnostic radiology services [ 1 Forman H.P. Price transparency comes to radiology: are we ready for the attention?. Radiology. 2022; 302: 625-626https://doi.org/10.1148/radiol.2021212464 Crossref PubMed Scopus (1) Google Scholar ].

Healing the homelessness, fixing a broken aid industry, and challenging the status quo: perspectives of a physician-activist

ABSTRACT Homelessness is among the most important problems in social medicine. While traditional studies provide useful answers (albeit for increasingly narrow phenomena), unique perspectives and first-person accounts hold potential to influence broader thinking about the field. Here, we provide a first-person account from physician-activist David Buck, a health policy expert and founder of Healthcare for the Homeless-Houston, on what it takes to tackle the homelessness epidemic, fix the broken aid industry, and challenge the status quo.

Protecting noncommunicable disease prevention policy in trade and investment agreements.

Preventing noncommunicable diseases is a global priority, for which the World Health Organization has recommended policies to reduce the consumption of tobacco products, alcohol and unhealthy foods. However, regulation has been strongly opposed by affected industries, who have invoked the provisions of legally binding trade and investment agreements. The aim of this analysis of the legal, economic and public health literature was to present a short primer on the relationship between noncommunicable disease prevention policy and trade and investment agreements to help public health policy-makers safeguard public health policies. The analysis identified opportunities for protecting, and even promoting, public health in trade and investment agreements, including: (i) ensuring exceptions for public health measures are included in agreements; (ii) committing to good regulatory practice that balances transparency and cooperation with the need for governments to limit the influence of vested interests; (iii) ensuring trade and investment agreement preambles acknowledge the importance of public health; (iv) excluding investor–state dispute settlement mechanisms from agreements; and (v) limiting the scope and definition of key provisions on investor protection to reduce the risk of investment disputes. This synthesis of the multidisciplinary literature also provides support for greater strategic and informed engagement between the health and trade policy sectors. In addition, ensuring a high level of health protection in trade and investment agreements requires cooperation between disciplines, engagement with experts in law, economics and public health policy, and fully transparent policy processes and governance structures.

What Does the State Innovation Model Experiment Tell Us About States' Capacity to Implement Complex Health Reforms?

For decades, Americans have debated whether the states need federal government support to reform health care. The Affordable Care Act has allowed the federal government to trial innovative ways of accelerating state-led reform initiatives through the State Innovation Model (SIM), which was run by the Centers for Medicare and Medicaid Services Innovation Center between 2013 and 2019. This study assesses states' progress implementing health reforms under SIM and examines how well the federal government supported them. Detailed case studies were conducted in six states: Arkansas, Connecticut, Oregon, New York, Tennessee, and Washington. Data was collected from SIM evaluation and annual reports and through semistructured interviews with 39 expert informants, mostly state or federal officials involved in SIM. Preliminary findings were tested and refined through an online forum with health policy experts, facilitated by the Milbank Memorial Fund. States that made the most progress implementing reforms had a strong track record and managed to sustain stakeholder, bureaucratic, and political support for their reform agenda. There was a clear correlation between past reform success and success under SIM, which raises questions about the value of federal government support beyond providing funding. State officials said the federal government could better support states, particularly those with less reform experience, by providing tailored advice that helped state officials overcome problems designing and implementing reforms. State officials also said the federal government could better support them by reforming their own programs, particularly Medicare, and committing to a long-term strategy for health system reform. States can make some progress reforming health care on their own, but real progress requires long-term cooperation between state and federal governments. Federal initiatives like SIM that foster cooperation between governments should be continued but refined so they provide better support to states.

Prioritizing Asian Americans, Native Hawaiians, and Pacific Islanders in the U.S. Health Equity Agenda.

Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are growing rapidly in the United States, yet AANHPIs remain understudied, overlooked, and misunderstood. During the COVID-19 pandemic, themes from the tragic history of anti-Asian bias and marginalization have resurfaced in a surge of renewed bigotry and xenophobic violence against AANHPIs. In this commentary, the authors discuss the role of medical schools in combating anti-Asian sentiment as an important step toward achieving health equity. Based on their collective expertise in health disparities research, medical education, and policy, they offer suggestions about how to disrupt the pattern of invisibility and exclusion faced by AANHPI populations. They consider ways that representative data, leadership in medical education, research funding, national policies, and broad partnerships can help address AANHPI health disparities.

Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools.

Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.

Multimorbidity clustering of the emergency department patient flow: Impact analysis of new unscheduled care clinics.

In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The objective of this study was to analyze the impact of opening new on-demand care services based on variations in patient flow at a large hospital emergency department. We performed a before-and-after study investigating the use of unscheduled care services in the Aube region in eastern France, that focused on ED attendance at Troyes Hospital. A hierarchical clustering based on co-occurrence of diagnoses was applied which divided the population into different multimorbidity profiles. Temporal trends of the resultant clusters were also studied empirically and using regression models. A multivariate logistic regression model was constructed to adjust the periodic effect for appropriate confounders and therefore confirm its presence. In total, 120,722 visits to the ED were recorded over a 24-month period (2018-2019) and 16 clusters were identified, accounting for 94.76% of all visits. There was a decrease of 56.77 visits per week in seven specific clusters and an increase of use of unscheduled health care services by 328.12 visits per week. Using an innovative and reliable methodology to evaluate changes in patient flow through the ED, these findings may help inform public health policy experts on the implementation of unscheduled care services to ease pressure on hospital EDs.

Students of Change: Health Policy in Action.

Health policy is more impactful for public health than many other strategies as it can improve health outcomes for an entire population. Yet in the "see one, do one, teach one" environment of medical school, most students never get past the "see one" stage in learning about the powerful tools of health policy and advocacy. The University of New Mexico School of Medicine mandates health policy and advocacy education for all medical students during their family medicine clerkship rotation. The aim of this project is to describe a unique health policy and advocacy course within a family medicine clerkship. We analyzed policy briefs from 265 third-year medical students from April 2016 through April 2019. Each brief is categorized by the level of change targeted for policy reform: national, state, city, or university/school. Implemented policies are described. Slightly less than one-third of the policies (30%) relate to education, 36% advocate for health system change by addressing cost, access, or quality issues, and 34% focus on public health issues. Fourteen policies have been initiated or successfully enacted. This curriculum gives each medical student a health policy tool kit with immediate opportunities to test their skills, learn from health policy and advocacy experts, and in some cases, implement health policies while still in medical school. A 1-week family medicine policy course can have impact beyond the classroom even during medical school, and other schools should consider this as a tool to increase the impact of their graduates.

Modifying Group Interpersonal Psychotherapy for Peripartum Adolescents in Sub-Saharan African Context: Reviewing Differential Contextual and Implementation Considerations

Background This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content. Methods A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual. Discussion Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented.

Understanding factors impacting global priority of emergency care: a qualitative policy analysis

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped...

AOA ophthalmology and otolaryngology program closures as a model to highlight challenges of maintaining GME in high need areas.

While 90% of former American Osteopathic Association (AOA) residency programs transitioned to Accreditation Council for Graduate Medical Education (ACGME) accreditation, surgical subspecialty programs such as ear, nose, and throat (ENT, 62%) and ophthalmology (47%) struggled to gain accreditation. Doctors of Osteopathic Medicine (DOs) actively participate in serving underserved communities, and the loss of AOA surgical specialty programs may decrease access to surgical care in rural and nonmetropolitan areas. To determine the challenges faced by former AOA-accredited surgical subspecialty programs during the transition to ACGME accreditation, particularly ENT and ophthalmology programs in underresourced settings. A directory of former AOA ENT and Ophthalmology programs was obtained from the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS). A secured survey was sent out to 16 eligible ENT and ophthalmology program directors (PDs). The survey contained both quantitative and qualitative aspects to help assess why these programs did not pursue or failed to receive ACGME accreditation. Twelve of 16 eligible programs responded, com-prising six ophthalmology and six ENT PDs. Among the respondents, 83% did not pursue accreditation (6ophthalmology and 4 ENT programs), and 17% were unsuccessful in achieving accreditation despite pursuing accreditation (2 ENT programs). Across 12 respondents, 7(58%) cited a lack of hospital/administrative support and5 (42%) cited excessive costs and lack of faculty support as reasons for not pursuing or obtaining ACGME accreditation. The survey results reflect financial issues associated with rural hospitals. A lack of hospital/administrative support and excessive costs to transition to the ACGME were key drivers in closures of AOA surgical specialty programs. In light of these results, we have four recommendations for various stakeholders, including PDs, Designated Institutional Officials, hospital Chief Medical Officers, and health policy experts. These recommendations include expanding Teaching Health Center Graduate Medical Education to surgical subspecialties, identifying and learning from surgical fields such as urology that fared well during the transition to ACGME, addressing the lack of institutional commitment and the prohibitive costs of maintaining ACGME-accredited subspecialty programs in underresourced settings, and reconsidering the Centers for Medicare & Medicaid Services (CMS) pool approach to physician reimbursement.

Harvesting a Forest

Harvesting a Forest

Health care utilization among beneficiaries with diabetes from federally qualified health centers: Analysis from a Medicaid managed care organization

We examined health care utilization among federally qualified health center (FQHCs) users from a Medicaid managed care organization based on 2016 administrative claims data (n = 8,402). FQHC users had fewer primary care visits (Adjusted Incidence Rate Ratios (aIRR): 0.82; 95% CI: 0.76–0.88) compared with non-FQHC users. Statistically significant differences were not observed in emergency department visits (aIRR: 1.19; 95% CI: 0.98–1.46) and hospitalizations (aIRR: 1.03; 95% CI: 0.80–1.34). FQHCs provide comprehensive primary care to Medicaid managed care beneficiaries with diabetes in fewer PCP visits. Results provide evidence to health policy experts and MCOs to increase provider network contracting with FQHCs.