Health Care Reform Research Articles (Page 1)

Although various studies have been conducted on satisfaction with healthcare service, few have explored universal factors that work in multiple countries. Therefore, this study focused on resident satisfaction with public health service and affecting factors in the UK, Germany, France, Sweden, and Norway. Considering significant heterogeneity among influencing factors, we constructed a stepwise multiple logistic regression model to investigate relationships between resident satisfaction with public health service and residents’ health status, service expectation, service effectiveness and other individual characteristics. The data was derived from the 7th European Social Survey data in 2014. The study empirically established that 63.45% of surveyed residents across five European countries reported moderate-to-high satisfaction with public health service. Crucially, self-assessed health status (βʹ = 0.0012, p < 0.001), mental health status (βʹ = 0.002, p < 0.01), service expectation (βʹ = 0.0011, p < 0.001), and service availability (βʹ = 0.016, p < 0.001) positively affected public health service satisfaction, whereas international migration negatively affected satisfaction (βʹ = −0.033, p < 0.001). Policymakers in Western welfare countries need to take advantage of these universal influencing factors affecting public health service satisfaction and align the service provision with residents’ reasonable expectation. The satisfaction-driven healthcare system also provides references for the public healthcare reformation in other countries and regions.

Purpose Medical expenditures for colorectal cancer (CRC) in China have risen substantially, with significant geographic disparities. This study aimed to comprehensively assess the level, temporal trends, and influencing factors of medical expenditures per patient, per clinical visit, and per day among CRC patients in Guangxi from 2005 to 2014. Methods A retrospective, hospital-based survey was conducted in 2015 at a Class A tertiary cancer hospital in Nanning, Guangxi. The study included patients newly diagnosed with primary CRC between January 1, 2005, and December 31, 2014. Data on demographics, clinical characteristics, and detailed medical costs were extracted from electronic medical records. All expenditure values were adjusted for inflation to 2011 Chinese Yuan (CNY) using China’s healthcare-specific Consumer Price Index. Statistical analyses included descriptive statistics, non-parametric tests, Spearman correlation, and binary logistic regression. Results A total of 1,029 eligible CRC patients were analyzed. The median medical expenditures were CNY 50,540 per patient, CNY 24,618 per clinical visit/admission, and CNY 1,410 per day. From 2005 to 2014, these expenditures increased by factors of 1.63, 1.13, and 2.44, respectively, with annual growth rates of 5.59, 1.41, and 10.42%. Notably, the annual per-patient medical expense was 2.2 to 3.3 times the per-capita GDP of Guangxi during the same period. Drug fees constituted the largest proportion of total costs (61.22%), followed by laboratory test fees (12.27%) and inspection fees (7.58%). Subgroup and regression analyses revealed that treatment regimen, number of clinical visits/admissions, and length of hospitalization were significant factors associated with higher costs. A high proportion of patients (59.87%) were diagnosed at an advanced stage (III-IV). Conclusion Medical expenditures for CRC diagnosis and treatment in Guangxi during the study period were substantial and increased rapidly, imposing a significant economic burden. The cost structure was heavily dominated by pharmaceutical expenses. The findings underscore the need for policies promoting early detection and efficient resource allocation. This study provides a critical baseline for evaluating the impact of subsequent healthcare reforms and informs future health economic research in Guangxi and similar regions.

In Lithuania, the year 2024 has been identified as a pivotal moment for healthcare reform, which encompasses two primary objectives: implementing a proactive public health policy and enhancing the accessibility, quality, and efficiency of healthcare through the restructuring of the service delivery network. This reform is essential for remote regions, where demographic shifts have modified service requirements. Certain services, such as midwifery, have diminished, while others, including elderly nursing care, require reestablishment. Adapting to these reforms has disrupted competencies, underscoring their importance as a critical area for regional development, particularly in enhancing new resources. By analysing the public health reform in Lithuania through the lens of remote regions, it becomes possible to identify specific strategies and practices that can be applied both nationally and internationally. The study aims to highlight shifts in the emerging needs of healthcare personnel's competencies in remote regional areas, particularly during the national healthcare system's structural transformations, and their capacity to achieve the reform goal of delivering top-quality health services based on transformative competencies. The study uses qualitative interviews to identify the competencies health professionals lack following the establishment of new Primary Health Care Centres. The study revealed that while clinical and professional competencies related to legal and clinical responsibilities are easier to adopt from a technical standpoint, competencies like leadership, collaboration, and patient involvement pose greater challenges, leading to community stress. The acquisition of these competencies requires long-term investment in staff development, emotional support, and clear change management. Moreover, the new structure of health centers and newly introduced work processes may increase employees’ emotional exhaustion, stress, or even the risk of burnout if adequate support or training is not provided.

We explore what happens to home-based healthcare practice 11 years after implementing a healthcare reform, the Coordination Reform in 2012. We conducted a qualitative study using document analysis and five focus group interviews with 27 department leaders in home-based healthcare practices in 2023. An inductive thematic analysis was conducted. Our qualitative design sheds light on how macro-ideas, reforms, and policies shape practice across healthcare institutions and the challenges they face. It highlights that reforms, often driven by efficiency goals, rarely lead to swift changes due to resistance rooted in established norms, values and practices. Still eleven years post-reform, we observe minimal progress in cross-level clinical coordination. The study identifies key barriers, including issues with information flow, trust and collaboration between hospitals and municipal healthcare services. Additionally, it examines the role of path dependency, explaining the persistence of prior routines despite reforms and provides a theoretical lens for understanding resistance to change in healthcare. By applying institutional theory to healthcare reforms, policymakers and practitioners can better navigate the complex forces shaping healthcare policy. Our findings illustrate how macro-ideas and policies are diffused across institutional levels in the municipality healthcare sector and how organizational actors and their immediate context shape practice when it comes to cross-clinical coordination.

The Philippine Health Insurance Corporation’s (PhilHealth) financial situation is in dire straits, with an official claiming that its actuarial life would last until 2027 only. To achieve free universal healthcare, alternative financing options for the Philippines’ national health care system would have to be considered. This paper aims to analyze historical government health care reform policies vis-à-vis social movement/civil society alternatives – and the corresponding paradigm shifts that they present – which culminate in the recently filed House Bill 9515 (“An Act Providing for a Free, Comprehensive, and Progressive, National Public Health Care System”) authored by the Makabayan Coalition – a bloc of grassroots partylists with strong links with social movements. House Bill 9515’s provisions would bring the Philippine system closer to Cuba’s and the United Kingdom’s systems which both offer useful springboards in making public health care free for all. Thus, the bill can potentially help the Philippines transition from privatization &amp; commodification which have characterized the prevailing framework in the country’s health care system for decades now.

The Exercise Science Practice Model (ESPM) is a foundational framework that unifies professional education, reasoning, and practice within the field of Exercise Science. Unlike allied health disciplines such as physical therapy, occupational therapy, and athletic training, Exercise Science has lacked an established practice model to guide curriculum design, professional identity, and accreditation. The ESPM bridges this gap by integrating the biopsychosocial model with critical thinking and clinical reasoning frameworks, emphasizing reflective, ethical, and evidence-based decision-making. Grounded in constructivist and transformative learning theories, the model promotes active, student-centered learning through case studies, simulations, and reflective exercises that cultivate higher-order cognitive skills.The ESPM is organized into six interrelated domains —Psychosocial, Assessment, Diagnosis, Prognosis, Intervention, and Outcome —that together provide a structured, cyclical approach to client management. Each domain incorporates both technical competencies and reflective reasoning, aligning with standards established by the American College of Sports Medicine (2020) and the National Strength and Conditioning Association (2025). Implementation within a regional University curriculum demonstrated enhanced student engagement, improved integrative reasoning, and strengthened professional identity. Preliminary outcomes suggest that ESPM fosters critical inquiry, ethical awareness, and interprofessional collaboration, aligning with current educational reforms in health sciences.Ultimately, the ESPM advances Exercise Science education by providing a replicable, evidence-informed framework that promotes curricular coherence, professional legitimacy, and the cultivation of reflective, competent practitioners prepared for the evolving demands of preventive health and performance science.

Background Healthcare-associated infections (HAIs) remain a global patient safety challenge, with prevalence rates ranging from 3.5–7% in high-income countries to over 15% in resource-limited settings. In Kazakhstan, ongoing healthcare reforms face barriers to effective infection prevention and control (IPC), particularly in maternity facilities where postpartum sepsis accounts for up to 18% of maternal deaths. Objective To assess the current state of IPC in Kazakhstan, compare it with international best practices, identify systemic gaps, and propose targeted recommendations to strengthen IPC programs. Methods A mixed-methods approach was used, combining literature review, analysis of national regulations, review of WHO, CDC, and ECDC guidelines, and comparative evaluation of IPC programs in selected countries using the WHO Infection Prevention and Control Assessment Framework (IPCAF). Results Kazakhstan demonstrates partial implementation of WHO IPC core components, with significant deficits in digital surveillance, trained IPC personnel, and antimicrobial stewardship. HAI prevalence in Kazakhstan (10–15%) exceeds rates in highincome countries (&lt;7%). Comparative analysis shows that robust governance, continuous staff training, and integration of digital monitoring systems are key to achieving sustained HAI reduction. Conclusion Strengthening Kazakhstan’s IPC requires integrated measures, including development of a national digital HAI surveillance platform, mass training and certification of IPC specialists, adaptation of WHO guidelines to local contexts, and prioritization of infection control in maternity care to reduce postpartum sepsis-related mortality. BJMS, Vol. 24 No. 04 October’25 Page : 1062-1071

Intersecting social inequalities in prenatal and postnatal care: Examining race, ethnicity, socioeconomic status, and geographic location.

Surgical advocacy as an academic career path: A guide for promotion discussions.

Sustainability in Critical Care units: an opinion paper from the SFAR (French Society of anaesthesia and Critical Care) Sustainability and Critical Care Committees.

Opioid Use Disorder (OUD) is defined by the persistent use of opioids despite adverse consequences. It is associated with increased mortality and a variety of mental and general medical comorbidities. Risk factors include younger age, male sex, lower educational attainment, lower income, and psychiatric disorders, such as other substance use disorders and mood disorders. Genetics also play a role in susceptibility to opioid use disorders. Long-term selfefficacy in opioid use for non-medical purposes suggests irreversible opioid use disorders. To evaluate the current understanding of opioid use disorders, the limitations in existing treatment approaches were examined, and strategies to improve outcomes through expanded treatment access and personalized care interventions were identified. An analysis was carried out regarding the role of existing pharmacological treatments, barriers within the care cascade, and potential advancements in healthcare delivery and innovation was carried out to address opioid use disorders. A comprehensive review of the literature was conducted by searching electronic databases (e.g., PubMed, Scopus) for articles published over the past 20-25 years. Relevant studies were selected based on predefined inclusion criteria, focusing on OUD risk factors, pharmacological treatments, barriers in the care cascade, and strategies for improving care. The selection process prioritized systematic reviews, clinical trials, and key guidelines. Although medications for opioid use disorders are effective, their impact is hindered by systemic issues at multiple levels of care. Addressing these challenges requires comprehensive efforts, including professional training, innovative treatments, and healthcare reforms to expand access and personalize care.

The Health Reform Act of 2025 (HR1) has increased financial strain on hospitals by reducing Medicaid funding, tightening DSH eligibility, and limiting access to the 340B program. Addressing these challenges requires strategic transformation in access, service lines, and payer strategies, as short-term cuts won’t resolve structural pressures.

Background: South Asia is disproportionately afflicted by Cardiovascular Diseases (CVDs), which are the world’s leading cause of death. Urbanization, sedentary lifestyles, poor food, and high levels of psychosocial stress are all contributing to the increased incidence of Sudden Cardiac Arrest (SCA) in India, a country with a sizable youth population. Aim: The purpose of this study is to describe the etiological aspects of SCA, highlight its rising frequency among Indian youth, and talk about management and prevention techniques to lower the number of preventable cardiovascular deaths. Methods: Using databases such as PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar, an extensive literature review was carried out. Keywords including “young adults,” “premature mortality,” “sudden cardiac arrest,” “sedentary lifestyle,” “herbal sources,” and “cardiovascular health” were employed. Additionally, pertinent national-level data from WHO, NCRB, and ICMR were included. Results: In addition to modifiable risk factors like obesity, hypertension, smoking, and alcohol use, SCA in young people is often linked to structural and hereditary conditions like hypertrophic cardiomyopathy, coronary artery anomalies, primary arrhythmias, myocarditis, and Marfan syndrome. According to recent data from India, childhood obesity and family history are major causes of the rising number of unexpected deaths among young people. However, only a few universities have access to AEDs, and bystander CPR rates are still extremely low (1–3 %). Using electrocardiography (ECG) and echocardiography in athletes and high-risk groups can greatly enhance results. Altering one’s lifestyle and using herbal medicines as a supplement may also help to maintain cardiovascular health. Conclusion: Early detection, preventive screening, quick emergency response, and policy-driven interventions are critically needed, as evidenced by the increased incidence of SCA among Indian young. To protect young cardiovascular health and lower premature mortality, a multimodal strategy including lifestyle changes, structured screening programs, community education, and healthcare reforms is essential. Major Findings: SCA among Indian youth is rising due to lifestyle factors, obesity, stress, and hereditary cardiac disorders. Emergency response remains weak, with CPR rates at 1–3 % and scarce AED access. Preventive screening and lifestyle interventions are essential to reduce premature mortality and improve cardiovascular outcomes.

ABSTRACT The Recovery and Resilience Facility (RRF) has been a significant innovation in European Union (EU) governance and represents an opportunity to prioritize healthcare investments and reforms, among other policies. While much has been written about the EU post‐pandemic, particularly regarding the potential for changing the economic paradigm and triggering substantial domestic policy changes, the present article sheds light on the RRF through a multi‐level governance and policy design approach. The article combines the examination of the EU policy strategy at the top with the analysis of national and regional capacities and implementation programs at the bottom. By focusing on the Italian case, we shed light on the opportunities and limitations of both the RRF and the Italian National Recovery and Resilience Plan (NRRP). The design of both the RRF and NRRP reveals weaknesses that could hinder the success of the initiative.

ABSTRACTIntroductionThe COVID‐19 pandemic highlighted the important role of trust in information sources in shaping vaccine uptake behavior. This study aimed to examine the relationship between trust in various information sources and COVID‐19 vaccine uptake.MethodsData were analyzed from the April 2021 wave of the Health Reform Monitoring Survey (HRMS). A total of 9067 US adults were included. Multivariate logistic regression models were used to assess associations between seven different information sources, trust, and vaccine uptake, adjusting for sociodemographic factors.ResultsTrust in personal doctors/healthcare providers was the strongest predictor of COVID‐19 vaccine uptake (adjusted odds ratio [AOR] = 1.53, p < 0.001), followed by trust in other doctors/community healthcare providers (AOR = 1.40, p < 0.001) and pharmacists (AOR = 1.32, p < 0.001). Non‐healthcare information sources, such as social service, neighborhood, or civic organizations (ARO = 1.27, p < 0.001), and local elected officials (AOR = 1.08, p < 0.001), showed weaker associations. Trust in religious leaders and family/friends was associated with a lower likelihood of vaccine uptake (AOR = 0.81, p < 0.001, and AOR = 0.85, p < 0.001, respectively). Older age, higher education, and Hispanic ethnicity were positively linked to COVID‐19 vaccine uptake.ConclusionTrust in healthcare professionals significantly influences COVID‐19 vaccine uptake, whereas trust in non‐healthcare sources plays a more limited role. Religious leaders’ and family/friends’ influence was minimal. Building and maintaining trust in healthcare providers is crucial for promoting vaccine acceptance, particularly amid widespread misinformation and political polarization. Public health efforts should prioritize improving healthcare provider–patient communication, utilizing trusted healthcare figures as role models, and implementing culturally tailored interventions to address hesitancy among marginalized groups.

ABSTRACTIssue AddressedThis study explores how community health and social service providers in Tasmania perceive local health challenges, navigate system barriers, and support socioeconomically disadvantaged populations. In the context of Tasmania's ongoing public health reform, these perspectives are critical for shaping equitable strategies grounded in lived experience.MethodSemi‐structured interviews were conducted with leaders from diverse health and social service organisations in southern Tasmania. Analysis combined inductive thematic coding with a critical realist framework to map relationships between the local context, mechanisms of change, and outcomes.ResultsHealth risks and chronic conditions are closely entwined with socioeconomic disadvantage, unmet basic needs, and systemic challenges. Providers responded with adaptive, community‐based strategies emphasising trust, accessibility, and contextual sensitivity. Yet, these mechanisms were constrained by limited resources, low health literacy, and broader contextual barriers, producing mixed outcomes ranging from engagement and empowerment to persistent disengagement and cycles of poor health.ConclusionCommunity health and social service providers are essential intermediaries, bridging gaps through integrated, localised programs. Findings support Tasmania's vision for an integrated wellbeing approach and highlight the need for greater investments in prevention, stronger local governance and coordination, and strategies that address the structural determinants of health and enhanced community participation.So What?This study extends Tasmanian health promotion scholarship by foregrounding provider perspectives and provides a unique system‐level account of how providers adapt to entrenched disadvantage. It also demonstrates the value of a critical realist lens for understanding cycles of disadvantage. Together, these insights offer practical guidance for equity‐oriented public health reform.

Introduction: Dementia has been a public health concern for several years. As the population continuously ages, the prevalence of dementia is projected to significantly rise, thus governments will face an increasing demand for support services. Unfortunately, dementia is not recognized as a major public health concern in the Philippines. As the extent of the dementia epidemic needs to be further delineated in the Philippines, and research on dementia is still limited, a larger study is needed to provide more information about the disease burden. This will raise awareness and inform policy makers about the necessity of social and health care reform in dementia care. We aimed to collect uniform data from patients with cognitive impairment and determine the frequency of dementia and mild cognitive impairment in the study population. These data are crucial for providing information to policy makers in the country. Methods and Analysis: This is a multi-center, prospective, observational, non-interventional study and standing database of patients clinically diagnosed with Mild Cognitive Impairment (MCI) or dementia seen at the participating training institutions. Corresponding anonymized data on demographics, medical history, risk factors, level of functional impairment, diagnosis, baseline cognitive scores and management will be collected from each patient and entered into the database using a secure online data collection tool. Collective data will be extracted, summarized and analyzed every year with oversight provided by the Philippine Neurological Association (PNA). Ethics and Dissemination: Approval from the ethics committees or institutional review boards (EC/IRB) was obtained from the Single Joint Research Ethics Board and all participating institutions. The PNA1DB-Dementia initiative will be crucial in providing information to policy makers, to further enhance the implementation of the Mental Health Act. The dissemination of results will be conducted through scientific or public conferences and scientific journal publication. Keywords: dementia, database, Philippines Trial Registration: NCT05484960; ClinicalTrials.gov.

Rural development plays a pivotal role in national progress, particularly in developing countries where a large proportion of the population resides in rural areas. This research paper presents a comparative analysis of rural development strategies employed by six successful nations: China, India, Japan, Iran, Turkey, and Malaysia. By examining and contrasting the approaches adopted in each country, the study identifies key strategies, challenges, and policy outcomes that have significantly contributed to the socioeconomic transformation of rural communities. The research utilizes a qualitative comparative methodology, relying on secondary data from scholarly articles, governmental reports, and international development databases. The analysis reveals that effective rural development is multifaceted, often involving integrated strategies such as agricultural modernization, infrastructure investment, decentralized governance, education and health reforms, and sustainable environmental practices. The study finds that while each country’s approach reflects its unique historical, cultural, and political context, common factors such as strong institutional frameworks, community participation, and targeted government support are consistently associated with successful outcomes. Moreover, the paper critically evaluates the role of international cooperation, innovation, and technology transfer in amplifying rural development impact. The findings offer valuable insights for policymakers, planners, and development practitioners in countries like Afghanistan that face persistent rural challenges. By learning from diverse international experiences, this research advocates for adaptive, context-sensitive policies that prioritize rural empowerment, equity, and resilience. Ultimately, the study contributes to the broader discourse on sustainable development by emphasizing the strategic importance of rural areas in achieving national development goals.

BackgroundThe global misallocation of healthcare resources has emerged as a critical impediment to public health. In China, healthcare resources are predominantly concentrated in major cities and high-tier hospitals, while primary care facilities suffer from inadequate capacity, contributing to issues such as “difficult and expensive access to healthcare.” Despite numerous healthcare reforms, significant disparities in resource distribution persist.ObjectiveThis study seeks to elucidate the causal effects of healthcare system reform on the misallocation of medical resources and to investigate the underlying mechanisms. Focusing on the healthcare reform implemented in Sanming in 2012 as a quasi-natural experiment, the research employs the synthetic control method (SCM) to assess the policy’s impact on resource misallocation.MethodsThe synthetic control method is applied to estimate the causal impact of the Sanming Medical Reform on the misallocation of healthcare resources. By constructing a weighted control group that replicates Sanming’s counterfactual resource allocation trajectory in the absence of the reform, the model controls for covariates such as industrial structure, GDP, and human resources to ensure precise estimation of the policy effect. Data were obtained from the National Bureau of Statistics, local health commissions, and other sources, forming a balanced panel dataset of 203 cities spanning 2007 to 2022.ResultsThe analysis reveals that the Sanming Medical Reform markedly reduced the misallocation of healthcare resources. Following the 2012 intervention, Sanming exhibited a substantial decline in misallocation, with the misallocation index decreasing by an average of 0.1412 between 2013 and 2017. Both city-level and time placebo tests confirm that the observed policy effect is statistically significant and not attributable to random variation. Mechanism analysis further indicates that the reform achieved its outcomes by increasing government expenditure on health and refining the structure of health insurance.ConclusionThe empirical evidence demonstrates that the Sanming Medical Reform effectively alleviated the misallocation of healthcare resources and bolstered primary care capacity through enhanced government spending and optimized health insurance payment structures. These findings offer valuable insights and empirical support for healthcare reforms in China and other countries, paving the way for more equitable and efficient resource allocation.

In the context of rapidly evolving public health challenges, the capacity for innovative work behavior (IWB) among health sector employees is increasingly vital to ensure adaptive and responsive healthcare delivery. This study examines the influence of talent management and psychological empowerment on IWB among employees of the Garut City Health Service in Indonesia. Drawing upon resource-based theory and self-determination theory, the study conceptualizes talent management as a strategic approach encompassing talent acquisition, development, retention, and succession planning. Psychological empowerment, defined through meaning, competence, self-determination, and impact, is explored as a cognitive-motivational state that may mediate the relationship between talent management and innovative behavior. Data were collected from 221 civil servants using a structured questionnaire and analyzed using Structural Equation Modeling (SEM). The findings reveal that talent management significantly positively affects both psychological empowerment and IWB. Moreover, psychological empowerment partially mediates, indicating that employees’ perceptions of autonomy and competence are essential to translate talent initiatives into innovative outcomes. This study contributes to the theoretical understanding of innovation in the public health sector by integrating HRM and organizational behavior perspectives. Practically, it highlights the importance of cultivating psychologically empowered environments to stimulate innovation within bureaucratic health institutions. The results provide evidence-based guidance for public sector leaders aiming to foster innovation through strategic investment in human capital. Implications for theory, policy, and future research are discussed, particularly in the context of decentralization and healthcare reform in developing countries.