This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians' retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness.

Crowding in Accident and Emergency Departments (AEDs) and long waiting times are critical issues contributing to adverse patient outcomes and system inefficiencies. These challenges are exacerbated by varying levels of AED attendance across different local areas, which may reflect underlying disparities in primary care provision and population characteristics.

During the COVID-19 pandemic, hospital emergency departments worldwide experienced a pronounced fall in utilisation of emergency care, with a decrease of up to 40% in many countries. Evidence suggests the cause of these changes include both population fear of COVID-19 and the effects of lockdowns and the interaction of these two effects. We analyse a sub-sample of national data on Accident and Emergency (A&E) attendances in England over an extended period from April 2019 to March 2022 for different patient groups, including by age, mental/physical health status, acuity, and common clinical groupings. Our results showed that all patient groups experienced substantial declines in attendances during the first two waves of the pandemic, including high acuity and cardiovascular patients. Mental health patients were the only exception, with a smaller decline in attendances. Our findings suggest that policymakers should recognise the potential harmful effects of lockdowns, public messaging, and changes in health care provision on all patients during health emergencies.

In response to the COVID-19 pandemic, many countries applied centralization strategies to the distribution of power between national government and regional/local governments over responsibility for regulatory tasks. As a result, health-policy decision-making competences were shifted from the regional level to the national level (vertical shift of decision-making competences). This centralization trend for the purpose of infection control is evident in Germany. We conducted a quantitative and qualitative analysis of health-policy regulatory measures (March 2018 to March 2020) in order to investigate whether the vertical shift in decision-making competences was already a trend in Germany before the COVID-19 pandemic and beyond infection control. Our results show that the centralization strategy observed during COVID-19 does not continue a trend. Before the COVID-19 pandemic, what was most important was the distribution of power at national level between government and non-government institutions (horizontal allocation of decision-making competences). This long-term trend strengthens the decision-making competences of government institutions and weakens non-government institutions.

Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals' strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.

According to the World Health Organization, 17 million people die every year of cardiovascular diseases (CVD), particularly heart attacks and strokes. More than half of all deaths across the Europe are caused by CVDs. 80 % of premature deaths from these causes could be avoided by controlling the main risk factors: tobacco, unhealthy diet and physical inactivity. Local authorities provide sport and recreation facilities to their communities. They also have a central role in forging partnerships with public and private sector to enhance the local sport delivery system. The present paper consists of an empirical exercise about the statistical relationship between the financial effort of Portuguese municipalities in the implementation of sports policies and the prevalence of CVDs. The estimation of a Spatial Autocorrelation Model confirms the strong spatial dependence between neighbouring municipalities and validates the existence of a positive impact of local sports policies on mortality rate from cardiovascular diseases. The results raise the need to reinforce local policies to promote active living based on holistic approaches to combating heart disease and promoting healthy lifestyles in partnerships with health professionals, educators, and community leaders.

Since April 2014 the age limitation on candidates listed for organ transplantation in Israel was abolished following the recommendations of a Public Committee. In this research the new policy was examined in light of scarce medical resources and the increased rate of aging in Israel.

The NHS is increasingly turning to the independent sector, primarily to alleviate elective care backlogs. However, implications for the healthcare system, patients and staff are not well understood. This paper provides a rapid narrative review of research evidence on NHS-funded elective care in the independent sector (IS) and the impact on patients, professionals, and the health care system. The aim was to identify the volume and evaluate the quality of the literature whilst providing a narrative synthesis. Studies were identified through Medline, CINAHL, Econlit, PubMed, Web of Science and Scopus. The quality of the included studies was assessed in relation to study design, sample size, relevance, methodology and methodological strength, outcomes and outcome reporting, and risk of bias. Our review included 40 studies of mixed quality. Many studies used quantitative data to analyse outcome trends across and between sectors. Independent sector providers (ISPs) can provide high-volume and low-complexity elective care of equivalent quality to the NHS, whilst reducing waiting times in certain contexts. However it is clear that the provision of NHS-funded elective care in the IS has a range of implications for public provision. These surround access and outcome inequalities, financial sustainability and NHS workforce impacts. It will subsequently be important for future empirical work to incorporate these caveats, providing a more nuanced interpretation of quantitative improvements.

Respiratory Syncytial Virus (RSV) is an ubiquitous respiratory virus, which spreads like seasonal influenza throughout winter time in temperate climate countries. RSV infections are usually mild in healthy children and adults, but may be severe in premature infants, young children with congenital heart disease or chronic lung disease, immunocompromised individuals and frail elderly people. At present, the pharmaceutical options to prevent RSV negative effects can be divided into monoclonal antibodies (mABs) and vaccines (active immunization). The two mABs licensed so far are indicated only for infants, while the first vaccines approved are mainly recommended for older adults. The pharmaceutical competitive arena of products to prevent RSV negative effects has recently become very crowded after more than two decades with only one mAB as the unique option. Here, we try to put order in the dramatically increasing mix of very different products which have been recently launched. The aim of our effort is to provide some suggestions for European policy makers in order to limit the potentially relevant financial impact of these new expensive options on public pharmaceutical expenditures. We hope the suggested strategies might help to avoid transforming RSV from an apparently underscored health issue into a clearly overestimated health risk for the whole population in European countries. This dramatic change could be driven by a bunch of powerful multinational companies.

Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.

Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.

This article provides a snapshot of primary prevention activities in hospitals in 20 European high-income countries, based on inputs from experts of the Observatory's Health Systems and Policies Monitor (HSPM) network using a structured questionnaire. We found that in the vast majority of countries (15), there are no systematic national policies on primary prevention in hospitals. Five countries (Cyprus, Finland, Ireland, Romania and the United Kingdom) reported systematic primary prevention activities in hospitals, although in one of them (Cyprus) this was due to the fact that small hospitals in rural areas or less populated districts host providers of primary care. In two of the five countries with systematic national policies on primary prevention, there are no incentives (financial or otherwise) to provide these interventions. The remaining three countries (Finland, Romania and the United Kingdom) report the existence of incentives, but only two of them (Romania and the United Kingdom) provide financial incentives in the form of additional funding. Only two of the 20 countries (Ireland and the United Kingdom) make explicit use of the Making Every Contact Count (MECC) approach. Overall, it can be concluded that there is little focus on primary prevention in hospitals in Europe, which may be seen as a missed opportunity.

Under recent reforms to the National Health Service (NHS) in England, NHS organizations have been given new objectives to contribute to social and economic development. Health systems in other high-income countries are pursuing related approaches. This paper analyses national policy documents to understand the framing of the NHS's new policy priorities on social and economic development. We focus on the role of NHS integrated care systems-area-based planning bodies responsible for managing NHS resources and coordinating local services. National policy is vague about what social and economic development means in practice. There is limited guidance on which approaches local organizations should prioritize, and which organisations are responsible for implementation. Greater clarity from national policymakers and an overarching framework to guide local action is needed to reduce the risk of inaction, poorly targeted interventions, and missed opportunities for learning and evaluation. Policymakers and health system leaders also need to be realistic about the limits of local action given the importance of national public policy choices in shaping the social determinants of health. Coordinated policy action and investment across government is needed to address underlying social and economic conditions.

The turnover intention rate among nurses is very high both worldwide, and in Europe. It is related to personal and professional factors that contribute to the decision to leave or stay. This descriptive cross-sectional study aimed to identify the personal and professional predictors that contribute to nurses' turnover intention in Croatia. A convenient sample of 448 nurses employed in public general hospitals was used. The Practice Environment Scale of the Nursing Work Index questionnaire and the Turnover Intention Scale were applied. A logistic regression model was used to determine the associations between nurses' turnover intention and their personal and professional factors. The results indicate that both types of factors can influence nurses' turnover intention. The associations between turnover intention and personal factors such as age (p = 0.033), gender (p = 0.023), job satisfaction (p < 0.001), and social satisfaction (p = 0.006), were recorded. Nurse participation in hospital affairs (p = 0.026), and the nurse manager ability, leadership, and support of nurses (p = 0.002), which are professional factors were also associated with turnover intention. In order to prevent turnover intention, continuous measures need to be planned and implemented to increase nurses' satisfaction and improve their working environment.

National policies are a key starting point to achieve changes in population health. This study aimed to provide an overview of the relationship between physical activity policy implementation and the levels of sufficient physical activity across the European Union over the last decade. Data from the 23 indicators of the European Union Health-Enhancing Physical Activity Monitoring Framework established to monitor country implementation of the European Union Physical Activity Guidelines from 2015, 2018 and 2021, and physical activity prevalence data from the Special Eurobarometer on Sport and Physical Activity in 2013, 2017 and 2022 were analysed. European Union Member States significantly increased their physical activity policy implementation from 2015 to 2021 by 13.2 % (63.30 ± 18.89 versus 76.51 ± 14.94 %, p < 0.001, 95 % CI [-19.97, -6.45]). However, no significant change in levels of sufficient physical activity was found between 2013 and 2022 (60.59 ± 15.67 versus 61.70 ± 17.67 %, p = 0.360, 95 % CI [-3.61, 1.39]). Additionally, most European Union countries are not on track to meet the targeted 10 % relative reduction in levels of insufficient physical activity by 2025. Physical activity policies in the European Union do not appear to be related with the intended goal of increasing levels of physical activity. Policies may need to be reviewed and policy monitoring expanded, strengthened, and better integrated.

The most effective method of preventing influenza infection and complications is through vaccination. However, annual vaccination rates remain low. This study examines the impact of influenza vaccination on healthcare utilisation among the elderly population in Catalonia, Spain. Indeed, we examine the impact of vaccination on various outcomes related to direct and indirect health costs. Utilising longitudinal data on healthcare resource utilisation for individuals born before 1965 in Catalonia, we used instrumental variables for vaccination shots based on previous flu campaign incidence individually and outbreaks in the area of residence. The results showed a significant (beneficial) impact of vaccination on using influenza-related healthcare (count of visits and health direct costs) and sick leave duration. However, no effects were observed on influenza-related mortality.

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators - amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.

At least in Western Europe, competitive social health insurance systems have implemented systems of morbidity-based risk adjustment to establish a level playing field for insurers. However, insured persons with specific socio-economic characteristics are still underfunded, leaving incentives for risk selection. In Germany, there is an ongoing debate about (re)implementing socio-economic variables to reduce this undercompensation. This study analyses whether the following four socio-economic groups are systematically under- or over-compensated under the present risk equalization system in Germany: insured persons with co-payment exemption (1), recipients of basic income support for unemployment (2), of benefits of social long-term care-insurance (3) and insured persons with reduced earning capacity (4). On this basis, several attempts of incorporating these variables into the German risk adjustment system, allowing a better fit for the socio-economically disadvantaged groups, are examined. With a data set of about 9.2 million insured persons, the performance of the modifications is demonstrated for the German system. The disparate outcomes of the various models in different dimensions necessitate the consideration of trade-offs and their incorporation into the implementation of a model designed to mitigate the undercompensation of the affected insured groups.

This research deals with Social Innovation (SI) and integrated and connected care in the hospital care, presenting a successful experience of telemedicine's implementation within the Italian context. Nowadays integrated care and connected care are relevant concepts for delivering people-centered healthcare; though their operationalization is challenging and requires accounting for systems' complexity. In this regard, SI may be a catalyst, since it consists in a kind of innovation motivated by social needs. Extant research on SI in healthcare is scant and fragmentary, overlooking operational features and enabling conditions. Considering these gaps, the paper investigates the potential contribution of SI management to integrated and connected care. For the purpose, it offers a revelatory case study, concerning the pediatric research hospital Gaslini (Genoa, Italy), which is, to our knowledge, the first Italian public hospital to have hired a SI manager. By referring to a telemedicine pilot project, the study analyzes main features of the SI management process and its approach to promote integrated and connected care. Research data are analyzed by combining Gioia methodology and systems thinking. The resulting grounded theory model is causal loops-shaped and highlights virtuous mechanisms of SI unveiling generative voids and existing skills.

The COVID-19 pandemic jeopardized individuals' health and economic stability, and the associated shocks might have decreased individuals' trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals' institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus.