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Health and Social Care Policy—2nd Edition

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Organizations, Systems, and Providers".

Deadline for manuscript submissions: closed (10 April 2026) | Viewed by 15283

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Editors

Dr. Sofia Koukouli

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Guest Editor

Department of Social Work, Hellenic Mediterranean University, 714 10 Heraklion, Greece
Interests: health and social care policy, social policy for vulnerable groups, family policy; mapping healthy strategies; quality of care
Special Issues, Collections and Topics in MDPI journals

Dr. Areti Stavropoulou

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Guest Editor

Department of Nursing, University of West Attica, 122 43 Athens, Greece
Interests: health and social care; health, safety and wellbeing; quality of care; qualitative research; nursing education

Special Issue Information

Dear Colleagues,

In our contemporary era, a time of rapid technological advancements, developing effective health and social care policies is becoming progressively essential. The necessity of upholding the issues of equity, equality and accessibility in health and social care is becoming a challenge within the context of highly demanding healthcare environments and societal transformations.

Individuals in need as well as specific population and patient groups are confronting adverse repercussions and unpredictable situations within the domains of healthcare and social services. Societal cohesion, well-being, empowerment, and self-care are some of the main concerns of health and social care scientists who are dedicated to enhancing and improving accessibility, continuity, effectiveness, and safety in health and social care services.

This Special Issue is continuing the exemplary work published so far in the field of health and social care policy. It attempts to further promote the exchange and advancement of knowledge and expertise on specific subjects within the domains of healthcare and social policy. Issues of needs assessments for vulnerable health and social populations, the development and implementation of quality improvement strategies for health and social care services, and engaging in the most recent technological initiatives are some of the issues to be addressed in this Special Issue.

Dr. Sofia Koukouli
Dr. Areti Stavropoulou
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

quality improvement strategies in health and social care
health and social care needs assessments
health, safety, and wellbeing
quality of care
transformational leadership in healthcare services
vulnerable social groups
health literacy and health education
mental health
empowerment strategies
IT in health and social care
self-management
evidence-based practice and policies
policy making in health and social care services
evaluation of services
deep learning and evaluation strategies
advanced learning and teaching in health and social care sciences
transformational education
technological advancements and healthcare innovation
technological initiatives and digital health tools
technological challenges in health and social care

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Related Special Issue

Health and Social Care Policy in Healthcare (21 articles)

Published Papers (7 papers)

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Research

17 pages, 1742 KB

Open AccessArticle

Comorbidity Burden and Acute-Care Utilization in Adult Trauma Patients Across the Injury Severity Spectrum in a Nationwide Community-Based Survey (Korea, 2019–2023)

by Su-il Kim, Sung Mo Moon, Gwang-Seok Kim, Sung-Soo Choi, Min-Seok Choi, Jae-Seong Park, In-Hye Kang, Duk-Hee Lee and Yun-Deok Jang

Healthcare 2026, 14(10), 1380; https://doi.org/10.3390/healthcare14101380 - 18 May 2026

Viewed by 236

Abstract

Background: This study aimed to evaluate the association between comorbidity and hospital admission, hospital length of stay (LOS), and in-hospital mortality among adult trauma patients across the injury severity spectrum in South Korea, and to assess whether these associations vary according to injury severity. Methods: We conducted a retrospective cohort study using the national Community-Based Severe Trauma Survey (2019–2023). Adult patients (≥18 years) with trauma were included after excluding records with missing key exposure or outcome variables. Comorbidity was defined using the ICD-10–based Elixhauser comorbidity framework. In addition to a binary classification (any vs. none), comorbidity burden was categorized into 0, 1, 2, and ≥3 conditions to evaluate dose–response relationships. The primary outcomes were hospital admission, LOS, and in-hospital mortality. Multivariable logistic regression models were used for admission and mortality, and regression models were applied for LOS, adjusting for demographic characteristics, injury mechanism, physiologic status, and system-level factors. Effect modification by injury severity was assessed using interaction terms and ISS-stratified analyses. Results: Among 49,259 patients, 32,999 (67.0%) had at least one comorbidity. Patients with comorbidities were older, had higher injury severity, and showed higher admission rates, longer LOS, and higher in-hospital mortality compared with those without comorbidities. After adjustment, comorbidity remained independently associated with increased odds of admission, prolonged LOS, and in-hospital mortality. A dose–response relationship was observed, with increasing comorbidity burden associated with progressively worse outcomes (p for trend < 0.001). In addition, substantial heterogeneity was identified across individual comorbidities, with conditions such as metastatic cancer, liver disease, coagulopathy, renal disease, and fluid and electrolyte disorders showing stronger associations with adverse outcomes. The magnitude of these associations varied across ISS strata, indicating injury severity-dependent effects. Conclusions: In this nationwide cohort, comorbidity burden and type were important determinants of acute-care utilization and in-hospital mortality among trauma patients. Incorporating comorbidity information into early risk stratification may improve prognostic accuracy and support more efficient resource allocation and clinical decision-making across the trauma care continuum. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

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14 pages, 237 KB

Open AccessArticle

Psychometric Properties of the Greek Version of the Inpatient Dignity Scale

by Maria Gkarliaridou, Vasiliki Matziou, Sofia Zyga, Evangelos Fradelos, Maria Polikandrioti and Victoria Alikari

Healthcare 2026, 14(7), 855; https://doi.org/10.3390/healthcare14070855 - 27 Mar 2026

Viewed by 473

Abstract

Background/Objectives: Patient dignity is one of the central values in nursing, equivalent to justice, freedom, and individuality. The purpose of this study was to investigate the psychometric properties of the Greek version of the Inpatient Dignity Scale (IPDS). Methods: In this descriptive, cross-sectional study, 280 patients from three Hemodialysis Units (HD) completed the IPDS, a self-completed questionnaire assessing patients’ expectations regarding dignity and patients’ satisfaction with dignity. Items are categorized into four dimensions, both for expectations and satisfaction: Respect as a Human Being, Respect for Personal Feeling and Time, Respect for Privacy, and Respect for Autonomy. For the translation into Greek, a double forward-backward translation process was followed, and subsequently, cultural adaptation was carried out. Construct validity was tested using the Confirmatory Factor Analysis (CFA) conducted in AMOS 26.0. Convergent validity was assessed through correlations with the Caring Behaviors Inventory-16 (CBI-16) and correlations between the dimensions of the IPDS. Repeatability was assessed using the Intraclass Correlation Coefficient (ICC), and internal consistency using Cronbach’s alpha. The SPSS 26.0 statistical program was used for the descriptive and correlational analyses (p < 0.05). Results: The mean age of participants was 64.8 years old. CFA revealed an acceptable fit for the questionnaire (CFI 0.92–0.93, TLI 0.91–0.94, and RMSEA < 0.08 for both expectations and satisfaction). The IPDS was significantly and positively correlated with the CΒΙ-16, indicating good convergent validity. Cronbach’s alpha was >0.70 in all dimensions of the IPDS, indicating good internal consistency. Conclusions: The Greek version of IPDS is a valid and reliable tool to measure patients’ perceived dignity. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

18 pages, 1127 KB

Open AccessArticle

Determinants of Emergency Department Length of Stay and the Mediation Effect of Disposition Among Injury Patients in South Korea: A Nationwide Retrospective Study

by Min-Seok Choi, Su-il Kim and Yun-Deok Jang

Healthcare 2026, 14(4), 469; https://doi.org/10.3390/healthcare14040469 - 12 Feb 2026

Viewed by 557

Abstract

Background/Objectives: Emergency department length of stay (ED LOS) is a key indicator reflecting emergency department crowding, patient safety, and healthcare resource efficiency. Among injured patients, ED LOS may be prolonged depending on injury severity and disposition pathways (admission and inter-hospital transfer). This nationwide study using the Korean National Emergency Department Information System (NEDIS) aimed to (1) describe the distribution and determinants of ED LOS among injured patients and (2) quantify the mediating effects of disposition (admission and transfer) on the association between injury severity measured by the International Classification of Diseases-based Injury Severity Score (ICISS) and ED LOS. Methods: We analyzed NEDIS injury-related ED visit records collected from the date of IRB approval through 12 January 2026. We conducted a retrospective observational study using NEDIS data. Of 1,048,575 injury-related ED visits, 1,035,484 visits with valid ED LOS and eligible records were included after excluding missing key variables and implausible time values. ED LOS was calculated in minutes using arrival and departure timestamps. Injury severity was assessed using ICISS (primary: based on 15 diagnoses; sensitivity: based on 20 diagnoses). Determinants of ED LOS were evaluated using gamma regression with a log link. Disposition was categorized as discharge, admission, and inter-hospital transfer; admission and transfer were modeled as binary mediators. Causal mediation analyses estimated the average causal mediation effect (ACME), average direct effect (ADE), total effect, and proportion mediated. Multiple sensitivity analyses (outlier handling, missing-data approaches, alternative log-linear modeling, and EMS arrival subgroup analyses) assessed robustness. Results: The median ED LOS was 150 min (IQR 90–260). ED LOS differed substantially by disposition: 120 min for discharged patients, 420 min for admitted patients, and 360 min for transferred patients. Overall, 17.9% of visits had an ED LOS ≥ 6 h, and prolonged stays were concentrated among admitted (≥6 h: 55.0%) and transferred (≥6 h: 45.0%) patients. In gamma regression, a 0.05 decrease in ICISS (greater severity) was associated with longer ED LOSs in the unadjusted model (Ratio 1.34) and remained significant in the fully adjusted model (Ratio 1.12, 95% CI 1.11–1.13). Admission and transfer were strong determinants of ED LOS in the final model (ratios of 2.35 and 2.05, respectively). In mediation analyses, admission mediated 36.8% of the severity–ED LOS association (ACME 0.085; ADE 0.146), and transfer mediated 14.3% (ACME 0.033; ADE 0.198). Findings were consistent across sensitivity analyses. Conclusions: In this nationwide cohort of injured patients, ED LOS showed a right-skewed distribution, with prolonged stays concentrated in admission and transfer pathways. Injury severity (ICISS) was independently associated with longer ED LOS, and a substantial proportion of this association was mediated through admission and transfer. Reducing ED LOS among severely injured patients likely requires not only streamlining diagnostic and treatment processes but also system-level interventions targeting output-stage bottlenecks, including inpatient bed operations/boarding management and transfer coordination. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

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32 pages, 741 KB

Open AccessArticle

Reforming China’s Rare Disease Security System: Risk Management Perspectives and a Dedicated Insurance Innovation

by Yumeng Zhang, Minghao Yang, Qiang Su, Yuanhao Sui and Lihua Sun

Healthcare 2025, 13(17), 2178; https://doi.org/10.3390/healthcare13172178 - 31 Aug 2025

Cited by 4 | Viewed by 3798

Abstract

Objectives: Patients with rare diseases in China face extremely high medical expenses. The current coverage framework remains inadequate in terms of coverage depth and proactive risk control, underscoring an urgent need for institutional reform. Methods: This study employs a policy content analysis approach to review the current landscape of rare disease protection in China. Drawing on risk management theory and the health capital model, it constructs an analytical framework to examine potential institutional reforms through the lens of risk response pathways and the efficiency of health investment. Results: The findings reveal that basic medical insurance (BMI) provides limited financial protection for patients with rare diseases. Among China’s 31 provincial-level administrative centers, 24 have set general outpatient reimbursement ceilings under the urban and rural resident basic medical insurance (URRBMI) at 1000 RMB or less. In comparison, 24 cities have set outpatient reimbursement limits under the urban employee basic medical insurance (UEBMI) at 6000 RMB or less. The security system relies predominantly on the BMI, while supplementary mechanisms have failed to provide effective support or continuity in coverage. Current policies are generally reactive, with coverage typically triggered only after a confirmed diagnosis and often lacking early intervention or preventive strategies. Conclusions: China’s rare disease security system urgently requires structural improvements in coverage depth and proactive risk management. The proposed Dedicated Insurance Scheme for Rare Diseases (DISRD) presents a feasible and sustainable model for China’s multi-tiered system of securing rare diseases. It provides valuable institutional insights for other countries and regions seeking to build public health systems with proactive risk control capabilities. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

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19 pages, 357 KB

Open AccessArticle

Resilience and Mobbing Among Nurses in Emergency Departments: A Cross-Sectional Study

by Aristotelis Koinis, Ioanna V. Papathanasiou, Ioannis Moisoglou, Ioannis Kouroutzis, Vasileios Tzenetidis, Dimitra Anagnostopoulou, Pavlos Sarafis and Maria Malliarou

Healthcare 2025, 13(15), 1908; https://doi.org/10.3390/healthcare13151908 - 5 Aug 2025

Cited by 2 | Viewed by 1840

Abstract

Background: Moral harassment (mobbing) in healthcare, particularly among nurses, remains a persistent issue with detrimental effects on mental health, resilience, and quality of life. Aim: We examine the relationship between the resilience of nurses working in Emergency Departments (EDs) and how these factors influence experiences of workplace mobbing. Methods: This cross-sectional study included 90 nurses from four public hospitals in Greece’s 5th Health District. Data were collected between October 2023 and March 2024 using the WHOQOL-BREF, Workplace Psychologically Violent Behaviors (WPVB) scale and the Connor–Davidson Resilience Scale (CD-RISC). The sample consisted primarily of full-time nurses (84.3% female; mean age = 43.1 years), with 21.1% reporting chronic conditions. Most participants were married (80.0%) and had children (74.4%), typically two (56.1%). Statistical analyses—conducted using SPSS version 27.0—included descriptive statistics, Pearson and Spearman correlations, multiple linear regression, and mediation analysis, with significance set at p < 0.05. Results: Resilience was moderate (mean = 66.38%; Cronbach’s α = 0.93) and positively correlated with all WHOQOL-BREF domains—physical, psychological, social, and environmental (r = 0.30–0.40)—but not with the overall WHOQOL-BREF. The mean overall WHOQOL-BREF score was 68.4%, with the lowest scores observed in the environmental domain (mean = 53.76%). Workplace mobbing levels were low to moderate (mean WPVB score = 17.87), with subscale reliabilities ranging from α = 0.78 to 0.95. Mobbing was negatively associated with social relationships and the environmental WHOQOL-BREF (ρ = –0.23 to –0.33). Regression analysis showed that cohabitation and higher resilience significantly predicted better WHOQOL-BREF outcomes, whereas mobbing was not a significant predictor. Mediation analysis (bootstrap N = 5000) indicated no significant indirect effect of resilience in the relationship between mobbing and WHOQOL-BREF. Conclusions: Resilience was identified as a key protective factor for nurses’ quality of life in emergency care settings. Although workplace mobbing was present at low-to-moderate levels, it was negatively associated with specific WHOQOL-BREF domains. Enhancing mental resilience among nurses may serve as a valuable strategy to mitigate the psychological effects of moral harassment in healthcare environments. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

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15 pages, 219 KB

Open AccessArticle

Factors Affecting Quality of Life of Caregivers of Patients with Heart Failure

by Maria Polikandrioti and Athanasia Tsami

Healthcare 2025, 13(12), 1363; https://doi.org/10.3390/healthcare13121363 - 6 Jun 2025

Cited by 3 | Viewed by 2392

Abstract

Introduction: The clinical syndrome of heart failure (HF) is progressive and disabling for patients who rely on their caregivers for help and support. The caregiving role is inducing major changes in the personal, social, and family life of caregivers and entails a heavy emotional and physical burden, which in turn negatively affects their quality of life (QoL). Purpose: The purpose of this study was to explore the QoL of caregivers of patients with HF as well as the associated caregivers’ and patients’ characteristics. Material and Methods: The sample of the study included 340 caregivers along with their hospitalized patients. Data collection was performed by the method of the interview using the questionnaire “SF-36 Health Survey (SF-36)” to assess caregivers’ QoL. Results: Τhe physical QoL component of caregivers was found to be statistically significantly associated with the type of relationship with their patient (p = 0.001), age (p = 0.001), level of education (p = 0.001), occupation (p = 0.001), information about HF patients (p = 0.001), worry about finances (p = 0.001), and insecurity about the future (p = 0.001). The mental QoL component of caregivers was found to be statistically significantly associated with the type of relationship with their patient (p = 0.001), gender (p = 0.009), age (p = 0.001), level of education (p = 0.001), occupation (p = 0.001), frequency of visits to hospitalized patient (p = 0.001), information about HF (p = 0.029), anxiety about patients’ self-care (p = 0.001), worry about finances (p = 0.001), and insecurity about the future (p = 0.001). In terms of HF patient’s characteristics, the physical QoL component of caregivers was found to be statistically significantly associated with the patients’ age (p = 0.001), patients’ education level (p = 0.001), patients’ occupation (p = 0.006), patients’ family history of cardiac disease (p = 0.006), and patients’ self-reported symptom management before hospital admission (p = 0.022). The mental QoL component of caregivers was found to be statistically significantly associated with the patients’ education level (p = 0.020), the patients’ NYHA stage (p = 0.001), prior hospitalization (p = 0.001), the patients’ family history of cardiac disease (p = 0.012), and the patients’ self-reported symptom management before admission (p = 0.001). Conclusions: In-depth understanding factors affecting QoL in caregivers with HF may enhance plans and actions to attain healthcare goals among societies globally. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

16 pages, 238 KB

Open AccessArticle

Promoting Women’s Mental Health and Resilience in Times of Health Crisis and Adversity via Personal Development Groups

by Maria Moudatsou, Areti Stavropoulou, Michael Rovithis, Dimitrios Mimarakis and Sofia Koukouli

Healthcare 2025, 13(9), 1035; https://doi.org/10.3390/healthcare13091035 - 30 Apr 2025

Cited by 1 | Viewed by 4272

Abstract

Background: Women carry out an array of demanding tasks due to their multiple roles as mothers, workers, spouses, and caregivers. Their responsibilities to the family and society are essential throughout life, but they become even more important at times of crisis and unanticipated events. All these obligations may have a detrimental effect on their mental health and general well-being. According to the social model of health, through personal development groups, women improve their health because they can transform their personalities, enhance their social and personal abilities, and strengthen their resilience to unforeseen occurrences, health crises, and adversity. Aim of the study: This follow-up study examined the viewpoints of women regarding the durability and efficacy of group therapy’s positive impact on their resilience and mental health, especially through unforeseen circumstances and crises. This group of women had taken part in group therapy six years ago to strengthen their resilience and improve their mental health. Methods: Data collection was implemented through semi-structured in-person interviews conducted from December 2020 to March 2021. Five topics emerged from the framework analysis: (a) personal development and mental health; (b) reinforcement of their resilience; (c) group therapy and women’s health during the COVID-19 pandemic; (d) an assessment of group therapy on women’s health through imagery; (e) future recommendations. Results: Most of the women stated that group treatment had a beneficial impact in terms of improving their individual abilities. The group experience was described as a bridge that allowed them to recognize and accept their emotions. Since COVID-19, women have developed helpful coping strategies to deal with daily tension, loneliness, and work-related stress. Conclusions: Our research results indicate that group therapy is a useful tool for women’s empowerment and mental health in times of crises and adversity. Social policy should take it into account in order to meet women’s highly demanding roles and personal needs. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

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