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27 pages, 3591 KB

Open AccessArticle

Leakage-Controlled and Survey-Weighted Machine Learning for Neonatal Mortality Risk Prediction Using NFHS-5 Data

by Moumita Mukherjee, Talha Ali Khan and Raja Hashim Ali

Healthcare 2026, 14(14), 2144; https://doi.org/10.3390/healthcare14142144 - 16 Jul 2026

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Abstract

Background: Neonatal mortality remains uneven across Indian states, while prediction studies using survey data are often limited by class imbalance, data leakage, inadequate calibration, and insufficient consideration of complex survey design. This study developed and rigorously evaluated survey-aware machine-learning models for neonatal mortality [...] Read more.

Background: Neonatal mortality remains uneven across Indian states, while prediction studies using survey data are often limited by class imbalance, data leakage, inadequate calibration, and insufficient consideration of complex survey design. This study developed and rigorously evaluated survey-aware machine-learning models for neonatal mortality risk prediction using NFHS-5 data. Methods: Data from 33,338 children in Bihar, Chhattisgarh, and Uttarakhand were analysed. Household-grouped development/test splitting, repeated grouped nested cross-validation, DHS sampling weights, fold-contained preprocessing, socioeconomic clustering, particle swarm optimisation, resampling, and out-of-fold feature augmentation were applied. Logistic regression, random forest, histogram gradient boosting (HGB), and artificial neural networks were compared using PR-AUC as the primary metric. Calibration, household-bootstrap confidence intervals, decision-curve analysis, prediction timepoint analysis, and leave-one-state-out validation were performed. Results: HGB achieved the highest repeated cross-validation PR-AUC (0.189) and ROC-AUC (0.778). On the untouched test set, ROC-AUC was 0.755 (95% CI 0.718–0.796), and PR-AUC was 0.202 (0.138–0.267), with sensitivity 0.813, specificity 0.517, PPV 0.063, and NPV 0.989. Clustering, PSO, SMOTE, and augmentation added little value. Antenatal performance was weaker, and state-wise transportability varied. Conclusions: Survey-weighted HGB provided the strongest predictive performance, but low PPV and heterogeneous state-level results restrict its use to low-cost screening. Prospective validation is required before deployment. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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12 pages, 9098 KB

Open AccessArticle

Economic Burden of RSV-Associated Hospitalizations in Switzerland: A Nationwide Analysis (2017–2023)

by Maria Boesing, Daphne McCarthy-Pontier, Joerg Daniel Leuppi and Nike Julia Kräutler

Healthcare 2026, 14(12), 1722; https://doi.org/10.3390/healthcare14121722 - 15 Jun 2026

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Abstract

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of respiratory illness across the lifespan, yet its health-economic burden in adults remains under-recognized. Building on a previously published nationwide analysis of RSV-associated hospitalizations in Switzerland (2017–2023), this study aimed to estimate age-specific direct [...] Read more.

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of respiratory illness across the lifespan, yet its health-economic burden in adults remains under-recognized. Building on a previously published nationwide analysis of RSV-associated hospitalizations in Switzerland (2017–2023), this study aimed to estimate age-specific direct inpatient hospitalization costs and assess their implications for healthcare systems. Methods: We conducted a nationwide health-economic analysis using Swiss Federal Statistical Office (FSO) hospitalization data (2017–2023) combined with SwissDRG-based cost statistics (2024). Age-specific costs per hospitalization were applied to RSV-associated hospitalization counts. To account for disease severity, additional estimates were derived by applying RSV-specific length-of-stay (LOS) ratios between RSV-associated and all-cause hospitalizations, reflecting the longer duration of RSV-associated admissions. Results: Total RSV-associated hospitalization costs were estimated at CHF 55.1–76.0 million annually. Children aged 0–9 years accounted for the highest number of hospitalizations and the largest share of total costs (CHF 27.8–34.3 million). Despite fewer hospitalizations, adults aged ≥60 years generated comparable total costs (CHF 23.6–36.7 million), driven by substantially higher costs per case. Costs increased markedly with age, reflecting longer hospital stays and higher clinical severity. Additional analyses demonstrated a substantial increase in costs in the post-pandemic period, particularly in older adults, suggesting improved detection of RSV-associated hospitalizations. Conclusions: RSV-associated hospitalizations impose a substantial economic burden on the Swiss healthcare system. The disproportionate contribution of older adults highlights the importance of targeted prevention strategies and provides a foundation for future health-economic evaluations and policy decision-making. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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40 pages, 916 KB

Open AccessArticle

Financing Regimes and Case-Mix Complexity in Psychiatric Hospitals Beyond the Pandemic Shock—Insights from a Regional European Healthcare System

by Andrian Țîbîrnă, Floris Petru Iliuta, Mihnea Costin Manea and Mirela Manea

Healthcare 2026, 14(9), 1181; https://doi.org/10.3390/healthcare14091181 - 28 Apr 2026

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Abstract

Background/Objectives: The COVID-19 pandemic intensified concerns regarding the resilience and financing architecture of mental health services, yet it remains unclear whether crisis-induced adjustments fundamentally altered hospital case-mix complexity or merely exposed pre-existing structural configurations. This study examines the relationship between financing regimes [...] Read more.

Background/Objectives: The COVID-19 pandemic intensified concerns regarding the resilience and financing architecture of mental health services, yet it remains unclear whether crisis-induced adjustments fundamentally altered hospital case-mix complexity or merely exposed pre-existing structural configurations. This study examines the relationship between financing regimes and case-mix complexity in psychiatric hospitals in Romania, a Central and Eastern European health system characterized by mixed financing arrangements and pronounced interregional heterogeneity. Methods: Using administrative data comprising 752 hospital section–year observations (2019–2024), we identify structural financing–organization regimes through a two-step clustering procedure (hierarchical Ward method followed by K-means refinement) based on revenue composition, expenditure allocation, workforce structure, and operational pressure indicators. Results: Three distinct regimes emerge, reflecting persistent institutional configurations rather than temporary crisis-induced groupings. Chi-square tests confirm that regime membership is statistically independent of pandemic timing. A multivariate regression model controlling for financing composition and expenditure structure shows that structural variables (particularly the share of contract-based revenues and the allocation of expenditures) exert systematic and economically meaningful effects on the case-mix index (CMI). Pandemic and post-pandemic indicators do not retain robust explanatory power once structural determinants are accounted for. Regional robustness analyses further demonstrate that financing architecture consistently outweighs temporal shock effects in explaining territorial variation in clinical complexity. Conclusions: The findings suggest that psychiatric hospital case-mix dynamics are structurally embedded within differentiated financing regimes whose influence persists beyond crisis periods. By integrating regime identification with outcome modeling in a Central and Eastern European context, this study contributes to the international literature on health system resilience and highlights the primacy of institutional financing architecture over episodic shock effects in shaping hospital complexity. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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32 pages, 13966 KB

Open AccessArticle

Systemic Health System Measurement Framework: An Approach Based on the Unified Care Model for Whole Systems Transformation

by Ther Lim, Yun Hu, Ada Wah Yean Lee, Jit Kai Tan, Qi Yin Ngoi, Naiying Liu, Audrey Cai Ling Tay, Justin Guang Jie Lee and Yeuk Fan Ng

Healthcare 2026, 14(9), 1141; https://doi.org/10.3390/healthcare14091141 - 24 Apr 2026

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Abstract

Background/Objectives: Health systems globally are transforming toward population-based, person-centred care, yet measurement systems frequently remain anchored in provider-centric or disease-specific frameworks. This paper presents the Systemic Health System Measurement Framework (SHSMF), a population health systems measurement architecture that completes a conceptual systemic health [...] Read more.

Background/Objectives: Health systems globally are transforming toward population-based, person-centred care, yet measurement systems frequently remain anchored in provider-centric or disease-specific frameworks. This paper presents the Systemic Health System Measurement Framework (SHSMF), a population health systems measurement architecture that completes a conceptual systemic health systems design and transformation trilogy with the Unified Care Model (UCM) and Systemic Health System Population Segmentation Model, addressing how health systems can measure whether systems integration is succeeding. Methods: This study employs a conceptual framework development and implementation case study design approach, with the Systemic Health System Measurement Framework (SHSMF) developed using the Health System Transformation Playbook (HSTP) methodology. The framework organises measurement around needs-based population segments, integrates Lifelong Care and Episodic Care measurement within a unified architecture, and cascades indicators across macrosystem, mesosystem and microsystem levels. Implementation was demonstrated through the development of performance and governance dashboards development at Yishun Health, a regional population health system serving approximately 320,000 residents in Singapore (2022–2024). Results: Descriptive analytics from the Lifelong Care Dashboard (207,980 residents across seven segments) and the Episodic Care Dashboard (230,365 inpatient cases across six segments) revealed systemic patterns not readily apparent through conventional approaches. Psychosocial complexity was consistently associated with disproportionate cost trends across both dashboards despite lower medical acuity. Quality indicator performance across psychosocially complex segments was not proportionally worse, yet these segments bore disproportionate costs, a pattern consistent with the view that segment-specific care redesign addressing psychosocial needs may be associated with both an improvement in outcomes and cost efficiencies. Conclusions: The Systemic Health System Measurement Framework (SHSMF) demonstrates that a measurement architecture explicitly designed around systemic needs-based population segments improves systemic health systems accountability and provides governance opportunities that conventional approaches may not achieve. The framework and its dashboard implementation offer a transferable methodology for health systems globally seeking to implement a whole-systems measurement architecture for value-based population health management. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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16 pages, 1382 KB

Open AccessArticle

Global Stakeholder Perspectives on Real-World Data and Evidence in Health Technology Assessment: An Exploratory Study

by Konstantinos Zisis, Elpida Pavi, Mary Geitona and Kostas Athanasakis

Healthcare 2026, 14(6), 822; https://doi.org/10.3390/healthcare14060822 - 23 Mar 2026

Cited by 1 | Viewed by 620

Abstract

Objective: This exploratory study presents an international, multi-stakeholder snapshot of perceptions regarding real-world data and real-world evidence in health technology assessment. The aim is to identify perceived opportunities, barriers, and enabling conditions rather than to generate generalizable conclusions. Methods: A 21-item, expert-validated questionnaire [...] Read more.

Objective: This exploratory study presents an international, multi-stakeholder snapshot of perceptions regarding real-world data and real-world evidence in health technology assessment. The aim is to identify perceived opportunities, barriers, and enabling conditions rather than to generate generalizable conclusions. Methods: A 21-item, expert-validated questionnaire was distributed via LimeSurvey to diverse health technology assessment stakeholders, including academia, industry, health technology assessment agencies, healthcare providers, policymakers, patients, and payers. The survey explored perceptions of value, methodological and regulatory challenges, and future outlooks for RWD/RWE use in HTA. Ethical approval was obtained by the University of West Attica Ethics Committee, and pilot testing was conducted prior to dissemination. Data were analyzed using descriptive statistics, consistent with the study’s exploratory intent and acknowledging that results are preliminary and not statistically generalizable. Results: Thirty-two completed responses demonstrated preliminary stakeholder support for integrating real-world data and real-world evidence into health technology assessment. Respondents represented academia, industry, HTA agencies, healthcare providers, policymakers, and patient/advocacy groups; however, no payer responses were obtained. Respondents emphasized the value of real-world data in complementing clinical trials by capturing real-world effectiveness, patient diversity, and long-term outcomes, especially in rare diseases and cancer. Key challenges included poor data quality, confounding biases, and regulatory barriers. Stakeholders highlighted the importance of standardization, transparency, and international collaboration. Opportunities included better decision-making, personalized healthcare, and improved post-market monitoring, with strong calls for robust infrastructure, clear methodologies, patient involvement, and supportive health policy frameworks. Conclusions: Real-world data and evidence enhance health technology assessment by supporting better decisions and personalized care. However, issues like data quality, methods, and trust must be addressed through standardization, strong infrastructure, and collaboration to ensure effective and impactful implementation in healthcare, while acknowledging these insights are based on a small exploratory sample. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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13 pages, 666 KB

Open AccessArticle

Short-Term Sulfurous Balneotherapy and Self-Reported Sleep Quality: An Exploratory Retrospective Real-World Pre–Post Observational Study at Terme di Saturnia (Italy)

by Elisabetta Ferrara, Manela Scaramuzzino, Giuseppe Balice, Giovanna Murmura and Bruna Sinjari

Healthcare 2026, 14(6), 782; https://doi.org/10.3390/healthcare14060782 - 19 Mar 2026

Viewed by 638

Abstract

Background: Sleep disturbances are highly prevalent, affecting approximately 21% of the European population, with chronic insomnia disorder estimated at 6%. Non-pharmacological alternatives to pharmacotherapy are needed. Sulfurous balneotherapy represents a potential intervention, yet real-world evidence remains limited. Objective: To explore changes in self-reported [...] Read more.

Background: Sleep disturbances are highly prevalent, affecting approximately 21% of the European population, with chronic insomnia disorder estimated at 6%. Non-pharmacological alternatives to pharmacotherapy are needed. Sulfurous balneotherapy represents a potential intervention, yet real-world evidence remains limited. Objective: To explore changes in self-reported sleep quality following sulfurous balneotherapy at Terme di Saturnia (Italy). Methods: Retrospective single-arm observational study of 76 participants (mean age 47.3 years, 54% female) undergoing a 7–12-day consecutive balneotherapy cycle with daily sulfurous thermal water immersion sessions (60–90 min/session). The Oviedo Sleep Questionnaire (OSQ) was administered pre- and post-treatment. Participants were stratified by baseline insomnia severity into Group A (OSQ ≥ 22, n = 47) and Group B (OSQ < 22, n = 29). The primary outcome was change in OSQ insomnia score in Group A. Statistical analysis was performed using the Wilcoxon signed-rank test. Results: In Group A, insomnia severity decreased significantly from 26.4 ± 8.3 at baseline to 20.1 ± 7.5 post-treatment (Δ = −6.3, 95% CI: −7.9 to −4.7, p < 0.001, r = 0.54). Sleep satisfaction also improved significantly from 3.2 ± 1.1 to 4.6 ± 1.2 (Δ = +1.4, 95% CI: 1.1–1.7, p < 0.001, r = 0.60). In Group B, no statistically significant changes were observed, consistent with ceiling effects. However, in an open-ended question, 72.4% (21/29; 95% CI: 54.3–85.3) of Group B participants reported enhanced relaxation during the spa stay. Due to the single-arm observational design without control groups, the observed improvements cannot be distinguished from non-specific factors, including the vacation effect, reduced work-related stress, placebo and expectancy responses, regression to the mean, or the effects of warm water immersion itself independent of sulfurous mineral content. Conclusions: This exploratory study documents pre–post improvements in self-reported sleep quality in a cohort undergoing sulfurous balneotherapy during a spa vacation. The absence of control groups and unmeasured confounders precludes causal inferences. Future randomized trials with heated non-mineral water controls are needed to isolate specific therapeutic contributions of sulfurous thermal waters. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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17 pages, 1093 KB

Open AccessArticle

Assessing the Early Economic Feasibility of a Curative Gene Therapy for Multiple Sclerosis Using a Risk-Adjusted Valuation Framework

by Attila Imre, Balázs Nagy and Rok Hren

Healthcare 2026, 14(5), 674; https://doi.org/10.3390/healthcare14050674 - 6 Mar 2026

Viewed by 703

Abstract

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This [...] Read more.

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This study assessed the early financial feasibility of IMMUTOL using a structured risk-adjusted net present value (rNPV) model, incorporating development and operating costs, probabilities of clinical and regulatory success, manufacturing expenditure, market dynamics, and revenue projections. Uncertainty was examined through one-way, probabilistic, and scenario analyses. Results: Under base-case assumptions, IMMUTOL generated a deterministic rNPV of −$223.8 million with an internal rate of return of 3.4%. Probabilistic analysis yielded a mean rNPV of −$99.4 million and a mean internal rate of return of 10.5%, with 70.2% of simulations producing negative values. Only scenarios combining higher treatment prices with lower manufacturing costs produced consistently positive rNPVs; a price of $1.5 million with a $200,000 production cost resulted in an rNPV of $711.2 million and an internal rate of return of 20.7%. Neither increased market size, reduced time to approval, nor modest cost reductions altered the conclusion. Conclusions: These findings emphasise a structural gap between value-based pricing and the pricing required for commercial viability. Without external support or reductions in cost structures, commercial development may be economically unattractive. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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28 pages, 1715 KB

Open AccessArticle

The Significance of Hypophosphatemia in Deciding on an Optimal Clinical Choice of Parenteral Iron Therapy in Patients with Chronic Inflammatory Bowel Disease in Slovenia: An Umbrella Review and Economic Evaluation

by Rok Hren, Tamás Dóczi, Erika Országh and Tomaž Kocjan

Healthcare 2026, 14(3), 393; https://doi.org/10.3390/healthcare14030393 - 4 Feb 2026

Cited by 1 | Viewed by 1263

Abstract

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized [...] Read more.

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized by very low IV iron infusion tariffs and recent pricing in which FCM is substantially less expensive than FDI, warrants a setting-specific cost effectiveness evaluation. Methods: We integrated two methodological components: (i) a payer-perspective cost-effectiveness analysis using a patient-level microsimulation model with (ii) an umbrella review of systematic reviews and a targeted search of expert consensus statements on IV-iron-associated hypophosphatemia. Results: In the base case, FDI required fewer infusions than FCM (11.1 vs. 14.2 over 10 years) but generated only €95 in IV iron administration savings due to low tariffs, while drug procurement was €1166 higher with FDI than FCM. When incorporating the clinical impact of hypophosphatemia, incremental quality-adjusted life years (QALYs) were 0.136, yielding an incremental cost-effectiveness ratio (ICER) of €6590/QALY. The umbrella review consistently showed higher hypophosphatemia incidence with FCM (up to 92%) compared with other IV iron formulations (<10%), with recent recommendations emphasizing phosphate monitoring and risk mitigation through alternative formulations. Conclusions: Despite Slovenia’s low IV iron infusion tariffs and lower FCM price, FDI remained cost-effective in this model, largely due to its more favorable hypophosphatemia profile within the model. These findings suggest that hypophosphatemia risk should be considered when selecting IV iron therapy in routine IBD care. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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11 pages, 975 KB

Open AccessArticle

Cost Effectiveness of Adjunctive Neurofeedback vs. Psychotherapy or Pharmacotherapy for Post-Traumatic Stress Disorder

by Jeffrey D. Voigt, Aron Tendler, Carl Marci and Linda L. Carpenter

Healthcare 2025, 13(19), 2388; https://doi.org/10.3390/healthcare13192388 - 23 Sep 2025

Viewed by 3236

Abstract

Background: Neurofeedback shows promise as an adjunctive therapy for post-traumatic stress disorder (PTSD), but its cost effectiveness has not been studied. Objectives: To assess the cost and effectiveness of neurofeedback plus other therapies (NF + OT) vs. guideline therapies alone. Methods: TreeAge software [...] Read more.

Background: Neurofeedback shows promise as an adjunctive therapy for post-traumatic stress disorder (PTSD), but its cost effectiveness has not been studied. Objectives: To assess the cost and effectiveness of neurofeedback plus other therapies (NF + OT) vs. guideline therapies alone. Methods: TreeAge software was used to develop Markov models comparing NF + OT therapy to psychotherapy and pharmacotherapy over 1–3 years. Costs were derived from Medicare rates and literature. Effectiveness was measured using CAPS-5 score reductions converted to quality-adjusted life years (QALYs) using regression analysis. Dropout and relapse rates were derived from systematic reviews and meta-analysis. Results: NF + OT resulted in greater improvements in CAPS-5 scores and was less costly than OT. In the base case, NF + OT was less expensive (on average) for years 1–3 by USD 2568−USD 4140 (vs. psychotherapy) and USD 2282−USD 7217 (vs. pharmacotherapy). QALYs improved by 0.04 compared to psychotherapy and 0.24 compared to pharmacotherapy. NF + OT dominated (lower cost, better outcomes) psychotherapy 12% of the time and pharmacotherapy 26.5% of the time in Monte Carlo simulation. Further, Monte Carlo simulation did not demonstrate dominance at any point in time for either pharmacotherapy or psychotherapy over NF + OT. Conclusions: Based on lower costs and improved effectiveness, NF + OT should be considered for treating PTSD. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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17 pages, 1579 KB

Open AccessArticle

Eliciting Distributive Preferences in Health Care Resource Allocation: A Person Trade-Off Study

by Nan Fang, Chang Su and Jing Wu

Healthcare 2025, 13(11), 1309; https://doi.org/10.3390/healthcare13111309 - 30 May 2025

Cited by 3 | Viewed by 1301

Abstract

Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed [...] Read more.

Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed total health benefits, vary with the magnitude of individual health gains. Methods: Using the person trade-off (PTO) method, we conducted an online survey with a nationally representative sample of Chinese adults (N = 500). The respondents evaluated five allocation programs differing in both individual health gain magnitude and number of beneficiaries. Distributive preferences are classified into five distinct types: diffusion, concentration, maximization, extreme egalitarianism and extreme inequality seeking. Threshold regression analysis identified critical transition points in preference patterns. Results: Non-maximizing tendencies were dominant (79% of the respondents). The health gain threshold was estimated to be 4.6 years (95% CI: [4.28, 4.85]): below this threshold, respondents tend to allocate smaller benefits to more patients (diffusion preference); above the threshold, people are inclined to allocate larger benefits to fewer patients (concentration preference). The income level and self-reported health status of the participants were identified as potential factors influencing distributive preferences. Conclusions: This study provides the first quantitative evidence from China that distributive preferences exhibit a non-linear shift based on the magnitude of health benefits. The identified 4.6-year threshold provides policymakers with an empirically based instrument to strike a balance between efficiency and the reduction in inequality in resource allocation. These findings advocate for incorporating social value weights into health technology assessments, especially for interventions that offer substantial individual benefits. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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Review

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13 pages, 482 KB

Open AccessReview

Free Riding in Healthcare Through a Game-Theoretic Lens: A Cross-Domain Narrative Review and Conceptual Synthesis

by Christos Ntais and Michael A. Talias

Healthcare 2026, 14(12), 1651; https://doi.org/10.3390/healthcare14121651 - 11 Jun 2026

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Abstract

Background/Objectives: Free riding in healthcare occurs when actors benefit from health-related public goods, risk-pooling arrangements, common resources, or cooperative institutions while contributing less than is socially optimal. This review clarifies how free-rider dynamics differ across vaccination, health insurance and universal health coverage, antimicrobial [...] Read more.

Background/Objectives: Free riding in healthcare occurs when actors benefit from health-related public goods, risk-pooling arrangements, common resources, or cooperative institutions while contributing less than is socially optimal. This review clarifies how free-rider dynamics differ across vaccination, health insurance and universal health coverage, antimicrobial resistance, organ donation and transplant allocation, and global health cooperation. Methods: A narrative review with conceptual synthesis was conducted. Searches of PubMed and Scopus were complemented by citation tracking and targeted inclusion of foundational economics, game theory, public-health ethics, and market-design sources. Sources were mapped by domain, actors, strategies, payoff structure, information conditions, time horizon, enforcement mechanism and policy relevance. Results: Across domains, free riding arises when private payoffs diverge from collective welfare, but the underlying game differs: threshold public-good and coordination games in vaccination, adverse-selection and participation games in insurance, common-pool-resource dilemmas in antimicrobial use, donor-registration and matching-market problems in transplantation, and repeated public-goods games in global health. The review identifies three policy functions: altering payoffs, altering information and beliefs, and changing the structure, repetition, or enforceability of the game. Conclusions: Game theory is most useful as a mechanism-based framework rather than a stand-alone policy prescription. Its policy value depends on empirical calibration, institutional context, ethical legitimacy, and attention to equity, incomplete information, behavioral responses, and enforcement capacity. The synthesis also emphasizes boundary conditions: game-theoretic prescriptions can fail when political economy, asymmetric power, implementation capacity, access barriers, or trust-related drivers are ignored. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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20 pages, 678 KB

Open AccessReview

Healthcare Information Management and Accreditation in Europe

by Radu Ilinca, Laura Iosif, Dan Adrian Luțescu, Mircea Valentin Trică, Ionela Ganea, Tudor-Claudiu Spînu and Ana-Maria Cristina Țâncu

Healthcare 2026, 14(6), 748; https://doi.org/10.3390/healthcare14060748 - 16 Mar 2026

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Abstract

Background/Objectives: Healthcare systems increasingly rely on standardized diagnostic information to support clinical decision-making, reimbursement, and public health governance. Although accreditation of medical laboratories underpins trust in diagnostic services, in practice, it is encountered primarily through the way in which accredited status is communicated [...] Read more.

Background/Objectives: Healthcare systems increasingly rely on standardized diagnostic information to support clinical decision-making, reimbursement, and public health governance. Although accreditation of medical laboratories underpins trust in diagnostic services, in practice, it is encountered primarily through the way in which accredited status is communicated in routine healthcare documentation. This study examines national rules that govern the communication of accreditation-related information and their relevance for healthcare management and policy. Methods: A descriptive, document-based comparative analysis was conducted across all 42 national accreditation bodies participating in the European Co-operation for Accreditation Multilateral Agreement (EA-MLA). Official regulations and policies governing the use of accreditation symbols and references in medical laboratory documentation were analyzed. Only documents confirmed as valid and in force as of January 2026 were included. The analysis focused on report-level identification, differentiation of accredited and non-accredited results, use beyond reports, and consequences of misuse. Results: Across countries, accreditation communication rules define how laboratory results are recognized, reimbursed, and operationally used within healthcare systems. While regulatory detail varies, common requirements exist regarding clear identification of accredited results and safeguards against misinterpretation, which directly influence administrative processes and financing mechanisms. For example, in some healthcare systems, accredited reporting determines eligibility for public reimbursement, while in others, it constitutes a legal prerequisite for providing laboratory services. Conclusions: Accreditation-related communication functions as an element of healthcare information governance rather than a purely technical marker. National variations reflect healthcare policy and management priorities, with implications for efficiency, transparency, and access to care. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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Other

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21 pages, 1677 KB

Open AccessSystematic Review

Pharmacoeconomic Profiles of Advanced Therapy Medicinal Products in Rare Diseases: A Systematic Review

by Marianna Serino, Milana Krstin, Sara Mucherino, Enrica Menditto and Valentina Orlando

Healthcare 2025, 13(15), 1894; https://doi.org/10.3390/healthcare13151894 - 2 Aug 2025

Cited by 1 | Viewed by 1999

Abstract

Background and aim: Advanced Therapy Medicinal Products (ATMPs) are innovative drugs based on genes, tissues, or cells that target rare and severe diseases. ATMPs have shown promising clinical outcomes but are associated with high costs, raising questions about cost-effectiveness. Hence, this systematic [...] Read more.

Background and aim: Advanced Therapy Medicinal Products (ATMPs) are innovative drugs based on genes, tissues, or cells that target rare and severe diseases. ATMPs have shown promising clinical outcomes but are associated with high costs, raising questions about cost-effectiveness. Hence, this systematic review aims to analyze the cost-effectiveness and cost-utility profiles of the European Medicines Agency-authorized ATMPs for treating rare diseases. Methods: A systematic review was conducted following PRISMA guidelines. Studies were identified by searching PubMed, Embase, Web of Science, and ProQuest scientific databases. Economic evaluations reporting incremental cost-effectiveness/utility ratios (ICERs/ICURs) for ATMPs were included. Costs were standardized to 2023 Euros, and a cost-effectiveness plane was constructed to evaluate the results against willingness-to-pay (WTP) thresholds of EUR 50,000, EUR 100,000, and EUR 150,000 per QALY, as part of a sensitivity analysis. Results: A total of 61 studies met the inclusion criteria. ATMPs for rare blood diseases, such as tisagenlecleucel and axicabtagene ciloleucel, were found to be cost-effective in a majority of studies, with incremental QALYs ranging from 1.5 to 10 per patient over lifetime horizon. Tisagenlecleucel demonstrated a positive cost-effectiveness profile in the treatment of acute lymphoblastic leukemia (58%), while axicabtagene ciloleucel showed a positive profile in the treatment of diffuse large B-cell lymphoma (85%). Onasemnogene abeparvovec for spinal muscular atrophy (SMA) showed uncertain cost-effectiveness results, and voretigene neparvovec for retinal diseases was not cost-effective in 40% of studies, with incremental QALYs around 1.3 and high costs exceeding the WTP threshold set. Conclusions: ATMPs in treating rare diseases show promising economic potential, but cost-effectiveness varies across indications. Policymakers must balance innovation with system sustainability, using refined models and the long-term impact on patient outcomes. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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