Search Results (542)

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

The intersection of green finance and artificial intelligence (AI) represents a rapidly emerging and high-impact research domain with the potential to reshape sustainable economic systems. This study presents a comprehensive bibliometric and network analysis aimed at mapping the scientific landscape, identifying research hotspots, and highlighting methodological trends at this nexus. A dataset of 268 peer-reviewed publications (2014–June 2025) was retrieved from the Web of Science Core Collection, filtered by the Business Economics category. Analytical techniques employed include Bibliometrix in R, VOSviewer, and science mapping tools such as thematic mapping, trend topic analysis, co-citation networks, and co-occurrence clustering. Results indicate an annual growth rate of 53.31%, with China leading in both productivity and impact, followed by Vietnam and the United Kingdom. The most prolific affiliations and authors, primarily based in China, underscore a concentrated regional research output. The most relevant journals include Energy Economics and Finance Research Letters. Network visualizations identified 17 clusters, with focused analysis on the top three: (1) Emission, Health, and Environmental Risk, (2) Institutional and Technological Infrastructure, and (3) Green Innovation and Sustainable Urban Development. The methodological landscape is equally diverse, with top techniques including blockchain technology, large language models, convolutional neural networks, sentiment analysis, and structural equation modeling, demonstrating a blend of traditional econometrics and advanced AI. This study not only uncovers intellectual structures and thematic evolution but also identifies underdeveloped areas and proposes future research directions. These include dynamic topic modeling, regional case studies, and ethical frameworks for AI in sustainable finance. The findings provide a strategic foundation for advancing interdisciplinary collaboration and policy innovation in green AI–finance ecosystems. Full article

Vaccine equity and access remain critical challenges in global health, particularly in regions with complex socio-political landscapes, like the Middle East. This review examines disparities in vaccine distribution within the Middle Eastern context, analyzing the unique challenges and opportunities across the region. It provides an overview of the area’s diverse finances and its impact on healthcare accessibility. We examine vaccination rates and identify critical barriers to vaccination, which may be particular issues in developing countries, such as vaccine thermostability, logistical hurdles, financial constraints, and socio-cultural factors, or broader problems, like political instability, economic limitations, and deficiencies in healthcare infrastructure. However, we also highlight successful efforts at the regional and national levels to improve vaccine equity, along with their outcomes and impacts. Ultimately, by drawing on the experiences of previous programs and initiatives, we propose strategies to bridge the gaps in vaccine access through sustainable financing, local manufacturing, and the strengthening of health systems. This approach emphasizes the importance of regional collaboration and long-term self-sufficiency in enhancing global health security and achieving more equitable outcomes in the Middle East. Full article

This study analyses the conditions under which co-opetition improves the supply of healthcare services in Benin. Using non-centralised administrative data from a sample of public and private health centres, we apply network theory and negative binomial regression to assess the extent to which competition affects collaboration between public and private healthcare providers. We found that competition reduces the degree of collaboration between private and public health providers. However, the COVID-19 pandemic significantly mitigated this effect, highlighting the potential for competition within the healthcare system without compromising social welfare. Notwithstanding that, we show that these benefits are not sustained over time. These findings have policy implications for the sustainability of health system financing in Africa, particularly by promoting sustainable financial mechanisms for the private sector and more inclusive governance structures. Full article

Background: In Canada, despite universal healthcare coverage, dental care remains predominantly privately financed, creating financial barriers that prevent many from accessing essential services. This case study is part of a larger initiative, the One Smile Research program, which evaluates the impact of cost-free dental care on the oral health and overall well-being of individuals who have been unable to access dental services in the past two years due to financial constraints. Participants in the program receive necessary dental care and attend follow-up appointments to assess the long-term effects of continuous cost-free care. Clinical Case: This mixed-methods case report focuses on a 26-year-old male participant and integrates a qualitative semi-structured interview with clinical and self-reported data, providing an in-depth understanding of his experiences. Results: Clinical outcomes demonstrated the effectiveness of the provided dental treatments, while self-reported measures indicated improved oral health, satisfaction with dental appearance, enhanced psychosocial well-being, increased self-esteem, reduced dental anxiety, and better oral hygiene habits. The qualitative interview identified three key themes reflecting positive experiences with the program: ease of admission, staff kindness, and overall well-being improvement. The integration of both quantitative and qualitative analyses revealed significant advancements in both objective and subjective measures, particularly regarding overall well-being. Conclusions: The continuity of cost-free dental care effectively addressed the participant’s oral health and overall well-being, with most benefits sustained even at the two-year follow-up. These individual-level outcomes offer preliminary insight into the potential advantages of universal dental coverage within the Canadian healthcare system. Full article

Our four-year interdisciplinary behavioral weight loss program is fully covered by public health insurance for patients with a body mass index of ≥35 kg/m². We evaluated the real-world outcomes of anthropometric, metabolic and psychologic parameters collected prior to the start (t₀, n = 381, 71% women) and after each segment of the program (t_1–4, n = 243, 126, 94, and 77). It is a prospective evaluation of clinical real-world data including all patients who started the first segment of behavioral treatment until they quit/finished the program. The mean dropout rates per treatment segment were 23%. Body weight after one year decreased from 127.3 kg to 122.2 (p < 0.001). Average hemoglobin A1c value decreased from 5.8% to 5.6% in all patients (p < 0.001) and from 6.6% to 6.2% in patients with type 2 diabetes (p < 0.001). Further metabolic and psychological parameters improved significantly as well. The average weight nadir was reached after two segments, co-occurring with the most beneficial changes in laboratory parameters. Afterwards, mean weight slightly increased accompanied by a discrete loss of benefits in laboratory parameters. Our real-world data with significant health improvements adds important value to discussions about the funding of obesity therapy and thus has the chance to improve therapy availability for obesity patients worldwide. Full article

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts. Methods: Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance. Results: DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development. Conclusions: Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings. Full article

Background/Objectives: Value frameworks are useful tools to explicitly define the dimensions and criteria important for decision-making, but no existing frameworks capture the broad value domains of population genomic programs. Using a mixed methods approach, we aimed to develop a novel value framework for evaluating population genomic programs (PGPs). Methods: We first conducted a targeted literature review of published evidence on the value of PGPs and existing frameworks to evaluate and quantify their impact. Value domains and elements were extracted and summarized to develop a preliminary framework. Semi-structured stakeholder interviews on the preliminary framework were conducted from March 2024 to October 2024 with 11 experts representing 9 countries. A thematic analysis of interview transcripts was conducted to map value elements to domains of the final framework. Results: We identified 348 potentially relevant articles from MEDLINE-indexed and the gray literature sources. After title and abstract screening, 23 articles met the inclusion criteria and underwent full-text review, and 8 reported value elements were extracted and mapped to a preliminary framework for testing in interviews. Stakeholder themes were summarized into the value domains and elements of the final framework, which included health as a primary domain, education and research, enterprise and finance, and labor as the core domains, and agriculture and security as extended domains. Domains and elements may be excluded based on stakeholder objectives and program characteristics. Conclusions: This novel framework for assessing the comprehensive value of PGPs provides a foundational step to assess the value of these programs and may promote more efficient and informed allocation of resources. Full article

Air pollution poses a growing threat to public health and the environment, highlighting the need for continuous and precise urban air quality monitoring. The aim of this study was to implement and evaluate an autonomous air quality monitoring platform developed by the University of Ruse, “Angel Kanchev”, under Bulgaria’s National Recovery and Resilience Plan (project BG-RRP-2.013-0001), co-financed by the European Union through the NextGenerationEU initiative. The system, based on Libelium’s mobile sensor technology, was installed at a height of two meters on the university campus near Rodina Boulevard and operated continuously from 1 March 2024 to 30 March 2025. Every 15 min, it recorded concentrations of CO, CO₂, NO₂, SO₂, PM₁, PM_2.5, and PM₁₀, along with meteorological parameters (temperature, humidity, and pressure), transmitting the data via GSM to a cloud-based database. Analyses included a distributional assessment, Spearman rank correlations, Kruskal–Wallis tests with Dunn–Sidak post hoc comparisons, and k-means clustering to identify temporal and meteorological patterns in pollutant levels. The results indicate the high operational stability of the system and reveal characteristic pollution profiles associated with time of day, weather conditions, and seasonal variation. The findings confirm the value of combining calibrated IoT systems with advanced statistical methods to support data-driven air quality management and the development of predictive environmental models. Full article

Sub-Saharan Africa (SSA) is experiencing escalating climate variability, land degradation, and food insecurity, which threaten livelihoods and economic stability. Sustainable agricultural practices (SAPs), including climate-smart agriculture, conservation agriculture, and agroecology, offer promising strategies to boost productivity while enhancing ecological stability. This review proposes that multidisciplinary integration of SAPs, encompassing agronomy, socioeconomics, and governance, is the most promising route to achieving climate-resilient food systems in SSA by 2030. Despite its proven benefits, the use of SAPs remains limited. This is largely because of financial constraints, weak institutional frameworks, and inadequate infrastructure. To address these challenges, this review evaluates the role of SAPs in mitigating climate risk, improving soil health, and enhancing food security. It also identifies systemic adoption barriers and examines the effectiveness of policy and financing frameworks. Drawing on evidence from across SSA, including Ethiopia’s agroforestry success and Senegal’s millet resilience, this review highlights how integrating sustainable practices with postharvest innovation and community-driven approaches can strengthen food systems. Ultimately, the findings underscore that weaving science, policy, and grassroots action is essential for building a resilient and food-secure SSA, particularly within the context of the 2025 global adaptation agenda. Full article

Retrofitting the existing housing stock to a high level of energy efficiency will not be limited to achieving the decarbonisation of 80.3 MtCO2e residential emissions and reducing fuel poverty in 4.16 million households, but also improving the health and well-being of UK residents and their overall quality of life. The current progress of housing retrofitting is poor, at less than 1%. The UK expects to achieve net zero by 2050, and the challenge is immense as there are more than 30 million houses. The challenge is similar in other global contexts. Even if the required technology, supply chain, skilled labour, and finance could have been provided, the retrofitting would not move forward without positive engagement from the clients. Proper strategies are required to retrofit at scale. Focusing on the challenges of stakeholder engagement in housing retrofitting, this study focused on developing a hybrid one-stop shop solution through design science research. A theoretical artefact and an empirical system requirement specification document were developed to propose a one-stop shop solution. This was tested through retrofit industry stakeholders. Findings reveal that the one-stop shop model will be a good answer to retrofitting at scale, providing the resident engagement of 30.1 million households. The model can support residents with or without computer literacy due to its hybrid approach. The proposed theoretical and industrial models can be used as base models for developing one-stop shops for housing retrofitting by adapting them for context-specific requirements. Full article

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants. Results: Our findings provide clear evidence that health inequality among participants has fluctuated—narrowing, widening, and then narrowing again—in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality. Conclusions: We recommend that the URRBMI design take participants’ income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality. Full article

The increasingly observable financial vulnerability of households in emerging market countries makes it imperative to investigate the factors influencing it. Considering that China stands as a representative of emerging market economies, analyzing the factors influencing household financial vulnerability in China presents great reference significance for the sustainable development of households in emerging market countries. Using data from the China Household Finance Survey (CHFS) household samples, this paper presents the regional distribution of households with financial vulnerability in China. Utilizing machine learning (ML), this research examines the factors that influence household financial vulnerability in China and determines the most significant ones. The results reveal that households with financial vulnerability in China takes up a proportion of more than 63%, and household financial vulnerability is lower in economically developed coastal regions than in medium and small-sized cities in the central and western parts of China. The analysis results of the SHAP method show that the debt leverage ratio of a household is the most significant feature variable in predicting financial vulnerability. The ALE plots demonstrate that, in a household, the debt leverage ratio, the age of household head, health condition, economic development and literacy level are significantly nonlinearly related to financial vulnerability. Heterogeneity analysis reveals that, except for household debt leverage and insurance participation, the key characteristic variables exerting the most pronounced effect on financial fragility differ between urban and rural households: household head age for urban families and physical health status for rural families. Furthermore, digital financial inclusion and social security exert distinct impacts on financial vulnerability, showing significantly stronger effects in high per capita GDP regions and low per capita GDP regions, respectively. These findings offer valuable insights for policymakers in emerging economies to formulate targeted financial risk mitigation strategies—such as developing household debt relief and prevention mechanisms and strengthening rural health security systems—and optimize policies for household financial health. Full article

Background/Objectives: This study investigates the evolution of hospital capacity and utilization in California between 2003 and 2023, focusing on emergency departments (EDs) and trauma centers (TCs). We seek to document structural changes in the healthcare delivery system with respect to hospital-based emergency and trauma services. Methods: This analysis examines changes in population demographics, hospital resources, and patient utilization patterns across facility types. Given the significant increase in the proportion of the population aged 65+ and the documented higher use of emergency and trauma services by this population, we expected to observe an expansion in ED and trauma service capacity and utilization. Results: Utilizing a comprehensive dataset of California general acute care hospitals over this 20+ year period, our descriptive analysis reveals major shifts in the healthcare delivery system, notably the increased prominence of hospitals with EDs, particularly those designated as trauma centers. Findings indicate that, while the overall number of hospitals and licensed beds has slightly decreased, facilities with EDs, especially trauma centers, have increased their capacity and manage a greater proportion of inpatient admissions and ED visits. Conclusions: The increase in ED visits and inpatient admissions at trauma centers, contrasted with decreases in both capacity and utilization at non-trauma hospitals, indicates a significant restructuring of the health delivery system with significant implications for healthcare policy, financing, operations, and affordability. The high and increasing percentage of inpatient admissions originating from hospital EDs and from hospitals with trauma centers suggests a need for policies that foster integration between ED and inpatient care and the broader healthcare delivery system, while at the same time managing the increase in prices and costs associated with growing emergency services utilization. Further research is needed to explore the implications of these trends, particularly concerning their impact on the affordability of healthcare in the US. Full article

Background: The global number of operatively treated proximal femoral fractures is steadily growing, driven by the demographic shift toward an increasingly elderly, frail, and comorbid population. This clinical condition profoundly impacts not only patient health but also the finances of healthcare systems. The aim of this economic analysis was to investigate the impact on direct costs of orthogeriatric co-management (OGCM) compared to standard of care (SOC). Methods: A retrospective analysis was conducted investigating two comparable cohorts of patients aged 75 and above, originating from the exact same geographic area, who underwent surgical treatment for proximal femoral fractures in 2023. The two cohorts differed in their perioperative care protocols: one followed an OGCM (n = 143) protocol, while the other adhered to a SOC protocol (n = 141). Economic data were retrieved from the centralised finance department managing the two hospital sites under investigation. Results: The findings revealed that the OGCM protocol was associated with direct costs that were not higher (CHF 16,019 vs. CHF 16,713, p = 0.78) compared to SOC, despite higher daily costs in the OGCM cohort (CHF 2504 vs. CHF 2202, p < 0.0001). This difference was largely driven by a significantly shorter length of stay in the OGCM group (6 days vs. 7 days, p = 0.002). Conclusions: Optimising resource allocation through tailored geriatric care protocols suggests not only an improvement in clinical outcomes but also a reduction in economic burden, thereby alleviating pressure on the healthcare system. Full article