Search Results (572)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Background: Delays in breast cancer treatment negatively affect prognosis and have increased over time. Data on waiting times in Switzerland are limited. Patients and Methods: This study analyzed cancer registry data from 2003 to 2005 (2628 patients) and 2015 to 2017 (421 patients) to evaluate waiting times for diagnosis, surgery, and radiotherapy; temporal trends; and survival in women with stage I–III invasive breast cancer treated with surgery without chemotherapy. Associations with demographic/clinical factors and overall survival (OS) were assessed using ANOVA, uni-/multivariable regression, Kaplan–Meier, and Cox regression. Results: From 2003 to 2005, mean intervals were biopsy-to-diagnosis 4.3 days, diagnosis-to-surgery 18.8 days, biopsy-to-surgery 26.8 days, and surgery-to-radiotherapy 56.7 days. Longer diagnosis-to-surgery times were associated with metropolitan areas, public hospitals, basic insurance, mastectomy, and older age (all p < 0.001). Radiotherapy delays were also longer in metropolitan areas and after mastectomy (p < 0.001). Between 2003–2005 and 2015–2017, diagnosis-to-surgery times rose in Eastern Switzerland (from 21.3 to 31.2 days), while radiotherapy timing remained stable. Five-year overall survival improved (from 76.7% to 88.4%), but was not significantly impacted by diagnosis-to-surgery intervals. Conclusions: Despite timely surgery in Switzerland (2003–2005), disparities existed, and time to surgery increased by 2015–2017. Reducing waiting times remains important despite no significant short-term OS impact. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

Hope and loneliness are significant psychosocial factors that greatly influence the quality of life (QoL) among older adults. However, few studies have examined these constructs simultaneously in rural aging populations in Southeast Asia. This study aimed to investigate the relationships between hope, loneliness, and QoL among community-dwelling older adults in northeastern Thailand. A cross-sectional study was conducted with 250 participants aged 60 years and older, recruited through convenience sampling. Descriptive statistics summarized participant characteristics, while hierarchical regression identified QoL predictors. The participants (mean age = 70.41 years; 52.8% female) reported a high level of hope (M = 33.35), a moderate level of loneliness (M = 8.81), and a good level of QoL (M = 99.13). Hierarchical regression analysis revealed that age, occupation, monthly income, income source, education, health insurance, comorbidities, hope, and loneliness were significant predictors of QoL. Together, these factors accounted for 55.1% of the variance in QoL. Both hope and loneliness have a significant impact on QoL in older adults. Interventions designed to reduce loneliness and foster hope may prove effective in enhancing the well-being of aging populations. These findings underscore the importance of integrating psychosocial and community-based approaches into geriatric care and public health planning. 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

Purpose: Despite increasing rates of prostate cancer among men, prostate cancer risk assessments continue to rely on invasive laboratory tests like prostate-specific antigen and Gleason score tests. This study aimed to develop a noninvasive, data-driven risk model for patients to evaluate themselves before deciding whether to visit a hospital. Materials and Methods: To train the model, data from the National Health Insurance Sharing Service cohort datasets, comprising 347,575 individuals, including 1928 with malignant neoplasms of the prostate, 5 with malignant neoplasms of the penis, 18 with malignant neoplasms of the testis, and 14 with malignant neoplasms of the epididymis, were used. The risk model harnessed easily accessible inputs, such as history of treatment for diseases including stroke, heart disease, and cancer; height; weight; exercise days per week; and duration of smoking. An additional 286,727 public datasets were obtained from the National Health Insurance Sharing Service, which included 434 (0.15%) prostate cancer incidences. Results: The risk calculator was built based on Cox proportional hazards regression, and I validated the model by calibration using predictions and observations. The concordance index was 0.573. Additional calibration of the risk calculator was performed to ensure confidence in accuracy verification. Ultimately, the actual proof showed a sensitivity of 60 (60.5) for identifying a high-risk population. Conclusions: The feasibility of the model to evaluate prostate cancer risk without invasive tests was demonstrated using a public dataset. As a tool for individuals to use before hospital visits, this model could improve public health and reduce social expenses for medical treatment. Full article

Against the backdrop of evolving global climate patterns, the frequency and intensity of extreme weather events have increased significantly, posing unprecedented threats to agricultural production. This change has particularly profound impacts on agricultural systems in developing countries, making the enhancement of farmers’ capacity to withstand extreme weather events a crucial component for achieving sustainable agricultural development. As an essential safeguard for agricultural production, agricultural insurance plays an indispensable role in risk management. However, a pronounced gap persists between policy aspirations and actual adoption rates among farmers in developing economies. This study employs the integrated theory of planned behavior (TPB) and protection motivation theory (PMT) to construct an analytical framework incorporating psychological, socio-cultural, and risk-perception factors. Using Jiangsu Province—a representative high-risk agricultural region in China—as a case study, we administered 608 structured questionnaires to farmers. Structural equation modeling was applied to identify determinants influencing insurance adoption decisions. The findings reveal that farmers’ agricultural insurance purchase decisions are influenced by multiple factors. At the individual level, risk perception promotes purchase intention by activating protection motivation, while cost–benefit assessment enables farmers to make rational evaluations. At the social level, subjective norms can significantly enhance farmers’ purchase intention. Further analysis indicates that perceived severity indirectly enhances purchase intention by positively influencing attitude, while response costs negatively affect purchase intention by weakening perceived behavior control. Although challenges such as cognitive gaps and product mismatch exist in the intention-behavior transition, institutional trust can effectively mitigate these issues. It not only strengthens the positive impact of psychological factors on purchase intention, but also significantly facilitates the transformation of purchase intention into actual behavior. To promote targeted policy interventions for agricultural insurance, we propose corresponding policy recommendations from the perspective of public intervention based on the research findings. Full article

This study evaluates the current Spanish insurance framework for catastrophic flood risk, administered by the Consorcio de Compensación de Seguros (CCS), based on nationwide loss data reported by the CCS for the period 1996–2020. The analysis of historical claims data enables a clear differentiation between frequent, low-cost events and infrequent, high-impact catastrophes. While the CCS has fulfilled a critical role in post-disaster compensation, the findings highlight the parallel need for ex ante risk mitigation strategies. The study proposes a more efficient, two-tier risk coverage model. Events whose impacts can be managed through standard insurance mechanisms should be underwritten by private insurers using actuarially fair premiums. In contrast, events with catastrophic implications—due to their scale or financial impact—should be addressed through general solidarity mechanisms, centrally managed by the CCS. Such a risk segmentation would improve the financial sustainability of the system and create fiscal space for prevention-oriented incentives. The current design of the CCS scheme may generate moral hazard, as flood exposure is not explicitly priced into the premium structure. Empirical findings support a shift towards a more transparent, incentive-aligned model that combines collective risk sharing with individual risk responsibility—an essential balance for effective climate adaptation and long-term resilience. Full article

Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally. Full article

This study examines the decision-making processes that were used in the development of the National Disability Insurance Scheme (NDIS). It draws on research that highlights that decision-making can be improved if organisations follow specific decision-making processes. This study sought to examine whether formal decision-making rules and processes were used in the development of the NDIS. Semi-structured interviews were conducted with 58 senior public servants between 2016 and 2021 in the Commonwealth government departments that had policy oversight and responsibility for both the design and implementation of the NDIS. The data showed that there were examples of data-driven decisions and risk analysis used, but also considerable gaps in decision-making processes. These gaps potentially resulted in poorer decision-making quality, which may have negatively impacted the design of the NDIS and could potentially explain some of the current problems with the scheme. The paper concludes with recommendations for future research to improve decision-making processes within public administration. Full article

Amid the global drive to enhance public sector performance in the digital economy era, improving government spending efficiency has become a critical governance objective. This study investigates the impact of digital inclusive finance on government spending efficiency from a digital finance systems perspective using county-level panel data in China’s Yangtze River Delta for the period 2014–2022 and constructing the fixed-effects model and instrumental variable method to estimate the effect of digital inclusive finance and explore its underlying mechanisms. Heterogeneity across regions with varying economic development levels is analyzed, and fiscal pressure is examined as a potential mediating factor. The results indicate that (1) digital inclusive finance significantly enhances government spending efficiency, primarily through broad service coverage and deep usage of digital financial services such as mobile payments, digital credit, and insurance; (2) the positive effect is more pronounced in counties with lower government spending efficiency and economic development; and (3) fiscal pressure acts as a key transmission channel, with broader digital inclusive finance coverage helping to alleviate fiscal stress and improve government spending efficiency. These findings offer empirical insights into the role of digital finance in promoting effective and adaptive public financial governance. Full article

Background: Diabetes is rapidly increasing in developing and industrializing nations, primarily due to type 2 diabetes (T2DM). With the global prevalence of diabetes steadily increasing, estimates suggest that by 2045, nearly 548 million people will be living with the disease worldwide. Alzheimer’s disease (AD), recognized as the primary contributor to dementia in aging populations, exhibits an escalating prevalence that parallels the demographic shifts toward older age groups worldwide. This progressive neurodegenerative disorder has emerged as a critical public health challenge, with epidemiological patterns closely tracking the trajectory of population aging across industrialized and developing nations. This study investigates whether metformin may help reduce the risk of dementia. Previous studies from various countries have explored the association between metformin use and dementia risk; however, the findings have been inconsistent. Therefore, we conducted this study to examine whether the observed protective effect of metformin also applies to the Taiwanese (Han Chinese) population, potentially providing valuable insights into ethnic or regional differences in drug response. Methods: We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database 2000 (LHID2000), including 2 million individuals from 2000 to 2013. Patients with T2DM aged ≥40 years who initiated metformin between 2000 and 2005 formed the exposed group, while those starting other second-line antidiabetic medications formed the non-exposed group. Propensity score matching was used to control for age, sex, index date, and major comorbidities. Incident dementia (2007–2013) was identified using relevant ICD-9-CM codes. Adjusted hazard ratios were estimated using Cox regression with time-dependent covariates. Results: The metformin-exposed cohort demonstrated a risk reduction for dementia incidence relative to the comparator group (adjusted HR 0.472, 95% CI = 0.328–0.679). This protective association remained robust in sex-stratified analyses and age-stratified subgroups. Temporal analysis further revealed a duration-dependent risk attenuation, with extended therapeutic exposure correlating with progressive dementia risk decrement. Conclusions: Our findings suggest that metformin use may be associated with a lower risk of developing dementia in individuals with type 2 diabetes mellitus. Full article

Background/Objectives: Rural public health is significantly impacted by social drivers of health (SDOH), a set of community-level factors, with rural areas facing challenges such as a higher rate of aging population, fewer jobs, lower income, higher mortality, and poor healthcare access. While much research exists on rurality and SDOH, methodological issues remain, including a narrow definition of SDOH that often overlooks the critical location aspect of healthcare. Methods: This study utilized county-level data from the 2020 Agency of Healthcare Research and Quality SDOH database to investigate geospatial variations in healthcare across the spectrum of rurality. This study employed a set of novel spatial–statistical methods: gradient boosting machines (GBM), Shapley additive explanations (SHAP), and multiscale geographically weighted regression (MGWR). Results: The analysis of 262 variables across 1976 counties identified 20 key variables related to rural healthcare. These variables were grouped into three categories: health insurance status, access to care, and the volume of standardized Medicare payments. The MGWR model further revealed both global and local effects of specific healthcare characteristics on rurality, demonstrating that geographically varying relationships were strongly associated with socio-geographical factors. Conclusions: To improve the SDOH in vulnerable rural communities, particularly in Southern states without Medicaid expansion, policymakers must develop and implement equitable and innovative care models to address social determinants of health and access-to-care issues, especially given the potential cuts to public health programs. Full article

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability Survey), namely, Workplace Hazards (potential dangers that may result in injury or illness) and Workplace Vulnerability (inadequate occupational health and safety resources), and described health and demographic characteristics associated with these conditions. Eligible participants were women aged 18 and over, born in Brazil, currently residing in the United States, and employed. A cross-sectional online survey was conducted between July and August 2020. Recruitment occurred through community partnerships and social media. Multivariable models among n = 191 women revealed that greater exposure to Workplace Hazards was associated with employment in private household settings, including childcare and housecleaning (p < 0.001). The association between Workplace Vulnerability and jobs in private household services approached statistical significance (p = 0.07). Both Workplace Hazards and Workplace Vulnerability were associated with lower incomes and educational attainment, as well as having public insurance. Our findings suggest the need for stronger OHS protections and policies, particularly among those working in private household services, to ensure safer working conditions for Brazilian immigrant women. Full article