International Journal of Health Policy and Management
Volume:10 Issue: 3, Mar 2021

In 2016 the World Health Organization (WHO) called upon nations worldwide to eliminate viral hepatitis. Due to suboptimal hepatitis C virus (HCV) therapies in the past, many patients could not be treated or cured. With the current options, all patients can be treated and >90% is cured. However, these developments have not reached all patients, especially those who were lost to follow-up (LTFU) in previous years, an estimated 30% in the Netherlands. Retrieving these patients can contribute to HCV elimination. In light of this, we aimed to develop a nationwide retrieval strategy. During development we identified four major challenges. The first challenge is ethical and arises from the aim of the project: should physicians retrieve LTFU patients? We argue that the arguments in favour outweigh those against. The three other challenges are methodological and mainly legal in nature. Firstly, how far back are we allowed to trace LTFU patients? In the Netherlands, patient files should be kept for a minimum of fifteen years, but in chronic disease they may be archived longer. Secondly, which professional should identify the LTFU patients? Ideally this would be the treating physician, but we describe the circumstances that allow inclusion of assistance. Lastly, what is the proper way to invite the LTFU patients? We found that we can often request current address information from municipalities, and explain this process in detail. The offered solutions are feasible and translatable to other healthcare environments. We hope to take away any insecurities people may have about the ethical and legal nature of such a retrieval project and hope to inspire others to follow in our footsteps.

Although the incidence and mortality of gastric cancer (GC) decreased in the last years, some countries remain highly affected. Especially in high-income economies the cases of cardia types are steadily increasing. Currently, GC is ranked third as cause for cancer death worldwide, whereby two-thirds of deaths still occur in lowincome countries. But the global numbers are changing, and new regional challenges must be addressed.

Therefore, this disease has been chosen for in-depth bibliometric analyses that combines the evaluation of publication meta-data with density equalizing visualization techniques. This study focuses on the chronological and geographical characteristics of GC research worldwide. Epidemiological and socio-economic parameters were analyzed and the influence of political framework conditions was examined. In addition, international collaborations and research priorities were evaluated.  

In the last years, the publication numbers are rising more extensively in comparison to other cancer types. Albeit the usual leading positions, the United States is not the most publishing country on GC. It occupies the third position. Instead, China and Japan are the most publishing countries and together with South Korea also the key players as well as the most affected countries. These countries’ governments are also the main donors for GC-research. The number of articles and the expenditures for research and development (R&D) as well as the incidence rate are correlated. Despite the scarce contribution of low-economic countries to the publication output, international collaborations lead to a modest output in those regions.  

This study pools background information for scientists, practitioners, funders and decision-makers by providing information on the development and priorities of GC research. Adaptive international approaches and partnerships are crucial to meet future changing epidemiological features worldwide.

Men demonstrate disproportionately poor uptake and engagement in HIV services with strong evidence linking men’s disinclination to engage in HIV services to their masculinity, necessitating adaptive programming to accommodate HIV-positive men. Differentiated service delivery models (DSDMs) – streamlined patient-centred antiretroviral treatment (ART) delivery services – have demonstrated the potential to improve men’s engagement in HIV services. However, it is unclear how and why these models contribute to men’s reframing of ART-friendly masculinities – a set of attributes, behaviours and roles associated with boys and men that favour the uptake and use of ART. We sought to unveil how and why DSDMs support the formation of ART-friendly masculinities to enhance men’s participation in HIV-related services.  

A theory-driven qualitative approach underpinned by critical realism was conducted with 30 adult men using 3 types of DSDMs: facility-based adherence clubs (FACs), community-based adherence clubs (CACs) and quick pharmacy pick-ups (QPUPs). Focus group discussions (FGDs) (6) and in-depth interviews (IDIs) (20) were used to elicit information from purposively selected participants based on their potential contribution to the theory development – theoretical sampling. Recordings were transcribed verbatim in isiXhosa, then translated to English and analysed thematically. Theoretical constructs (themes) related to programme context and generative mechanisms were distilled and linked by retroduction and abductive thinking to formulate explanatory theories.  

Three bundles of mechanisms driving the adoption of ART-friendly masculinities by men using DSDMs were identified. (1) DSDMs instil a sense of cohesion (social support and feeling of connectedness), which enhances their reputational masculinity – having the know-how and being knowledgeable. (2) DSDMs provide a sense of assurance by providing reliable, convenient, stigma-free services, which makes men feel strong and resilient (respectability identity). (3) Through perceived usefulness, the extent to which an individual believes the model enhances their disease management, DSDMs enhance men’s ability to be economically productive and take care of their family (responsibility identity).   

DSDMs enhance the refashioning of ART-friendly versions of masculinity, thus improving men’s engagement in HIV services. Their effectiveness in refashioning men’s masculinities to ART friendly masculinities can be improved by ensuring conducive conditions for group interactions and including gender-transformative education to their existing modalities.

In light of worrying public health developments such as declining life expectancy gains and increasing health inequalities, there is a heightened interest in the relationship between politics and health. This scoping review explores the possible welfare policy consequences of populist radical right (PRR) parties in Europe and the implications for population health. The aim is to map the available empirical evidence regarding the influence of PRR parties on welfare policy reforms and to understand how this relationship is mediated by political system characteristics in different countries.  

A scoping review of peer-reviewed empirical literature addressing the relationship between PRR parties, political systems and welfare policy in Europe was performed using the methodology by the Joanna Briggs Institute. Data was charted on main study characteristics, concepts and relevant results, after which a qualitative content analysis was performed. The data was categorised according to the political system characteristics: constitution, political economy, interest representation and partisanship. Five expert interviews were conducted for validation purposes. Early evidence from 15 peer-reviewed articles suggests that exclusionary welfare chauvinistic positions of PRR parties are likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. Differences in implementation of welfare chauvinistic policy reforms are partly explained by mediation of the constitutional order (judicial institutions at national and European Union [EU] level), political economy (healthcare system funding and European single market) and partisanship (vote-seeking strategies by PRR and mainstream parties). No clear evidence was found regarding the influence of interest representation on welfare chauvinistic policies.  

While early evidence suggests that the welfare chauvinistic ideology of PRR parties is harmful for public health, the possible mediating role of political system characteristics on PRR welfare policy influence offers risk and protective factors explaining why the PRR ideology plays out differently across Europe.

This commentary considers two editorial pieces, written by Hajizadeh and Edmonds, and Lewis, which address universal pharmacare in Canada. The pieces focus on the social inequities of the existing system and the challenges of successful implementation. After identifying the significant strengths of both articles, this commentary then delves into the reasons why universal pharmacare may not be the solution, and identifies numerous thorny issues that will complicate the implementation of such a publicly funded program. Both discussions point to the need for caution and transparency going forward.

In this commentary, we respond to Bowen and colleagues’ empirical study of research partnerships between Canadian health organizations and university-based investigators. We draw on our experiences of university and health-services partnerships to elaborate on some of the misalignments between researchers and health services leaders identified by Bowen et al. We take up Bowen and colleagues’ call to re-imagine research by proposing three promising points of intervention in research partnerships. These are: (1) orient towards research relationships rather than project-based partnerships; (2) recognize shared and diverging expectations and objectives; and (3) foster a more nuanced understanding of mutual gains.

There are at least two reasons why health technology assessment (HTA) agencies need to seek process-based solutions to support the legitimacy of healthcare resource allocation, ie, (i) in pluralistic societies, the existence of often conflicting and incommensurable claims (ie, the “fragmentation of value”) and the lack of a broadly accepted, ethically defensible analytical framework, and (ii) the well-documented loopholes of the conventional logic of cost-effectiveness (CE) with its reductionist concept of allocative efficiency, which fails to reflect the distributive dimension of resource allocation decisions in collectively financed health schemes.

Policy decisions about healthcare coverage in Canada and the United States in the 1960s placed two virtually identical systems on different evolutionary paths in the physician and hospital sectors. However, prescription drug coverage remained outside Canada’s single-payer model, and employer-based coverage continued to be the norm for the workforce population, as is the case across the broad healthcare system in the United States. As a result the current debate about pharmacare in Canada mirrors in political microcosm the larger debate on universal health insurance among American Democrats. In each case the near-term prospects for a single-payer plan appear slim.

Partnerships have various purposes and exist in many configurations. Although there has been a refocusing in health system research on forming strategic partnerships between researchers and knowledge users (KUs) to maximise the relevance and uptake of research in practice; research knowledge frequently fails to reach KUs nor impact the community served. Whilst there have been many attempts to engage KUs, researchers and decisionmakers often promote a top down approach that has lacked insight into KUs’ specific needs and values. Bowen and colleagues uncovered a plethora of negative experiences from a group of Canadian health leaders involved in researcher partnerships. Their comments reflect their experiences seemingly at an earlier stage of a partnership so we were not surprised by their pessimism. However, our experience reflects an established research-health service partnership network where we collaborate and co-create for mutual benefit and with a shared purpose. The reason for its sustained success over several decades is the focus on co-creation of value between stakeholders. Reimagining must prioritise a paradigm shift towards value co-creation if partnerships are to create opportunities for innovation, productivity and impact.

Drug coverage in Canada is a patchwork; an inequitable inefficient and unsustainable patchwork with no coherence or purpose. Some people think that we can solve the problem by adding more patches, but the core of the problem is that it is a patchwork. For the working population, access to medicines is still organized as privileges offered by employers to their employees. Universal pharmacare would not only provide better access to needed prescription drugs, but also eliminate waste, ensure value-for-money and help improve drug safety and appropriate prescribing. Opponents fear that a universal pharmacare plan would ration drugs, and impede drug access for some patients. However, these claims misunderstand the reality of drug coverage, pricing and access. Opponents propose, instead, to “fill the gap” of current drug coverage by implementing catastrophic coverage, which would serve commercial interests without maximizing health outcomes for the Canadian population. In spite of overwhelming evidence and consensus in the academic community in favour of universal pharmacare, the battle is far from over.

Partnerships between academic institutions and healthcare organisations have been proposed as an effective way to integrate academic research findings into changes in health policy and practice. Bowen and colleagues explore these partnerships from a different angle, analysing them in relation to the experiences of health system leaders. The authors made a call to re-imagine research, rethinking how we train applied health researchers, fund health research and evaluation and design studies and collaborations with the health sector. In this paper, I respond to this call by discussing three strategies we can use to make sure our research is timely, relevant and responsive to the needs and context of healthcare organisations: the widespread use of rapid research approaches, the integration of scoping stages in all studies, and the training of applied health researchers to work in the health system and develop collaborative relationships with staff.