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Background: South Korea achieved universal health coverage (UHC) through the National Health Insurance (NHI). However, humanitarian sojourners under temporary stay permits were initially excluded. Alongside recommendations from the National Human Rights Commission of Korea (NHRCK), the 2019 Amendment of the NHI Act expanded eligibility of the NHI. While this marked significant progress toward greater universality in health care, it also led to unintended consequences for humanitarian sojourners., Methods: This study employed a two-fold approach aligned with the trajectory of the Amendment. First, we conducted semi-structured in-depth interviews to analyze diverse perspectives on the universality of health coverage, the benefits of NHI, and the limitations of policies prior to the 2019 Amendment. Participants included government officials from the Ministry of Health and Welfare, Ministry of Justice, and NHRCK, as well as humanitarian sojourners sharing real-life experiences. Second, we examined the expected and unexpected outcomes of the Amendment by reviewing legal documents, reports, and media coverage after the Amendment. Specifically, we analyzed precedents set by the Korean Constitutional Court regarding the constitutional litigation, white papers, and interviews published in the news., Results: Despite achieving UHC, Korea had limited universality of health coverage prior to the 2019 Amendment, as humanitarian sojourners were excluded from local subscription. The 2019 Amendment of NHI Act expanded eligibility, making local subscription mandatory for humanitarian sojourners. However, unintended consequences emerged from differential treatment in calculating insurance premiums, determining dependents within the same households, and enforcing penalties for missed payments. Such disparities not only continue to restrict access to care but jeopardizes visa extensions for humanitarian sojourners., Conclusions: Our findings highlight a critical gap between policy intent and policy impact, revealing the consequences that disproportionately affect the most vulnerable populations, even under the UHC. Effective implementation of UHC requires a deeper understanding of how government officials and judicial authorities perceive universality and view refugee populations. The discrepancies identified in this study underscore the urgent need for coherent policies that not only expand health coverage but also establish a robust safety net to protect marginalized groups., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki. The first half of the study interviewing study participants was approved by the Institutional Review Board (IRB) of Ewha Womans University (IRB No. 94–11) in 2015. The entire study was deemed not human subject research using secondary dataset by the IRB of the Montclair State University (IRB-FY24-25–4019). Consent for publication: N/A. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This article analyzes the performance of the Brazilian National Regulatory for Private Health Insurance and Plans Agency (ANS, acronym in Portuguese) in the regulation of care in the sector from 2000 to 2018. After documentary analysis, the main initiatives of the regulatory dimension were characterized in the five terms of the agency's board of directors in the period. Furthermore, the study explores the legal and infra-legal norms related to the theme and the ANS main actions to guarantee coverage and qualification of the assistance offered by operators and service providers. These regulations were organized into three axes of care regulation: list of procedures and events in healthcare and care coverage; care segmentation; and Initiatives for health promotion, disease prevention, and qualification of care. We observed that the measures of care regulation implemented followed a continuity trend, despite the variation in political orientations and professional trajectories of their CEOs or the configuration of the collegiate board. This can be attributed to factors such as the professionalization of the regulation and the establishment of ANS institutional framework. Despite the micro-regulatory nature of the agency's performance, care regulation contributed to the promotion of comprehensive care for health plan beneficiaries and to the induction of better care practices by operators and their service providers. However, companies stakeholders still pressure public managers, aiming at making care regulation more flexible.

Background: With the introduction of the Digital Healthcare Act (DVG) at the end of 2019, digital health applications (DiGA) were included in the statutory health insurance in Germany. DiGA are digital medical products whose primary function is based on digital technologies. In the definition of the approval process, the term "therapeutic benefit", which is crucial to the evaluation of pharmaceuticals, was expanded to include the broader concept of "positive healthcare effect" ("pVE"). In particular, the concept of "patient-relevant structural and procedural improvements" (pSVV) has been introduced alongside the well-known "medical benefit" to facilitate market access for applications that specifically aim to strengthen the role of the patient in healthcare. Three and a half years after the implementation of DiGA, it has become evident that the concept of pSVV has not yet been adopted in the healthcare system to the extent intended by the legislation. As of July 1 st 2024, only one of the 56 listed DiGA uses pSVV as a primary endpoint, with ten others using pSVV as a secondary endpoint., Method: A qualitative approach was chosen to explore the new and under-researched topic of DiGA and, in particular, pSVV. The Grounded Theory method was applied in combination with the Gioia method, which is particularly suitable for analyzing innovative subject areas. The inductive approach allows for new concepts to be developed from the data of the study participants, thus supporting flexible and dynamic theory building. Decision-makers from groups including DiGA manufacturers with and without pSVV, manufacturers of digital medical products without DiGA approval, consultancies, and institutions involved in the DiGA approval process were included in the study by conducting semi-structured interviews. The evaluation was conducted through a multi-step analysis leading to the identification of first-order concepts, second-order themes, and aggregated dimensions. The developed data structure was supported by the presentation of relevant quotes as part of the Anhang A., Results: The analysis indicates that refining the benefit definition for the pSVV categories defined in the DiGA guidelines is critical to the successful establishment of the pSVV concept. Additionally, further analysis of potential methods for demonstrating pSVV, suitable measurement tools, and the general inclusion of economic considerations in the benefit analysis appear sensible., Discussion: The qualitative analysis demonstrates that refining the pSVV concept and defining appropriate measurement methods are essential for a successful implementation in the German healthcare system. An economic evaluation could bring objectivity to the debate on DiGA costs and contribute to transparency in the approval process. Further research and the involvement of key stakeholders are necessary to clarify the intended benefits within the pSVV categories, thereby promoting the introduction of digital health applications with a particular focus on empowering patients in healthcare., (Copyright © 2024. Published by Elsevier GmbH.)

This article examines the trends and trajectories of the nursing profession and healthcare practices in Israel from a historical perspective, following the enactment of the 1995 National Insurance Health (NHI) Law, which entitled every Israeli resident to healthcare services. Since then, Israel's health funds have become more competitive and services to patients have improved. Nurses in Israel have taken on new roles in the healthcare system, including working with professional colleagues to develop efficient teamwork that serves patients' needs. Nursing in Israel has also become increasingly academized, with all nursing training taking place in universities or academic colleges as of 2024. These changes mirror global trends in nursing and demand new thinking about the role of nurses, including how nursing can best serve patients and the wider healthcare system., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In 2021, the sole paragraph of article 40 of the Industrial Property Law (LPI) was declared unconstitutional. As a result, some companies filed lawsuits seeking an extension of the term of validity of their pharmaceutical patents. This article aims to estimate the possible economic consequences of the extension of the term of patents in spending on medicines for centralized procurement and the private market. This research consists of a descriptive case study in which an estimate of expenses is made on the economic effects of lawsuits filed in from May 12, 2021 to July 27, 2022. As a result, it was observed that the effects on expenses for the Brazilian Unified National Health System (SUS) and for families in the private market are much greater in the case of court extension than by the extinct sole paragraph of article 40. Considering the three hypothesized price reductions, expenses generated by court extensions to the SUS account for 28% (basic reduction), 20% (average), and 18% (drastic), which are higher than the old sole paragraph of article 40 provided for. For the private market, the expenses resulting from extensions would be 37.5% higher in the basic reduction, 28.9% in the average, and 28.8% in the drastic one, when compared to the sole paragraph of article 40. It is concluded that the judicial extension is even more harmful than the extinct paragraph of article 40, especially for consumers, in the three hypotheses of price reductions considered.

At the latest since the Medical Services Healthcare Insurance Reform Act (MDK), the declared will of the legislation is the conversion of operations previously carried out in an inpatient setting to an outpatient setting. In trauma surgery and orthopedics numerous operations are carried out that could principally also be performed in an outpatient setting; however, a prerequisite is a medical assessment of the suitability of patients as well as an economic and normative framework that makes outpatient surgery attractive. Both the Outpatient Surgery in Hospitals Catalogue (AOP-Katalog) and the first edition of the Hybrid Diagnosis-related Groups (DRG) define interventions in trauma surgery that could be carried out in an outpatient setting. Hospitals are therefore required to find solutions for these interventions under processual and economic provisos. These range from omission of outpatient operations to the expansion as a separate financial department in the hospital. With the introduction of the hybrid DRG, the legislation enables equal remuneration for outpatient versus short-term inpatient treatment and leaves the case management up to the hospital; however, the performance of the AOP in the setting of a hospital and also hybrid case flat rates are as a rule not economically viable and bear the risk of the failure of all efforts at conversion to outpatient settings. It is necessary to carry out a fundamental revision of the remuneration and framework conditions for outpatient operations in trauma surgery and orthopedics in hospitals, involving practitioners. This is the only way that the conversion to outpatient treatment can succeed., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: N. von Dercks, A. Schuster, C. Kleber und P. Hepp geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Health reform sees health promotion (HP) and health literacy (HL) as essential cornerstones for achieving health policy goals. This article examines the extent to which the legal foundation in the Austrian healthcare system provides a basis for orientation towards HP and HL. The focus of the analysis was set on medical professions, the health care and nursing professions, hospitals, and primary health care facilities., Methods: In a first step, legal and other relevant documents were reviewed. For this, a literature-based coding grid was created. In a second step, the legal bases were analyzed and interpreted using the coding grid. Recommendations were derived from the analysis of the legal basis and experts' assessments., Results: Health promotion and health literacy are included in the general legal foundations. However, HP/HL is primarily conceived as a supplementary service with separate financing and is thus less understood as an integral part of any patient contact. The primary health care units and the nursing professions have a relatively clear mandate with regard to HP/HL compared to the hospitals and medical professions. Overall, it was recognized that terminology should be used more coherently and operationalized for the respective areas of cure and care. In particular, the legal bases relating to the medical professions do not build on one another in a coherent manner., Conclusions: Having adequate staff is the key to HP/HL. If these are in place, competencies in the field of HP/HL should be required, promoted, evaluated, and rewarded. HP/HL should be an integral part of any care setting. The concepts of health promotion and health literacy should be operationalized in the legal frameworks of health professions and organizations. This is especially true for the Physicians' Act and for hospitals. Furthermore, the role of patients should be strengthened and the involvement of users in the planning of health services should be further developed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: The development of Swiss medical law is closely linked to social and medical development. In the early days and in the Middle Ages, healers and monasteries shaped medical care, with canon law playing an important role. In the early modern period, the first regional regulations for the medical profession emerged. With the founding of the federal state in 1848, the modernisation of medical law began; important laws such as the Factory Act (1877) and the first Health Insurance Act (1911) were introduced. In the 20th century, the introduction of the AHV/IV (1948) and the Health Insurance Act (KVG, 1996) marked the beginning of further professionalisation. Medical law is currently being adapted to meet modern ethical and legal challenges through laws such as the Human Research Act (2014) and remains a dynamic field., Competing Interests: Der Autor hat keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: Due to the development of digitalisation and information technology, medicine is subject to constant change. This development raises many new legal questions, most of which are still unanswered. This article first looks at the subarea of telemedicine and its regulation in federal and cantonal law and the question of the extent to which telemedicine is legally permissible. The particular focus here is on the doctor's perspective. Furthermore, this article deals with digital healthcare from the perspective of data protection law. Due to the central position of personal data in medicine, this area has become an integral part of everyday medical practice. This article provides a brief overview of this extensive field and highlights the most important key points of data protection law. Finally, this article uses a case study to address the question of the extent to which digital health applications should be considered medical devices. In practice, it is often very difficult to determine in advance whether such a digital health application is to be considered a medical device and is therefore subject to stricter regulations. The most important conditions in this regard are then presented and analysed., Competing Interests: Der Autor hat keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: The legal framework in Switzerland regarding medicine and health care is complex. Switzerland doesn't have a specific federal law on medicine or health care. Instead, numerous legal provisions apply to very different medical and health care situations. There are regulations located at different hierarchical legal levels with a variety of international, national and cantonal regulations, as well as the (soft) law of the medical profession. Under federalism and the principle of subsidiarity, the Swiss Federal Parliament is only responsible for the federal legal re-gulations where the Swiss Federal Constitution grants it the power to do so. The 26 cantons of Switzerland are responsible for all other matters. Therefore, the cantons have enacted specific health laws, patient laws and other regulations relevant to the medicine and health care sector. In addition, the Swiss Criminal Code is particularly relevant to medical treatments. The Swiss Criminal Code punishes, among others, assaults on life and physical integrity. Criminal liability is an individual responsibility and is determined by whether the requirements for criminal behavior are met in the individual case., Competing Interests: Die Autorin hat keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: The basic principles of medical liability in Switzerland are the same regardless of whether a physician is self-employed or employed. The first part of this article provides an overview of the jurisdiction of the Federal Supreme Court on the requirements for medical liability under civil law and state liability law, which is aimed at financial compensation for damages suffered by patients. The second part describes the insurance cover and important obligations that the physician has in the event of a claim. The third part of the article contains recommendations developed from the practice of a hospital on what to do after a possible medical error., Competing Interests: Der Autor hat keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: In vascular surgery too, more services and procedures will have to be shifted from the previous inpatient to the outpatient sector in the future. Therefore, the previous and new legal requirements as well as their implementation in vascular surgery will be explained and evaluated., Material and Methods: Professional policy analysis from a perspective of medical vascular surgery., Results: The AOP catalog from 01.01.2023 was extended by 208 additional OPS codes. The inpatient performance of services which, according to the AOP contract, must be regularly performed on an outpatient basis, are now to be justified on the basis of context factors.A special sector-equivalent remuneration, which is independent of whether the remunerated service is performed on an outpatient or inpatient basis, is a prerequisite for a cost-covering expansion of outpatient operations and inpatient-replacing services. The rehabilitation of primary varicosis under outpatient conditions is undoubtedly the standard. The majority of AV shunt installations are performed as inpatient procedures. No new OPS codes were added to the 2023 AOP catalog for varicose vein, shunt and endovascular surgery., Discussion: The shift of inpatient services to the outpatient sector can be a feasible path, based on the experience of other European countries. However, the structures, economic conditions and incentives should first be created to successfully promote transfer to outpatients. Integrated care offers the possibility for the health insurance funds to conclude contracts with the service providers named in § 140a of the Social Code, paragraph 3, for special care. The use of telemedicine in the sense of tele-premedication or tele-monitoring can be a way to expand outpatient surgery, especially in rural regions. In order to enable therapy concepts from one expert in vascular medicine, the outpatient service billing of interventional procedures must also be demanded by vascular surgeons and specialists., Conclusion: The potential to transform inpatient services into the outpatient setting of service provision is realisable in vascular surgery in the core areas of varicose vein surgery, shunt surgery and peripheral interventional procedures under specific conditions., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

This article aims to analyze the performance of the Brazilian Unified National Health System (SUS, acronym in Portuguese) hospital network based on the national databases of the Brazilian Hospital Information System (SIH, acronym in Portuguese) and the Brazilian National Registry of Health Establishments (CNES, acronym in Portuguese). The research used a set of indicators covering the production of admissions, the profile, quality and performance of care, associated with hospital size and legal nature. For data analysis, the Analysis of Variance with Tukey-Kramer test was used to highlight the differences between public and private hospitals, the moderation analysis to verify the effect of hospital size and the Pabon Lasso model to integrate the results. The results show that the increase in the number of beds influences the performance of the indicators differently for public and private hospitals. Public hospitals showed higher gains in scale efficiency with the increase in beds, whereas private non-profit hospitals showed a higher performance in the set of indicators and a more balanced performance in the different sizes. The application of the Pabon Lasso model showed that small hospitals, both public and private, perform poorly. It also showed that from medium-sized onwards, public and private hospitals perform well. However, each category displays particularities in its performance profile, reflecting a diversity of practices and operational results. This study thus confirms previous findings that hospital performance tends to improve as the number of beds increases, but also reveals that it varies significantly depending on the legal nature of these institutions.

On 15 May 2024, the National Health Insurance Act No. 20 of 2023 (the Act) was signed into law, and South Africa (SA) officially adopted a national health insurance (NHI) system as part of its efforts to achieve universal healthcare across the country. While NHI has been controversial and much talked about, plenty of how the scheme will operate remains an unknown, and has not been defined within the Act. However, it is evident that, with SA's limited healthcare budget, the NHI scheme is not going to cover everything for everyone. Some decisions will need to be made about what kinds of healthcare and other benefits South Africans can expect to have covered by the scheme - in other words, decisions about what will be included under NHI and what will be excluded. This paper does not aim to discuss the constitutionality or legality of the NHI Act, but focuses only on the issue of how government ought to consider making decisions about what services the NHI covers.

In addition to the existing social law options for primary care under medical responsibility for those with statutory health insurance, there are several projects to supplement the service structures: healthcare kiosks, primary care centers and community health nursing as well as general practitioner outpatient clinics in hospitals. These new projects amount to an institutionalization of services that were previously based at outpatient offices and partially to the transfer of medical services that were previously the responsibility of doctors to the responsibility of non-physician healthcare professionals, with additional financial outlay but without creating new care capacities. The constructs considered do not appear to be suitable for making a relevant contribution to compensating for the gap in doctors specialized in general or internal medicine and in other medical professionals in a demographically induced capacity phasing out process that is forecast to last until around 2036. The further development of German social law on primary care should instead focus on increasing the efficiency of resources which are becoming scarcer through guided and graduated access to doctors according to medical criteria., (© 2024. The Author(s).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.

Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model., Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams., Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018., Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Coelho Tavares da Silva, Tavares da Silva, Antão de Medeiros and Barbosa do Nascimento.)

Background: The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites., Methods: The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated., Results: The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials., Discussion: The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete., (© 2024. The Author(s).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

After discharge of premature infants with complex care needs from the neonatal intensive care unit, a care gap arises due to the transition from inpatient to outpatient care. Consequences can be rehospitalization, revolving door effects, and high costs. Therefore, following hospitalization or inpatient rehabilitation, the patient is intended to transition to sociomedical aftercare. The legal basis for this is formed by § 43 paragraph 2 of the Fifth Book of the German Social Code (SGB V). Over 80 aftercare institutions in Germany work according to the model of the Bunter Kreis. The comprehensive concept describes possibilities for networking which exceed the services provided by sociomedical aftercare. Simultaneously, depending on their stage of development, young adults can receive aftercare according to this model up to their 27th year of life. The interdisciplinary team at the Bunter Kreis comprises nurses, social workers, social education workers, psychologists, and specialist physicians. The largest group of supported persons, with 6000-8000 children per year, is comprised of premature and at-risk babies as well as multiple births, followed by 3000-5000 children with neurologic and syndromic diseases. Other common diseases are metabolic diseases, epilepsy, and diabetes, as well as children after trauma and with rare diseases. Overall, the various diseases sum up to around 20 clinical pictures. The current article presents the Bunter Kreis aftercare process based on case examples., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht..

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

Integrated regulations for medical and nursing care in long-term care: qualitative results of the process evaluation: Innovative form of care in long-term care Abstract: Background: Long-term care patients, most of whom suffer from multimorbidity, are dependent on appropriate medical and nursing care. Inadequate interdisciplinary cooperation structures and processes pose a challenge for nursing care when residents' conditions deteriorate and can lead to hospital admissions that could potentially be avoided. Objective: Structures and processes of interdisciplinary cooperation were developed and implemented as part of the SaarPHIR innovation fund project "Saarländische PflegeHeim Versorgung Integriert Regelhaft". The aims of the qualitative part of the process evaluation were the subjective assessment of the structural and process level of the complex intervention across all project phases from the perspective of the participants as well as an analysis of the context factors. Method: Qualitative interviews were conducted with all participating facilities and the medical care communities formed as part of the project in order to record the subjective experiences gained in the implementation and impact of the complex intervention. The data analysis was carried out using qualitative content analysis. Results: Both professional groups perceive a structural organizational change that has a positive effect on interdisciplinary cooperation. The benefits in terms of care are rated as high. Conclusion: Various measures (e.g. pre-weekend ward rounds, extended on-call duty) at the structural and process level should be retained when transferring to standard care.

Importance: The Inflation Reduction Act of 2022 authorizes Medicare to negotiate prices of top-selling drugs based on several factors, including therapeutic benefit compared with existing treatment options., Objective: To determine the added therapeutic benefit of the 50 top-selling brand-name drugs in Medicare in 2020, as assessed by health technology assessment (HTA) organizations in Canada, France, and Germany., Design, Setting, and Participants: In this cross-sectional study, publicly available therapeutic benefit ratings, US Food and Drug Administration documents, and the Medicare Part B and Part D prescription drug spending dashboards were used to determine the 50 top-selling single-source drugs used in Medicare in 2020 and to assess their added therapeutic benefit ratings through 2021., Main Outcomes and Measures: Ratings from HTA bodies in Canada, France, and Germany were categorized as high (moderate or greater) or low (minor or no) added benefit. Each drug was rated based on its most favorable rating across countries, indications, subpopulations, and dosage forms. We compared the use and prerebate and postrebate (ie, net) Medicare spending between drugs with high vs low added benefit., Results: Forty-nine drugs (98%) received an HTA rating by at least 1 country; 22 of 36 drugs (61%) received a low added benefit rating in Canada, 34 of 47 in France (72%), and 17 of 29 in Germany (59%). Across countries, 27 drugs (55%) had a low added therapeutic rating, accounting for $19.3 billion in annual estimated net spending, or 35% of Medicare net spending on the 50 top-selling single-source drugs and 11% of total Medicare net prescription drug spending in 2020. Compared with those with high added benefit, drugs with a low added therapeutic rating were used by more Medicare beneficiaries (median 387 149 vs 44 869) and had lower net spending per beneficiary (median $992 vs $32 287)., Conclusions and Relevance: Many top-selling Medicare drugs received low added benefit ratings by the national HTA organizations of Canada, France, and Germany. When negotiating prices for these drugs, Medicare should ensure they are not priced higher than reasonable therapeutic alternatives.

When encountering the outbreak and early spreading of COVID-19, the Government of Japan imposed gradually upgraded restriction policies and declared the state of emergency in April 2020 for the first time. To evaluate the efficacy of the countering strategies in different periods, we constructed a SEIADR (susceptible-exposed-infected-asymptomatic-documented-recovered) model to simulate the cases and determined corresponding spreading coefficients. The effective reproduction number R t was obtained to evaluate the measures controlling the COVID-19 conducted by the Government of Japan during different stages. It was found that the strict containing strategies during the state of emergency period drastically inhibit the COVID-19 trend. R t was decreased to 1.1123 and 0.8911 in stages 4 and 5 (a state of emergency in April and May 2020) from 3.5736, 2.0126, 3.0672 in the previous three stages when the containing strategies were weak. The state of emergency was declared again in view of the second wave of massive infections in January 2021. We estimated the cumulative infected cases and additional days to contain the COVID-19 transmission for the second state of emergency using this model. R t was 1.028 which illustrated that the strategies were less effective than the previous state of emergency. Finally, the overall infected population was predicted using combined isolation and testing intensity; the effectiveness and the expected peak time were evaluated. If using the optimized control strategies in the current stage, the spread of COVID-19 in Japan could be controlled within 30 days. The total confirmed cases should reduce to less than 4.2 × 10 5 by April 2021. This model study suggested stricter isolating measures may be required to shorten the period of the state of emergency., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Zhongxiang Chen et al.)

Introduction: The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce "out-of-pocket" payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders' views on ways to improve the financial sustainability of the operations of NHIS., Methods: Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 software., Results: Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers' fraud and protection from political interference. Secondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims' reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage., Conclusion: The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers., Competing Interests: The authors have declared that no competing interests exist.

The procedures of prenatal and preimplantation diagnostics are discussed critically again and again in our community. In addition to the permanently controversial issues of embryo protection and abortion, considerations that discrimination on the basis of disability could occur with problematic consequences also for already born people with disabilities and their relatives now play a central role., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: In 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS) to enable all Ghanaian residents to have access to health services at the point of care without financial difficulty. However, the system has faced a number of challenges relating to delays in submission and reimbursement of claims. This study assessed views of stakeholders on claims submission, processing and re-imbursement under the NHIS and how that affected health service delivery in Ghana., Methods: The study employed qualitative methods where in-depth interviews were conducted with stakeholders in three administrative regions in Ghana. Purposive sampling method was used to select health facilities and study participants for the interviews. QSR Nvivo 12 software was used to code the data into themes for thematic analysis., Results: The results point to key barriers such as lack of qualified staff to process claims, unclear vetting procedure and the failure of National Health Insurance Scheme officers to draw the attention of health facility staff to resolve discrepancies on time. Participants perceived that lack of clarity, inaccurate data and the use of non-professional staff for NHIS claims vetting prolonged reimbursement of claims. This affected operations of credentialed health facilities including the provision of health services. It is perceived that unavailability of funds led to re-use of disposable medical supplies in health service delivery in credentialed health facilities. Stakeholders suggested that submission of genuine claims by health providers and regular monitoring of health facilities reduces errors on claims reports and delays in reimbursement of claims., Conclusion: Long delays in claims reimbursement, perceived vetting discrepancies affect health service delivery. Thus, effective collaboration of all stakeholders is necessary in order to develop a long-term strategy to address the issue under the NHIS to improve health service delivery., Competing Interests: The authors have declared that no competing interests exist.

Background: In all Canadian provinces, physicians can decide to either bill the provincial public system (opt in) or work privately and bill patients directly (opt out). We hypothesized that 2 policy events were associated with an increase in physicians opting out in Quebec., Methods: The 2 policy events of interest were the 2005 Supreme Court of Canada ruling on Chaoulli v. Quebec and a regulatory clampdown forbidding double billing that was implemented by Quebec's government in 2017. We used interrupted time-series analyses of the Quebec government's yearly list of physicians who chose to opt out from 1994 to 2019 to analyze the relation between these events and physician billing status., Results: The number of family physicians who opted out increased from 9 in 1994 to 347 in 2019. Opting out increased after the Chaoulli ruling, and our analysis suggested that between 2005 and 2019, 284 more family physicians opted out than if pre-Chaoulli trends had continued. The number of specialist physicians who opted out rose from 23 in 1994 to 150 in 2019. Our analysis suggested that an additional 69 specialist physicians opted out after the 2017 clampdown on double billing than previous trends would have predicted., Interpretation: We found that the number of physicians who opted out increased in Quebec, and increases after 2 policy actions suggest an association with these policy interventions. Opting out decisions are likely important inputs into decision-making by physicians, which, in turn may influence the provision of publicly funded health care., Competing Interests: Competing interests: Damien Contandriopoulos provided an affidavit (pro bono) for the Attorney General of British Columbia on matters related to this article. Michael Law received compensation for providing expert witness testimony for the Attorney General of Canada on matters relating to this article and from the Federation of Post-Secondary Educators on matters not related to this work. He has also consulted for Health Canada, the Hospital Employees’ Union and the Conference Board of Canada on unrelated topics., (© 2021 Joule Inc. or its licensors.)

Introduction: Background: the legislation currently regulating the inclusion of Food for Special Medical Purposes (FSMP) among the benefits of the National Health System (SNS) was made approximately 15 years ago. The evolution of the technical characteristics of the FSMP justifies an analysis of the current regulation and the consideration of possible regulatory modifications that would allow the incorporation of the progress achieved. Material and methods: four successive focus groups of experts, mostly doctors (91%), hospital specialists in disciplines related to nutrition (73%), from 8 different hospitals and 6 autonomous communities. Previously, 4 documents summarizing different technical aspects of the regulation on FSMP in Spain were sent to the participants. The audio of the meetings was transcribed anonymously and its content was codified. Results: the contents of the focus groups were grouped into 9 codes: 1) problems and regulation; 2) clinical benefits and evidence of efficacy or effectiveness; 3) clinical indications; 4) international context and comparisons with other countries; 5) budgetary impact; 6) cost-effectiveness; 7) risks and reasons for maintaining current regulation; 8) proposals for progress, feasibility and aspects that make implementation difficult; and 9) other issues. Conclusions: based on the technological development and clinical application of the FSMP carried out in recent years, an update of the regulation of these products can be proposed for financing by the National Health System in Spain. Most of these changes do not imply an increase in expenditure if current conditions regarding indications and maximum prices are maintained.

The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.

Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context., (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.