Introduction The Egyptian health care system is undergoing significant transformation towards universal health coverage, and it is, therefore, necessary to evaluate the sustainability and resilience of the health system financing. Aim Our study aims to analyze the sustainability and resilience of health system financing in Egypt and provide evidence-based recommendations for evidence-informed policymaking. This was achieved through: (1) studying the current financing mechanisms of Egypt's health system; (2) determining how sustainable are these financing mechanisms given current trends; and (3) evaluating how resilient was the Egyptian health system financing during the COVID-19 pandemic. Methods The study was conducted from July 2023 to December 2023 over three stages: (1) literature review, (2) semi-structured interviews with 16 key stakeholders, and (3) focus groups with 12 experts. We conducted qualitative data analysis using a framework analysis approach, with findings triangulated across the three data sources. Narrative synthesis was used to summarize the main findings. Findings The health system in Egypt is currently financed through the old health insurance system, the newly implemented universal health insurance (UHI) system, private insurance system, and out-of-pocket financing. Financial indicators showed improved sustainability of health financing. Between 2010 and 2020, Egypt's health spending as a percentage of GDP increased, while out-of-pocket spending as a percentage of current health expenditures decreased. However, significant structural challenges persist, including a heavily regressive financing structure and coverage gaps for vulnerable populations. The UHI program ensures sustainability of health financing for the whole population in the longer term. Key insights demonstrated the resilience of the Egyptian health system financing during the COVID-19 pandemic, where supplementary public funds were released to cover the additional pandemic-related expenditures. Conclusion: This study provides valuable insights and evidence-based recommendations for policymaking to promote the sustainability and resilience of health system financing in Egypt. Recommendations are organized by health system sustainability and resilience domains and explicitly linked to policy implications to support evidence-informed policymaking.
Background The reimbursement of high-impact medicines (HIMs) poses growing clinical and budgetary challenges for publicly funded health systems. In Catalonia, pharmaceutical spending has increased considerably in recent years, driven by the uptake of high-cost therapies and expanded indications under clinical and economic uncertainty. To mitigate these risks, payers have increasingly used managed access mechanisms in reimbursement strategies. Objective To assess the economic impact of newly reimbursed high-impact medicines in Catalonia and describe the role and economic implications of managed access mechanisms applied to address clinical and financial uncertainty. Methods We conducted a retrospective study using real-world data from Catalonia's health service registries and billing systems. Expenditure trends for HIMs between 2019 and 2024 were analysed. Newly reimbursed indications from 2022 to 2024 were evaluated by therapeutic class, volume of patients, and aggregated expenditure per patient, taking into account the managed access mechanisms applied. Results From 2019 to 2024, HIM expenditure rose by 53% in nominal terms, from €1.10 billion to €1.69 billion; after adjustment for inflation, 2019 expenditure corresponded to approximately €1.30 billion in 2024 euros, indicating a real increase of approximately 30%. In 2024, HIM expenditure represented about 11% of the total healthcare expenditure managed by the Catalan Health Service. The top 10 medicines accounted for 43% of expenditure. Newly reimbursed indications in 2024 represented €23.6 million. Managed access mechanisms were applied to nearly three-quarters of these indications, including indication-based restrictions and formal agreements. Formal managed access agreements included confidential discounts, spending caps, patient-level spending caps, free-dose schemes, price–volume agreements, outcome-based payment models, and staggered payments. Conclusions Newly reimbursed HIMs exert concentrated expenditure pressure. These findings illustrate how the broad use of managed access mechanisms can support balancing access to innovation with health system sustainability. Future research is needed to identify the most effective managed access strategies to facilitate access to new HIMs at costs sustainable for health systems.
Background Quality monitoring ensures quality standards and improvement, while public reporting aims to inform patient choice. In Switzerland, quality monitoring and public reporting have fallen short of stakeholder expectations due to a misalignment with needs. Objectives This study explores stakeholder needs in inpatient and outpatient care for public reporting and quality monitoring in Switzerland. Methods In 2023, nine focus groups with 50 stakeholders from in- and outpatient somatic care were conducted. The data underwent qualitative content analysis to identify themes related to the purpose, challenges, and drivers of public reporting and quality monitoring, as well as indicator selection criteria. Results Public participants emphasised accessible quality information to guide decisions, especially in chronic or serious illness. A major gap was a single point of contact for navigating care and shared decision-making. Public and expert views diverged on who should access and interpret quality data. Experts prioritised monitoring for internal improvement. Both groups cited administrative burden and system fragmentation as key barriers. Conclusion While patients seek more involvement and access to data, expert reluctance to share quality information persists. Advancing public reporting requires recognising the public as a core audience and addressing data challenges through a national strategy.
Background Spain is considering restricting personal training to university graduates, which would exclude vocationally trained professionals (NUCPs). Objectives To conduct an exploratory policy scenario analysis, integrating narrative evidence synthesis, descriptive epidemiology, legal proportionality assessment, and economic modeling, to examine potential public health, legal, and economic implications of excluding NUCPs, under the explicit assumption that such exclusion reduces client access to professional supervision. Methods We synthesized legal, institutional, and scientific sources (January–May 2025) and developed illustrative scenario models using official workforce statistics and published injury and cost parameters. Results Under a hypothetical supervision-reduction scenario, not empirically observed consequences of the regulation, illustrative projections suggested 8812 additional injury events annually (probabilistic 95% uncertainty interval: 3552–14,802) among clients losing supervision, with an estimated productivity cost from temporary work disability of €16,504,725 (direct healthcare costs not included). A supply elasticity model projected short-term price increases of 18% (Es = 0.5) to 30% (Es = 0.3). Available evidence did not demonstrate that university qualification per se reduces injury risk. Conclusions The proposed exclusion lacks direct empirical support; modeled scenarios indicate potential adverse consequences under conservative assumptions. Less restrictive alternatives merit consideration.
Background Implementing national hospital reforms is challenging in decentralised health systems, where subnational governments are responsible for execution. In 2012, Switzerland introduced a national hospital reform, with implementation delegated to cantons. By applying the Health Policy Triangle, we examine how cantons have implemented the national hospital planning reform and what factors explain observed variation. Methods We employed a mixed-methods design. A document analysis and 25 semi-structured interviews with experts and cantonal representatives were combined with an unsupervised cluster analysis, examining whether structurally similar cantons showed comparable patterns of deviation.Findings.By 2024, 25 out of 26 cantons had adopted service groups with varying introduction timepoints and diffusion toward a shared model. Differences in the number of service groups and most requirements were minor. In contrast, minimum volume requirements varied considerably, driven by political feasibility concerns and the perceived risk of financially destabilising local hospitals. Conclusion The Swiss case shows that voluntary harmonisation can emerge in decentralised health systems through policy diffusion, where one canton's planning approach became a de facto standard for others. However, convergence is incomplete where implementation decisions are politically sensitive and where administrative capacities are limited. Decentralised systems may benefit from stronger national standardisation combined with transparent mechanisms for local adaptation, enabling a balance between quality, cost, and access considerations.
