Search Results (337)

Background/Objectives: Despite major advances in precision medicine, equitable and timely access to innovative oncology therapies remains challenging because of differences in reimbursement systems, health technology assessment (HTA), and healthcare organization. Physicians are well positioned to identify barriers affecting the implementation of these therapies in routine practice. This study evaluated Bulgarian physicians’ perceptions of innovative oncology therapies, assessed patient access, identified barriers to timely availability, and examined factors perceived as associated with these perceptions. Methods: A cross-sectional web-based survey was conducted between March and May 2025 among physicians involved in oncology care in Bulgaria. The questionnaire comprised six domains addressing professional characteristics, self-perceived knowledge, clinical implementation, perceptions of patient access, barriers to implementation, and policy priorities. Descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and multivariable ordinal logistic regression were used to analyze the data. Results: A total of 114 physicians participated. Respondents generally reported moderate-to-high levels of self-perceived knowledge regarding innovative oncology therapies. Self-perceived knowledge was higher among medical oncologists (adjusted p < 0.001) and physicians treating at least 100 patients with cancer per month (adjusted p = 0.003). Overall, 57.9% of respondents (95% CI: 48.7–66.6%) rated the perceived timeliness of access as good or very good, while 68.4% (95% CI: 59.4–76.2%) reported encountering patients who sought treatment abroad because innovative therapies were perceived as unavailable or insufficiently accessible in Bulgaria. Professional experience (aOR = 0.68, 95% CI: 0.50–0.93; p = 0.014) and higher monthly patient volume (aOR = 0.45, 95% CI: 0.21–0.96; p = 0.039) were independently associated with more favorable perceptions of access. Financial constraints, regulatory and HTA-related delays, and perceived delays in pharmaceutical-company submissions were the principal perceived barriers. Conclusions: Bulgarian oncology specialists demonstrate high self-reported professional readiness for innovative oncology therapies; however, the perceived timely patient access remains constrained primarily by financial, organizational, and reimbursement-related factors. Although, these findings reflect physicians’ perceptions and do not establish causal determinants of access, strengthening reimbursement pathways, HTA implementation, molecular diagnostic capacity, and clinical research infrastructure may improve equitable access to innovative oncology therapies within the evolving European HTA framework. Full article

Medical tourism is among the fastest-growing segments of the global travel industry, and Taiwan’s internationally recognised healthcare system positions it well to compete in this market. Yet the companies best placed to lead this development have traditionally been identified through online word-of-mouth or personal recommendation rather than objective evidence, and performance criteria are rarely weighted to reflect both subjective opinion and objective data. This study addresses both gaps with a hybrid framework that uses main path analysis to identify, objectively, the companies most active in medical aesthetic technology, and integrates the Best–Worst Method (BWM), Entropy, Game Theory, and Grey-based TOPSIS to weight a four-dimensional, seventeen-criterion framework and rank company performance in medical tourism. An empirical application to seven Taiwanese companies engaged in medical aesthetics alongside medical tourism, drawing on industry expert assessments, shows that Service and Healthcare Resources is the most influential dimension, and that cloud-based customisation, multilingual personnel, and professional in-trip medical care are the most important criteria. Sensitivity analysis across nine weighting scenarios and comparison against four alternative ranking methods confirm the robustness of the ranking. The framework offers a replicable, objective template for evaluating medical tourism performance and provides managerial guidance for companies and policymakers seeking to strengthen Taiwan’s position in this market. Full article

Background: In line with international aging policies, most people with dementia receive care at home. Community-based respite services aim to relieve, support, or share caregiving responsibilities. More person-centered knowledge based on experiences from this group is needed to increase informed decisions about planning of qualitative respite care. The aim of this study is to describe how people with dementia experience respite care with alternating housing, i.e., living partly at home, partly in residential care, refer to their everyday life and well-being. Methods: A mixed-methods design was used. The qualitative approach focused on variations of dilemmas in interviews with people with dementia who were granted and received respite care (n = 8). Also, a quantitative approach focused on quality of life using behavioral and psychological symptom scores. Results: Everyday life at the respite care accommodation described by people with dementia included morning routines, variation in the environment, activities in the company of roommates, but also a lack of activities. Social belonging was described by people with dementia through living with roommates and through social contact with the healthcare staff. Quality of life and behavioral and psychological ratings varied between individuals and settings, but no consistent pattern was identified. Conclusions: Respite care appears to maintain a high quality of life and a low level of psychological symptoms for most of the people with dementia. Although the sample was small, these results are nevertheless an important contribution to the phenomenon, experiences of respite care by people with dementia, that need further research. Furthermore, these results can give decision-makers guidance for professional care efforts. Full article

Alcohol consumption is associated with significant social and economic challenges for nations worldwide, including alcohol-related healthcare costs and alcohol-related crime. According to the U.S. Center for Disease Control (CDC), even moderate drinking correlates with greater health risks compared with not drinking at all. These health risks include physical harm to a person’s heart, brain, liver, and other organs; impaired social functioning; reduced work performance; and increased incidence of alcohol-related violence and injury (e.g., physical and sexual assault and drunk driving-related injuries and death). Although personal health and social problems are correlated with alcohol consumption across genders, women experience disproportionately worse problems associated with alcohol-related crime and family disruption. At the societal level, alcohol use coincides with substantial negative economic problems, including increased healthcare costs, often covered by the government; reduced worker productivity; and higher criminal justice system costs. This paper applies an econometric analysis to evaluate the association between alcohol consumption and key social and economic factors and suggests actions that business firms, government entities, universities, and other organizations can take to reduce alcohol-related harm, such as encouraging sobriety in the workplace, offering alcohol-related counseling services, and not establishing associations with nor accepting payments of any kind from alcohol beverage companies. The findings have implications for business managers, government leaders, policy-makers, and others. Full article

This paper assesses the impact of uncertainty for investors on the economic valuation of medical innovation projects for orphan drugs or rare diseases. Conventionally, investor evaluation uses the deterministic discounted cash flow (DCF) method with an appropriate sensitivity analysis that captures some level of uncertainty. In healthcare, and particularly for rare diseases, the levels of uncertainty in financial outcomes (return on investment and net present value (NPV)) are broader than the ones normally captured by the DCF formula. Uncertainties include R&D costs, the approval process (level and timing) for obtaining reimbursement, sales, the production cost, and the failure probabilities of the clinical trial phases, to name a few. Additionally, there is not only one type of investor to consider, but different investors exposed to different levels of risk management of their investment. Our analysis tried to capture those two dilemmas (higher levels of uncertainty and different investor types) in two ways. One way was to identify a better method to enhance the different levels of uncertainty. The real option method of evaluation was proposed instead of DCF. For instance, the real option method better captures the uncertainty of the different phases of product development. The other way is to differentiate the investor types through their level of risk assessment perspectives. Small investors and start-up companies may see more benefit in applying the real option methodology to estimate their NPVs at different time points during product development. In summary, our evaluation identified various types of uncertainty when assessing an investment, along with methods to manage their effect on the economic/financial outcomes of medical innovations. Given the high uncertainty associated with early-stage drug development, such as orphan drugs for rare diseases, the real options approach is preferable to traditional DCF models. The analysis also showed that there is not just a single investor perspective to consider but specific perspectives that enhance the prime use of the real option methodology. Full article

The deployment of natural-language-to-SQL (NL-to-SQL) systems in primary healthcare requires more than accurate query generation: it also requires governed data access, robustness to local terminology, and reliable handling of ambiguous user requests. This study evaluated a pilot proof-of-concept integrating a Spanish-language NL-to-SQL assistant with a governed, read-only outpatient scheduling repository derived from the Rayen information system used in a Centro de Salud Familiar (CESFAM) setting in Renca, Chile. The data used by the prototype were accessed through an external company responsible for data management in this context. The prototype was implemented with MindsDB as an artificial intelligence (AI)-enabled database layer and operated on anonymized, delayed secondary scheduling data. Evaluation was conducted through a Slack interface using 252 audited interactions from 42 users, with six assigned interactions per user and up to three exchanges per interaction. SQL correctness reached 240/252 (95.2%), whereas both query correctness and answer correctness reached 144/252 (57.1%). These findings suggest that governed pilot deployment for outpatient schedule monitoring may be feasible under controlled institutional conditions, while indicating that the main remaining barriers are semantic rather than purely syntactic, specifically ambiguity handling, institution-specific operational language, and faithful answer verbalization. The study therefore contributes deployment-oriented pilot evidence and clarifies where operational Spanish NL-to-SQL remains fragile under real institutional constraints. Full article

Objective: This study identifies specific patterns of exclusion in health insurance policies in India, based on age, gender and pre-existing ailments. Method: For its purposes, extensive primary research was conducted across different levels of the health insurance infrastructure, spanning the national health insurance scheme, 14 state health insurance policies, and individual and group health insurance policies offered by four government and five fourteen state health insurance policies as well as individual and group health insurance policies offered by four government and five private companies. In addition, a secondary literature review was conducted on topics such as health insurance, health financing, universal access to healthcare, and legal and regulatory frameworks. Results: The findings reveal that health insurance policies fail to address the distinct health needs of specific groups, such as women, children, and older people, and the concerns about their access to healthcare. Age-based exclusions demonstrate that the mere existence of specific policies for “seniors” is not sufficient to achieve the goal of universal health coverage in India. Health insurance policies for women lack coverage for reproductive and other health services, including gender affirming procedures. These exclusions can signify that such health services are unimportant and can be ignored in the insurance policies being offered by both the government and private companies, exacerbating the discrimination faced by groups such as persons with the capacity for pregnancy, as well as transgender persons. Finally, most health insurance policies covered in this study exclude congenital external anomalies as “pre-existing ailments”, while others impose specific waiting periods before coverage begins. Conclusions: This study identifies specific patterns of exclusion in both private and public health insurance policies in India, including those based on age, gender, and pre-existing conditions, to assess how these exclusions affect access to healthcare for specific groups. Full article

Background/Objectives: Small-scale workplaces often have limited access to occupational health services, despite potential exposure to hazardous solvents. Biological monitoring can provide worker-level evidence of internal exposure when routine environmental monitoring is limited. This study evaluated urinary biomarkers of benzene and toluene exposure among workers in small-scale printing workplaces in South Korea and examined whether self-reported chemical handling corresponded with biomarker patterns. Methods: In this cross-sectional field biomonitoring study, 21 workers from eight printing companies provided end-of-shift urine samples. Creatinine-adjusted urinary concentrations of trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), phenol, and o-cresol were analyzed and compared with applicable biological reference values. Associations between reported chemical handling and elevated biomarker levels were estimated using Firth’s penalized logistic regression, and correlations among log-transformed biomarkers were explored. Results: Nine workers (42.9%) had urinary o-cresol concentrations at or above the American Conference of Governmental Industrial Hygienists (ACGIH) biological exposure index of 300 μg/g creatinine. Workers reporting benzol handling, a local term for petroleum-based cleaning products, had higher odds of elevated SPMA, although the estimate was imprecise and hypothesis-generating (age-adjusted OR 6.04, 95% CI 0.75–104.90, p = 0.093). The correlation between SPMA and t,t-MA was stronger among workers reporting benzol handling (r = 0.94) than among those reporting toluene handling (r = −0.01). Conclusions: These exploratory findings indicate that toluene-related internal exposure is a relevant occupational health concern in small-scale printing workplaces, while reported benzol handling may indicate possible low-level benzene-related exposure. Urinary biomonitoring may support exposure surveillance and preventive occupational healthcare in small enterprises when interpreted alongside workplace observations, product information, ventilation, protective equipment use, and worker education. Full article

This study examines how innovation and green management influence business sustainability and firm value in Indonesian healthcare companies. Innovation is measured using Value-Added Intellectual Capital (VAIC) efficiency, green management through Environmental, Social, and Governance (ESG) scores, business sustainability as carbon emission disclosure (CEDI), and firm value as Market Value Added (MVA). The sample consists of 123 firm-year observations from healthcare firms listed on the Indonesia Stock Exchange (2019–2023). Based on the capital-based theory of sustainability and stakeholder theory, hypotheses are tested using fixed-effect panel regression, Baron and Kenny mediation analysis, and Structural Equation Modelling (SEM). The results show that VAIC is the only significant predictor of MVA, with a consistent positive effect across all model specifications. Neither ESG Score nor CEDI shows a significant effect on market value, indicating that sustainability disclosure has not yet translated into measurable financial returns in this context. Within the structural model, ESG governance is the strongest predictor of carbon disclosure, while firms with higher VAIC tend to prioritise value creation over environmental reporting. All mediation hypotheses are rejected. These findings suggest that intellectual capital and sustainability practices currently function as separate strategic priorities in Indonesian healthcare. Intellectual capital produces tangible market value in the short term, while the financial benefits of sustainability disclosure are likely to emerge only as Indonesia’s ESG reporting standards and investor awareness continue to develop. Full article

Across the globe, companies are facing significant pressure to reduce waste, improve resource efficiency, and report their sustainability efforts transparently. ESG frameworks have become essential tools for sustainability transformation. However, traditional business models, based on a linear “take–make–dispose” approach, continue to dominate industries, limiting the impact of ESG efforts. The circular economy offers a compelling alternative: it encourages designing products for reuse, recycling, and regeneration, thus aligning closely with ESG principles. When businesses transition to circular models, they reduce their environmental footprint, create new green jobs and social inclusion opportunities, and strengthen accountability across business value chains. This study explores how selected firms in the mining, energy, consumer cyclical, technology, and healthcare sectors are aligning circular principles with ESG practices. Using a longitudinal, multi-sector comparative analysis of ESG indicators spanning 2014–2024, the research examines sector-level ESG evolution, firm-level ESG leadership, and the alignment of ESG performance with circular business model pathways. Rather than directly measuring circular transformation, ESG indicators are interpreted as signals of emerging circular business model pathways. This study identifies ESG-based ways and enabling conditions through which circularity may be increasingly embedded across different sectors. Full article

Background: Stroke remains a significant health and economic challenge both globally and in the Czech Republic. Although a structured network of specialized stroke centres exists, comparative data on patient outcomes and healthcare costs across hospital types are still lacking in the Czech context. This study analyzed real-world administrative data to assess 90-day mortality and healthcare costs after ischemic stroke, categorized by intervention and provider type. Methods: Claims data from six Czech health insurance companies, covering approximately 44% of the population, were used for the years 2017–2020. Patients aged 18 and older with a primary diagnosis of ischemic stroke (ICD-10 code I63) were included. Interventions were categorized as thrombectomy, thrombolysis, or other treatment, and providers were classified as comprehensive stroke centres (CSCs), primary stroke centres (PSCs), secondary referral hospitals (SRHs), or others. Costs were calculated from the payer perspective using administrative claims data, and standardized 90-day mortality and effective cost per survivor (ECPS) were computed. Funnel plots were used to evaluate provider variability in outcomes and costs. The analysis included 23,568 patients (47% female; mean age 70.6). Results: Thrombectomy was associated with the highest mean costs (€13,385), the highest 90-day mortality (29.3%), and the highest ECPS (€18,880). Patients receiving other treatments had the lowest costs (€2725) and lower mortality (14.4%). CSCs recorded the highest average costs (€5087) and mortality (16.7%), while SRHs had the lowest costs (€2204) and mortality (13.7%). Funnel plots revealed greater variability in costs, mainly driven by primary hospitalization, while mortality rates showed less variation. Conclusions: These findings suggest that while stroke outcomes are relatively consistent across providers, costs differ, possibly reflecting efficiency differences and case-mix severity. The study is limited by the lack of clinical severity data, highlighting the need to link administrative data with clinical registries for more comprehensive future evaluations. Full article

Service industries are fast turning digital, and they are disrupting the manner in which firms organize and relate to their customers. Nevertheless, mechanisms that allow digital capabilities to be converted to better customer experience remain poorly understood, especially in the emerging economies. This paper presents the dual-mediation model to investigate the effects of Digital Supply Chain Integration (DSCI) and capabilities of digital customer engagement (DCEC) on Customer Experience Outcomes (CXO) based on Sustainable Business Model Innovation (SBMI) and Customer Value Co-Creation (CVC) with references to Dynamic Capabilities Theory and Service-Dominant Logic. The data were collected by a cross-sectional survey of 360 managers of the banking, telecom, healthcare, and hospitality organizations in Pakistan and analyzed with the help of Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings indicate that the customer experience is enhanced well beyond what is feasible alone by means of Sustainable Business Model Innovation due to the Digital Supply Chain Integration, whereas customer experience is enhanced by the Digital Customer Engagement Capabilities through Customer Value Co-Creation. The results also show that the mechanisms of co-creation have the largest impact on the outcome of customer experience. The research is an addition to the body of literature on digital transformation because it illustrates how digital integration, innovation that is focused on sustainability, and relational co-creation can collectively convert digital capabilities into experiential value. The results also provide practical factors that should be considered by service companies when embarking on digital transformation programs to align the programs with sustainability and customer engagement mechanisms. Full article

In South Africa, both economic and social entrepreneurship have become a game-changing strategy for tackling enduring socioeconomic issues, including inequality, unemployment, and poverty. In contrast to conventional business models that put profit maximisation first, social entrepreneurship combines entrepreneurial tactics with social goals to develop long-lasting solutions for underserved populations. This study examines how social entrepreneurship can be used to address socioeconomic problems in South Africa, highlighting how it can promote inclusive growth and help achieve both national and international development objectives. The study illustrates how social companies use innovation and community participation models to overcome structural impediments such as youth unemployment, healthcare disparities, and limited access to education. It is based on a thorough evaluation of academic literature. The results show that social entrepreneurship fosters social cohesiveness and resilience in marginalised areas in addition to creating job and income opportunities. However, issues including weak finance, insufficient policy frameworks, and a dearth of capacity-building programmes make it difficult for social enterprises to grow and survive. In order to strengthen the social enterprise sector, the study’s conclusion suggests creating supportive ecosystems through impact investments, policy reforms, and educational initiatives. South Africa can expedite its efforts to reduce inequality and achieve sustained socioeconomic transformation by presenting social entrepreneurship as a strategic development tool. Full article

Background/Objectives: In the United States, adult human papillomavirus (HPV) vaccination coverage remains low at 20–50%, depending on age, and cervical cancer (CC) screening rates range from 68 to 76%. Few studies have evaluated characteristics of women who are both HPV vaccinated and up to date (UTD) with screening as an integrated outcome. The purpose of the present study was to classify women into four prevention categories and examine factors associated with being double protected compared to unprotected. Methods: Data were gathered via an online survey from a sample of low-income women (household income < USD 50,000) provided by a research survey company (n = 719). Women were classified into four categories: vaccinated only, screened only, both vaccinated and screened (double protected), or neither (unprotected). Sociodemographic characteristics, healthcare access, and Health Belief Model constructs were assessed. Multivariable logistic regression compared women who were double protected with those unprotected (n = 274). Results: Most women were UTD with screening only (57.8%), while 15.5% were double protected and 22.6% were unprotected. Younger age (Odds Ratio [OR = 0.93; 95% Confidence Interval [CI]: 0.89, 0.98), having ≥1 medical visit in the past year (OR = 4.16; 95% CI: 1.74, 9.95), higher perceived CC risk (OR = 3.65; 95% CI: 1.41, 9.43), greater perceived benefits of CC screening (OR = 1.96; 95% CI: 1.45, 2.66), and higher HPV knowledge (OR = 1.09; 95% CI: 1.01, 1.17) were associated with higher odds of being double protected. Conclusions: A substantial proportion of low-income women lack comprehensive CC prevention. Integrated, bundled prevention strategies that simultaneously promote HPV vaccination and screening may be important to reduce CC disparities. Full article

Background: Climate change is a serious threat to global health. The healthcare sector contributes substantially to greenhouse gas (GHG) emissions, with anaesthetic gases being a major source of Scope 1 emissions. We aimed to evaluate the 2024 impact of the Sustainable Anesthesia Project, designed to reduce the environmental footprint of anaesthetic gases by eliminating and/or replacing the most polluting agents (nitrous oxide and desflurane) with more sustainable alternatives (sevoflurane, total intravenous anaesthesia, and regional/local anaesthesia). Methods: We conducted a descriptive analysis of anaesthetic gas consumption in 2023 and 2024, as well as a comparison of emissions in tons of CO₂, the impact on the carbon footprint, and the potential future emissions savings that full implementation of the project would entail. Results: In the first year, nitrous oxide consumption decreased by 64% and desflurane by 63%. Overall anaesthetic-gas emissions fell by 8386 tCO₂e versus 2023, a 54% relative reduction. Furthermore, the contribution of these gases to the total Scope 1 emissions markedly declined from 35.18% in 2023 to 21.22% in 2024. An additional reduction potential of around 4800 tCO₂e was identified for consolidation by 2025 with full implementation. Conclusions: The results observed in this study demonstrate the success of the Sustainable Anesthesia Project, whose strategy represents an extensible and applicable option to other centers and companies in the health sector to reduce their environmental impact. Full article