Traditional health technology assessments (HTAs) primarily focus on safety, clinical effectiveness, and economic impact, typically through cost-effectiveness analyses conducted from the healthcare payer perspective using metrics such as cost per quality-adjusted life year. This approach overlooks the broader societal impacts of new health interventions and may lead to under- or overestimation of their overall value. Broadening the value framework to include the societal perspective would allow for the consideration of direct and indirect costs beyond health system costs, including lost productivity, caregiver impact, as well as the effect on other sectors such as education or welfare. Despite many HTA guidelines recommending its inclusion, few countries provide guidance on valuing non-health sector impacts or mandating the use of the societal perspective in the reference case. Although there are many challenges associated with the integration of the societal perspective into HTA evaluations, the lack of an internationally standardized context-specific framework remains the major barrier. Regional collaboration between HTA agencies to develop a societal perspective framework, build technical capacity, as well as share methodologies and data may address some challenges. Pilot studies should be encouraged to test the inclusion of societal elements, alongside the routine conduct of sensitivity analyses for evaluations undertaken from both healthcare sector and societal perspectives. This would enable policy makers to address uncertainty without compromising the core economic analysis. A broader, more flexible value framework may better align HTA with societal needs and values, and reward industry innovation while informing equitable funding decisions, capturing the full value of health technologies.

Moral hazard is built into the structure of private equity investments, which incentivises debt-based extraction rather than value-adding investment. To craft effective regulation of private equity’s participation in healthcare, and to cut through the industry’s talking points, we must reframe and acknowledge private equity ‘investment’ as ‘extraction’. In the U.S. healthcare system, this debt-based extraction has produced higher risks of bankruptcy and financial distress and associated facility closures, cost-cutting that affects patient safety and care, rising healthcare costs, inefficient use of taxpayer dollars, erosion of clinician autonomy, and increased consolidation. Policies that address extractive behaviours are the most targeted and efficient means of safeguarding patient care and may discourage the worst actors from acquiring healthcare providers. As private equity invests in health systems beyond the U.S. where regulatory regimes differ, the fundamentals of its extractive business model remain the same. Regulations must be calibrated to country specifics, but they should address the debt-based extraction built into the very structure of private equity investments. As policy debates continue, it is worth asking why we need private equity’s extractive business model in healthcare in the first place.

Drug shortages disrupt healthcare delivery and pose a critical challenge to the resilience of pharmaceutical supply chains. This study investigates the drivers of drug shortages in Italy – Europe’s leading pharmaceutical producer – to identify the factors associated with supply disruptions and inform evidence-based health policy. Using national data from 2018 to 2023, we analysed 17,619 drugs across 3,013 groups of substitutes, covering community, dual-dispensed, and hospital distribution channels. Generalised linear mixed models were employed to assess how drug characteristics, market dynamics, and regulatory features influence shortage risk. Shortages were most prevalent among community drugs, where high market fragmentation and low-profit margins contributed to supply instability. Patent protection was associated with lower shortage risk for non-sterile drugs, while sterile drugs remained vulnerable regardless of patent status, likely due to manufacturing complexity. Notably, price effects were age-dependent: higher prices mitigated shortage risk, particularly for older drugs. This study offers a comprehensive evaluation of shortage patterns in a key pharmaceutical market, identifying structural risk factors and market vulnerabilities. The findings provide actionable insights for policymakers aiming to design targeted interventions, strengthen supply chain resilience, and ensure continuous access to essential medicines.

In response to an increase in state bans and restrictions of gender-affirming care, many states have enacted laws protecting patients and providers. This essay analyzes these protective state laws and offers recommendations to strengthen safeguards and ensure continued access to gender-affirming care nationwide.

This article examines how the design architecture of Medicaid work requirements shapes procedural attrition across the enrollment lifecycle. Using publicly available data from Arkansas and Georgia, the only two states to have operationalized work requirements prior to the federal mandate in H.R. 1 (P.L. 119–21), the analysis compares attrition patterns across two structurally distinct designs. Arkansas imposed requirements as a maintenance condition on enrolled populations, concentrating attrition at reporting checkpoints. Georgia imposed them as both an entry and maintenance condition, with attrition concentrated at the pre-application stage. The article extends Herd and Moynihan’s administrative burden framework. It proposes that when administrative burden becomes the dominant determinant of program participation, burden shifts from implementation friction to a rationing mechanism that allocates coverage based on administrative capacity rather than statutory criteria. The article evaluates three observable implications of this framework. Specifically, reporting frequency shapes procedural disenrollment, point of imposition determines where attrition concentrates, and targeted burden reduction produces only partial enrollment gains when exclusion is embedded across multiple design features. Comparative evidence supports H2 and is consistent with H1. Georgia’s 2025 burden-reduction reforms provide preliminary directional evidence relevant to H3, with confirmatory testing requiring post-reform data not yet available. The findings carry direct implications for the 41 expansion states required to implement work requirements by January 2027, where variation in administrative design will systematically shape coverage outcomes.

This commentary responds to Truby and Kantiana’s exploration of an international human right to an AI-extended lifespan. It argues that framing longevity as an individual technological entitlement risks converting time itself into a luxury good. Instead, health law should embrace “time justice”: the equitable distribution of socially produced chances to live a healthy life. Rather than debating a futuristic right to live to 120, legal frameworks must address the present-day theft of healthy years driven by profound socioeconomic disparities. Because AI longevity will emerge first as measurement rather than therapy, this commentary proposes concrete structural reforms to prevent algorithmic ageism and inequality. To prevent a temporal caste system, the commentary proposes four structural interventions: (1) establishing a biological age data firewall to prevent discrimination; (2) extending the equitable logic of the Nagoya Protocol to grant source communities input-stage sovereignty over human genomic training data; (3) exacting a “longevity dividend” to fund baseline public health; and (4) redesigning life course institutions. Ultimately, the central legal challenge is not securing a right to radical life extension, but preventing AI from deepening the unequal distribution of time.

For about twenty years, Chilean high courts have issued myriad standardized rulings against the annual price-fixing adjustments in private health insurance contracts, intervening in health policy and propelling the emergence of a buoyant litigation industry by awarding attorneys’ fees to claimants. In deciding thousands of cases almost identically in protecting fundamental rights, particularly those involving private property, courts overrode legal rules on price adjustability that several congressional bills intended to reform, albeit unsuccessfully. And in granting claimants’ fees, courts simultaneously reinforced private insurance clients’ ability to litigate. Thus, courts reviewed a critical aspect of a health-care delivery system that political actors across the entire electoral spectrum have called into question. Employing a sequential comparison between the politics of private health insurance premium regulation and the origins of mass standardized judicial decisions, this article explores how Chilean high courts addressed legislative stalemate through an unusual form of judicial policymaking.

This piece documents how policymakers have stigmatized mRNA vaccination, in contrast to other forms of vaccine technology, following the COVID-19 pandemic. It further argues that, although it is presently unclear whether elites’ efforts to stigmatize mRNA vaccines have spilled over to shape US public opinion, there is growing reason to believe that it might. Ultimately, mRNA vaccine stigmatization could erode public confidence in mRNA vaccination and limit access to life-saving vaccines. This piece concludes by outlining a research agenda for researchers at the intersection of politics and the life sciences who hope to better understand the causes and consequences of mRNA vaccine stigmatization.

This review explores opportunities and challenges across data, health metrics, nutrition science, digital technology and policy in the context of healthier food system transformation. Rapid advancements in digital technology and artificial intelligence have reshaped how food is produced, formulated, marketed, purchased and consumed, with vast quantities of data generated across supply chains and retail environments. How individuals access, track and generate food and health information has shifted. Despite unprecedented data availability, fragmentation, diverging definitions, inconsistent health metrics and misaligned timelines across academia, policy, industry and technology limit effective and timely integration. This review develops two interrelated concepts, The Food Data Landscape (FDL) and Nutrition Intelligence (NI). It explores the structure and limitations of the FDL, considers the role of health metrics and describes technological developments and emerging NI applications. A conceptual Food Data-Nutrition Intelligence (FD-NI) Framework is presented providing a shared foundation for advancing more coherent research, policy and practice. This framework positions NI as an integrative layer capable of translating complex, fragmented data into actionable, evidence-based insights that can inform healthier decision making at scale. Transformative potential of AI will not be realised through technological advancement alone. Standardised data infrastructures, transparent assumptions, traceable decision making and collaborative governance frameworks that embed scientific integrity are key. Coordinated collaboration is critical to harness the full potential of NI to deliver meaningful, system-wide, timely transformation towards healthier, more sustainable diets. Future research should define stakeholder roles across the FDL and develop methodological, governance and evaluative frameworks to support responsible and impactful NI.

Task-sharing psychological treatment to non-specialist providers, including lay health workers (LHWs), is central to WHO guidance in low- and middle-income countries (LMICs). LHWs are community members without formal mental health qualifications who are trained to deliver low-intensity psychological interventions (LIPIs) for depression and anxiety. Although trials show LHW-delivered LIPIs can reduce symptoms, less is known about LHWs’ experiences or the relational and emotional demands of delivery. This review synthesised qualitative evidence on LHWs’ experiences of delivering LIPIs in LMICs. We searched CINAHL, Embase, PsycINFO, MEDLINE, Cochrane Central, ASSIA and ProQuest Dissertations & Theses Global to June 2025, supplemented by grey-literature searches. We included qualitative, mixed-methods studies reporting interview or focus group data from LHWs delivering LIPIs for adults with depression and/or anxiety. Data were synthesised using meta-ethnography; quality and confidence were assessed using CASP and GRADE-CERQual. Thirty-three publications representing 28 studies from Africa, Asia and Latin America were included. Four themes were generated: doing more than psychological therapy; embedded in the community yet precariously held by the system; growing in the role; and the hidden cost of caring. Task-shifting redistributes not only technical tasks but also relational and emotional labour to LHWs, requiring support through training, supervision, safety and remuneration.

This study examines how intensive caregivers in Nova Scotia who receive the provincial government’s Caregiver Benefit interpret and experience the program, particularly in the context of its ambiguous goals. A qualitative descriptive methodological design was used to ensure that the reporting of findings remained close to participants’ own words and to emphasize the practicality of findings. Twenty family caregivers with experience receiving the Caregiver Benefit participated in a semi-structured interview. Our analysis captured four themes: (a) caregiving intensity shaping perceptions of the Benefit, (b) financial relief provided by the Benefit, (c) systemic barriers to access, and (d) policy problems. To our knowledge, this is the first study to explore the firsthand accounts of caregivers’ experiences with the Caregiver Benefit in Nova Scotia.

Ethics has been recognized as an integral part of Health Technology Assessment (HTA) since its beginning. However, the integration of ethical analysis in HTA practice has been limited and challenging. Members of the Health Technology Assessment international (HTAi) Interest Group (IG) for Ethical Issues in HTA reflected upon this situation, during a workshop and online meetings, to identify which challenges hinder integration of ethics in HTA and how to move the discipline forward. In this article, we present the results of that discussion, describing different ways that ethical analysis can occupy a more central role in HTA practice. We also describe developments in HTA that create a momentum for reflecting upon such integral role for ethical analysis in HTA: artificial intelligence-based health technologies, changes in the evidence landscape, assessing the environmental impact of health technology, and the new EU regulation on HTA.

Premarital screening policies are increasingly adopted to prevent hereditary disorders in populations with high consanguinity. In Oman, a Middle Eastern country with significant sickle cell disease prevalence, the shift toward mandatory premarital screening emerged through a strategic policy process influenced by cultural, tribal, and religious values. In this context, premarital screening offers a critical opportunity for early detection and informed reproductive decision-making. This paper provides an explanatory analysis of the agenda-setting process that enabled the formal adoption of compulsory premarital screening for genetic disorders, using Kingdon’s Multiple Streams Framework (MSF) as an analytical lens. The analysis demonstrates how hereditary blood disorders, in particular Sickle cell disease (SCD), transitioned from a socially normalised condition to a recognised public health and socioeconomic problem, and how a technically feasible and ethically sensitive policy solution was advanced. Oman’s case illustrates how preventive health policies targeting socially sensitive issues can gain traction through stream convergence, and incremental reframing.