Health policy analysis of the non-implementation of HPV vaccination coverage in the pay for performance scheme in France
Health policy analysis of the non-implementation of HPV vaccination coverage in the pay for performance scheme in France
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DOI：
10.1093/eurpub/cky173
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发表时间：
2019-02-01
影响因子：
4.4
通讯作者：
Chauvin, Franck
中科院分区：
文献类型：
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作者：
Ohannessian, Robin;Constantinou, Panayotis;Chauvin, Franck
2014 年启动的法国国家癌症控制计划 (NCCP) 设定了提高人乳头瘤病毒 (HPV) 疫苗接种覆盖率 (VC) 的目标。 NCCP 包括一项将 VC 指标纳入全科医生 (GP) 绩效工资 (P4P) 计划的措施，但该措施并未实施。本研究的目的是利用卫生政策分析框架来分析该措施未实施的原因。通过涉及的参与者、措施的内容、背景因素和政策制定过程，对从建议到未实施 HPV VC 指标到 P4P 计划的政策进行分析。参与者是卫生部 (MOH) 和国家癌症研究所作为政策制定者，公共健康保险作为间接目标，全科医生作为直接目标。该政策的内容没有证据支持，也没有纳入 NCCP 准备报告中。背景包括对疫苗的犹豫以及全科医生反对卫生部的道德担忧。该过程涉及多种利益相关者，治理复杂，且对措施缺乏严格监控。复杂的疫苗接种政策治理与非证据知情的政策内容和不利的背景相关，可能是政策失败的原因。
The French National Cancer Control Plan (NCCP) launched in 2014 set the objective to improve human papillomavirus (HPV) vaccination coverage (VC). The NCCP included a measure to integrate a VC indicator in the pay for performance (P4P) scheme for general practitioners (GPs), which was not implemented. The objective of the study was to analyse the reasons for non-implementation of this measure, using the health policy analysis framework.The policy from proposal to non-implementation of the HPV VC indicator into the P4P scheme was analysed through the actors involved, the content of the measure, the contextual factors and the processes of policy-making.The actors were the Ministry of Health (MOH) and National Cancer Institute as policy-makers, the public health insurance as an indirect target, and GPs as direct targets. The content of the policy was not evidence-informed and was not included into the NCCP preparation report. The context included vaccine hesitancy and ethical concerns from GPs in opposition with MOH. The process involved a diversity of stakeholders with a complex governance and no strict monitoring of the measure.Complex vaccination policy governance associated with a non-evidence-informed policy content and an unfavourable context may have been the reasons for the policy failure.