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The World Bank, under the stewardship of the United States, stands out as the global leader among international development organizations. Does China's establishment of the Asian Infrastructure Investment Bank (AIIB) undermine this status? Examining this question, we focus on the borrowing practices of a special set of countries: the founding members of the AIIB. These founders openly defied the public preference of the United States, arguably to create a potential rival to the World Bank. Using a new causal inference method, Pang, Liu, and Xu's Dynamic Multilevel Latent Factor Model—as well as several well-known estimation models as robustness checks—we document at least a temporary decrease in the number of World Bank infrastructure projects that the developing AIIB founders have entered into. This study presents the first systematic evidence that China's AIIB could unsettle the political influence the United States has enjoyed over developing countries through its leadership of the World Bank. An important set of countries may be parting ways with the World Bank and looking to a Chinese institution for leadership in the world of development.

Background. The current West African outbreak of the Ebola virus disease (EVD) began in Guinea in December 2013 and rapidly spread to Liberia and Sierra Leone. On 20 July 2014, a sick individual flew into Lagos, Nigeria, from Monrovia, Liberia, setting off an outbreak in Lagos and later in Port Harcourt city. The government of Nigeria, supported by the World Health Organization and other partners, mounted a response to the outbreak relying on the polio program experiences and infrastructure. On 20 October 2014, the country was declared free of EVD. Methods. We examined the organization and operations of the response to the 2014 EVD outbreak in Nigeria and how experiences and support from the country's polio program infrastructure accelerated the outbreak response. Results. The deputy incident manager of the National Polio Emergency Operations Centre was appointed the incident manager of the Ebola Emergency Operations Centre (EEOC), the body that coordinated and directed the response to the EVD outbreak in the country. A total of 892 contacts were followed up, and blood specimens were collected from 61 persons with suspected EVD and tested in designated laboratories. Of these, 19 (31%) were positive for Ebola, and 11 (58%) of the case patients were healthcare workers. The overall case-fatality rate was 40%. EVD sensitization and training were conducted during the outbreak and for 2 months after the outbreak ended. The World Health Organization deployed its surveillance and logistics personnel from non-Ebola-infected states to support response activities in Lagos and Rivers states. Conclusions. The support from the polio program infrastructure, particularly the coordination mechanism adopted (the EEOC), the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 EVD outbreak in Nigeria.

Public–private partnerships (PPPs) are known as challenging contractual endeavors to public sector managers, and governments are developing standard contracts in order to ease the contracting process toward PPP deals. This study examines the learning process governments go through while managing the procurement trajectories of PPPs over time and revising the model contract they use, thereby gradually moving toward the formulation of a standard contract. It presents a case study of four consecutive road infrastructure projects in Belgium that looks into the contractual changes that were made over time and explains the reasons behind those changes. The results indicate a learning process that is characterized by an open attitude to learning of public sector actors, and a leading role of private sector actors—primarily financiers—in proposing or even requiring change. Contrary to theory-based expectations, the government continuously tested whether its model contract was in line with market practice, rather than increasingly limiting the room for negotiation as it gained experience.

Although digital health technology (DHT) is widely used in the United States at both hospital provider and individual levels, it is beset with several challenges that have contributed to inequities in the health service delivery. Previous studies have shown that health inequities observed may be amplified many times by DHT requirements. The objectives of this scoping review are aimed at synthesizing information on DHT inequities by exploring evidence that describes DHT infrastructure needs focused on promoting health equity in the United States and identifying key challenges both at the individual or patient level and at the health service provider's level. We adapted Arksey and O'Malley's scoping review guidelines in our review. PubMed, Web of Science, CINAHL, and PsycINFO were searched. We also conducted supplementary searches on Google Scholar. The inclusion criteria were peer-reviewed publications that broadly conceptualize or analyze DHT infrastructure from a health equity perspective and the challenges of DHT requirements between 2020 and 2024. We have screened the full text of articles using eligibility criteria such as studies that were included if they examined DHT infrastructure in the United States from a health equity perspective, discussed health disparities resulting from DHT interventions, or investigated the variables influencing health inequities connected to DHT. Two researchers (SR and ZZ) evaluated each citation individually at the title and abstract levels. The thematic approach and qualitative analysis determined this scoping review's outcome. Of the 628 research papers from the search, 27 were included in the analysis based on the inclusion criteria. In this review, we discussed factors such as older adult population, education, race, ethnicity, and socioeconomic status leading to health inequities in DHT. Patients and service providers face challenges related to health inequities in the use of DHT. The most common challenges for service providers were infrastructure and technical issues such as inadequate integration with existing workflows, user-unfriendly health information exchange interfaces, and lack of skilled staff, while for individuals or patients, this included limited broadband web-based access, cultural or linguistic appropriateness, and access to digital tools. The study identified that in the United States, DHT is an essential part of the delivery of health services; yet, it is saddled with key challenges leading to health inequities. Finding pragmatic solutions to these challenges can improve health equity in DHT.

While research on the efficacy of digital health applications (DiHA) is progressing, health economic evaluations (EEs) remain limited but are urgently needed to guide reimbursement and coverage decisions. Existing health policy frameworks frequently overlook cost-effectiveness considerations, and many studies presuppose cost savings without sufficient empirical validation. Although previous reviews have assessed digital health interventions more broadly, none has specifically focused on the cost-effectiveness of those intended for independent patient use. This rapid review aims to summarize the current economic evidence and the methods used in health EEs, including modeling practices, and assess the quality of health economic studies on independently usable DiHA for patients. A systematic search was conducted in 4 electronic databases (PubMed, Cochrane Library, EconBiz, and Web of Science), supplemented by both systematic and unsystematic hand searches. Studies were included on predefined inclusion criteria, considering only complete health EEs of DiHA intended for independent patient use. Data were narratively synthesized. Risk of bias (RoB) was assessed using the Cochrane risk of bias tool 2 (RoB 2), and methodological quality was evaluated using the Consensus on Health Economic Criteria (CHEC) checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for implementation and reporting. A total of 3841 results were identified. After screening the full texts of 82 publications, 7 studies were included in the final analysis. Four of the studies concluded that the app under review was cost-effective compared to the chosen control group. Most of the studies that provided economic evidence incorporated indirect costs and used a societal perspective. All studies used cost-utility analyses (n=7), with the majority based on randomized controlled trials (RCTs) (n=5), considering the health care payer perspective (n=3). Standard care was the most common comparator (n=5). Health outcomes were primarily measured using the EQ-5D (n=3) and condition-specific instruments (n=7). The incremental cost-effectiveness ratio, reported as costs per quality-adjusted life year, was the most frequently reported outcome (n=4). Overall, the quality of the EEs was rated positively using the CHEERS 2022 and CHEC checklists. However, more than half of the underlying RCTs exhibited a high RoB. DiHA have the potential to be cost-effective, and evaluations of these are of increasing interest. However, health EE is not yet routinely applied in their assessment. Improved reporting of RCT outcomes and greater consistency in modeling practices are needed to support robust EEs in this domain, which could advance evidence-based decision-making and reimbursement policies. This review focused on studies of indication-specific apps, which may have excluded broader applications, highlighting opportunities for more comprehensive research as the field evolves.

The Alma-Ata Declaration of 1978 initiated a global focus on universal health, supported by the World Health Organization (WHO) through healthy cities policies. The concept emerged at the 1984 Toronto \"Beyond Health Care\" conference, leading to WHO's first pilot project in Lisbon in 1986. The WHO continues to support regional healthy city networks, emphasizing digital transformation and data-driven health management in the digital era. This study explored the capabilities of digital healthy cities within the framework of digital transformation, focusing on member countries of the Asian Forum of Healthy Cities. It examined the cities' preparedness and policy needs for transitioning to digital health. A cross-sectional survey was conducted of 9 countries-Australia, Cambodia, China, Japan, South Korea, Malaysia, Mongolia, the Philippines, and Vietnam-from August 1 to September 21, 2023. The 6-section SPIRIT (setting approach and sustainability; political commitment, policy, and community participation; information and innovation; resources and research; infrastructure and intersectoral; and training) checklist was modified to assess healthy cities' digital capabilities. With input from 3 healthy city experts, the checklist was revised for digital capabilities, renaming \"healthy city\" to \"digital healthy city.\" The revised tool comprises 8 sections with 33 items. The survey leveraged ChatGPT (version 4.0; OpenAI, Microsoft), accessed via Python (Python Software Foundation) application programming interface. The openai library was installed, and an application programming interface key was entered to use ChatGPT (version 4.0). The \"GPT-4 Turbo\" model command was applied. A qualitative analysis of the collected data was conducted by 5 healthy city experts through group deep-discussions. The results indicate that these countries should establish networks and committees for sustainable digital healthy cities. Cambodia showed the lowest access to electricity (70%) and significant digital infrastructure disparities. Efforts to sustain digital health initiatives varied, with countries such as Korea focusing on telemedicine, while China aimed to build a comprehensive digital health database, highlighting the need for tailored strategies in promoting digital healthy cities. Life expectancy was the highest in the Republic of Korea and Japan (both 84 y). Access to electricity was the lowest in Cambodia (70%) with the remaining countries having had 95% or higher access. The internet use rate was the highest in Malaysia (97.4%), followed by the Republic of Korea (97.2%), Australia (96.2%), and Japan (82.9%). This study highlights the importance of big data-driven policies and personal information protection systems. Collaborative efforts across sectors for effective implementation of digital healthy cities. The findings suggest that the effectiveness of digital healthy cities is diminished without adequate digital literacy among managers and users, suggesting the need for policies to improve digital literacy.

The health care industry is currently going through a transformation due to the integration of technologies and the shift toward value-based health care (VBHC). This article explores how digital health solutions play a role in advancing VBHC, highlighting both the challenges and opportunities associated with adopting these technologies. Digital health, which includes mobile health, wearable devices, telehealth, and personalized medicine, shows promise in improving diagnostic accuracy, treatment options, and overall health outcomes. The article delves into the concept of transformation in health care by emphasizing its potential to reform care delivery through data communication, patient engagement, and operational efficiency. Moreover, it examines the principles of VBHC, with a focus on patient outcomes, and emphasizes how digital platforms play a role in treatment among tertiary hospitals by using patient-reported outcome measures. The article discusses challenges that come with implementing VBHC, such as stakeholder engagement and standardization of patient-reported outcome measures. It also highlights the role played by health innovators in facilitating the transition toward VBHC models. Through real-life case examples, this article illustrates how digital platforms have had an impact on efficiencies, patient outcomes, and empowerment. In conclusion, it envisions directions for solutions in VBHC by emphasizing the need for interoperability, standardization, and collaborative efforts among stakeholders to fully realize the potential of digital transformation in health care. This research highlights the impact of digital health in creating a health care system that focuses on providing high-quality, efficient, and patient-centered care.

Although highly effective HIV pre-exposure prophylaxis (PrEP) is available, its usage and adherence among young men who have sex with men and young transgender women remain low, reducing its overall effectiveness. The study included a 3-arm randomized clinical trial of Prepared, Protected, emPowered (P3), a comprehensive PrEP adherence digital health intervention, compared to an enhanced version, P3+, which incorporates in-app adherence coaching. This study aims to analyze data from study participants in the P3/P3+ intervention arms to understand how different levels of user engagement with the app's features were associated with adherence to PrEP as well as the costs of each intervention and their relative cost-effectiveness. Descriptive statistics for study variables at baseline were calculated. To examine the differences in intervention engagement and acceptability by arm, independent samples 2-tailed t tests for continuous variables and a chi-square analysis for categorical variables were conducted. To examine the effect of arm and engagement categories on PrEP adherence at 3 months, three logistic regression analyses were conducted: (1) the effect of arm on PrEP adherence, (2) the effect of predefined engagement categories (high vs moderate and low) on PrEP adherence, and (3) the interaction effect of arm and predefined engagement categories on PrEP adherence, along with the main effects of arm and predefined engagement categories. The study team calculated the average cost per participant and the incremental cost-effectiveness for PrEP adherence and engagement measures. A total of 163 participants were randomized to the P3 intervention (82 to the P3 arm and 81 to the P3+ arm). Participants in the P3+ arm earned higher incentives (US $90.6 vs $75.4; P=.04), had more app log-ins (96.6 vs 76.1; P=.01), used the app on more days (63.3 d vs 53.2 d; P=.04), and spent more time in the intervention (378.8 min vs 186.66 min; P<.001) compared to those in the P3 arm. There was no significant association between intervention arm and PrEP adherence at 3 months (P=.99). Engagement category (high vs moderate or low) was significantly associated with PrEP adherence at 3 months (P=.003). The overall average total monthly cost of P3 was US $1118 (SD $305.1). Average total monthly cost per P3 participant was $280 (SD $118.5), with an additional cost for P3+ of $72. This study highlights the critical role of user engagement in enhancing PrEP adherence among young individuals at high risk for HIV. While the P3+ intervention led to increased engagement, this did not translate into significantly better adherence compared to the standard P3 arm. This, coupled with the increased cost and complexity of P3+ delivery, indicates that further studies are necessary to determine whether this intensified intervention is the appropriate fit.

An increasing number of early-stage breast cancer (EBC) survivors and limited health care resources have raised interest in developing digital methods for communication between patients and health care personnel. In 2015, Helsinki University Hospital (HUS) Comprehensive Cancer Center (CCC) launched a digital solution called Noona (Helsinki University Hospital; Noona Healthcare) for patients with cancer, which allows patients to report their symptoms or side effects and ask questions with a computer or smart mobile device. In this study, we compare the cost and contacts of surveillance of EBC by 2 follow-up methods: digital solution and phone calls during their first year of follow-up outside preplanned visits. This was a prospective, open-label, randomized crossover study. After postoperative radiotherapy, patients with EBC were randomized to surveillance with either a digital solution or phone calls in addition to routine follow-up visits. After 6 months, the patient switched to the alternative follow-up method. All patients were thus exposed to both follow-up methods, and the order was determined by randomization. Hospital contacts and the costs of specialized health care were extracted from the Ecomed database of the Helsinki and Uusimaa Hospital District. The Ecomed database records all hospital costs. The costs of follow-up visits and diagnostics at the HUS CCC were analyzed in a repeated measurements general linear model analysis. The study extended from July 2015 to January 2017. Of 765 patients, 734 were included in the final analyses. For the digital solution group, the mean number of contacts per patient was 1.06 (SD 1.57) during the first 6-month period and 1.22 (SD 1.04) in the second period, with associated costs of €269 (US $313.21) and €311 (US $362.11). Similarly, in the phone call group, the mean number of contacts increased from 0.95 (SD 1.39) to 1.24 (SD 1.14) with the costs of €236 (US $274.78) and €344 (US $400.53), respectively. There were no statistically significant differences in the number of outpatient contacts (P=.46 and P=.35) or total costs (P=.80 and P=.12) between the 2 follow-up methods or randomization groups. We did not find any statistically significant differences in the total cost of follow-up of EBC by digital solution or phone calls. The number of visits and costs were higher during the latter follow-up period, probably due to the scheduled routine 1-year visit. There were more visits and higher costs in the digital solution group during the first 6 months, but these were higher in the phone call group during the latter 6-month period. This shows that the digital solution may enable faster access to outpatient services than conventional follow-up.

Cost savings were achieved with the use of a smartphone-based care management platform, considering several health care resources following knee arthroplasty procedures without negatively impacting clinical outcomes.