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In the Italian healthcare system, private facilities can supplement public ones in delivering services within the framework of the Italian National Health System, provided they meet specific conditions and obtain the necessary authorisations. This set of requirements is known as the ‘four As’ system, comprising authorisation for the construction of the facility, authorisation to provide healthcare services, accreditation, and contractual agreements. A crucial element in this regulatory framework is the system of tariffs for the remuneration of healthcare services, which are periodically established by the Ministry of Health through a complex procedure. This model of ‘administered competition’ aims to protect both citizens’ health and fair competition among healthcare providers. Proper integration of private facilities into the National Health System is intended to enhance the effi ciency of service delivery. Th e purpose of this paper is to examine the current regulatory framework governing the participation of private clinics in the Italian National Health System and to identify any critical issues.

Background: COVID vaccines have been rolled out all over the world after emergency use authorization in the prevailing pandemic situation. However, hesitancy about its safety and efficacy exists among beneficiaries. Vaccine hesitancy can be a barrier to adequate immunization coverage. Aims and Objectives: This qualitative study was undertaken among health care workers in the rural field practice area of a tertiary care hospital, to find out their perceptions about COVID vaccines, and reasons behind hesitancy toward the same. Materials and Methods: Six focused group discussions (FGD) were held with the help of moderator. Each FGD had five members, so 30 members were included in the study. Health care workers included doctors, nurses, ANM/ASHAs, and other health care workers. Results: There were 17 males and 13 females. Doctors had a positive attitude toward vaccination, but other health care workers had mixed perception regarding vaccination. Most grass root level workers were sceptical about the efficacy of the vaccine. Conclusion: Mostly positive attitude toward COVID vaccines was observed in the present study. Hesitancy toward vaccines was observed in some health care workers, and it likely rooted from their inadequate knowledge about the vaccine.

Access control is a critical component of data protection, determining which individuals or systems are permitted to reach particular resources. Its purpose is to safeguard confidential information from unauthorized use, breaches, or unintended disclosure. In general computing environments, access control is relatively straightforward, but in complex domains such as healthcare, its implementation becomes significantly more challenging. The widespread adoption of Internet of Things solutions in medical systems, referred to as Healthcare IoT (H‐IoT), has introduced new layers of complexity. H‐IoT ecosystems combine medical devices, sensors, mobile health applications, and cloud platforms to continuously collect, transmit, and analyze patient data. In such dynamic, data‐intensive environments, traditional access control approaches often fall short. The study explores the application of access control within H‐IoT systems, analyzing established models including RBAC, ABAC, CapBAC, and CAAC, and discussing the benefits and limitations associated with each framework. The study addresses key healthcare‐specific challenges, including emergency access management and privacy compliance, and explores unified, adaptive, patient‐centric architectures that integrate roles, attributes, capabilities, and contextual factors. Additionally, it reviews emerging approaches such as predictive, machine learning‐driven mechanisms, decentralized enforcement at the edge or fog layer, and privacy‐preserving techniques aimed at enhancing responsiveness, scalability, and accountability. The paper concludes by identifying gaps in current research and suggesting directions for the development of H‐IoT systems that are adaptive, secure, and ethically responsible. This survey analyses access control mechanisms in Healthcare IoT, reviewing traditional and emerging models, identifying security and privacy challenges, and highlighting open research issues. It provides a comparative perspective to support the design of secure, scalable, and patient‐centric healthcare IoT systems.

Summary Background Defensive medicine is a growing concern in modern healthcare, driven by physicians’ fear of litigation. It involves unnecessary tests and procedures and avoidance of high-risk treatments. These practices increase healthcare costs, limit patient access to necessary care, and negatively impact the physician–patient relationship. Additionally, defensive medicine contributes to physician stress and dissatisfaction, thereby potentially reducing the attractiveness of the medical profession. Methods This survey explores the prevalence of defensive medicine in Czech surgical departments through a survey conducted among 31 surgeons in two county hospitals. Results The results confirm that all respondents engage in some form of defensive medical practice. Notably, 17% of radiological examinations were performed for assurance rather than medical necessity. A hypothetical case study demonstrated that knowledge of a patient’s history of litigation significantly increased the likelihood of additional defensively motivated tests. Conclusion Defensive medicine is a complex issue that requires cooperation between healthcare providers, legal professionals, policymakers, and medical organizations. We discuss different approaches to addressing defensive medicine. This includes the implementation of evidence-based clinical guidelines, improvements in physician–patient communication, and reforms in legal and regulatory frameworks. The main novel aspect of this article is that it brings attention to a widely overlooked issue in surgical literature and also proposes potential solutions.

The process by which state Medicaid programs develop their preferred drug lists, and determine which medications require prior authorization, is opaque to many clinicians. This process is a synthesis of cost and clinical information. For cost, the federal Medicaid Drug Rebate Program establishes mandatory rebates that pharmaceutical manufacturers must pay state Medicaid programs. In addition, state Medicaid programs may also negotiate supplemental rebates whereby, in exchange for a preferred position on the preferred drug list, manufacturers pay an additional rebate. These supplemental rebates are most important in therapeutic classes with multiple brand competitors (e.g., medication treatments for opioid use disorder). For clinical information, state Medicaid programs convene pharmaceutical and therapeutics committees, drug utilization review boards, or both, composed of a variety of stakeholders such as practicing clinicians. Cost factors such as federal rebate calculations and supplemental rebate negotiations may lead to counterintuitive preferred drug lists, for example, a state Medicaid program requiring prior authorization for a generic medication but not for its brand equivalent (e.g., buprenorphine/naloxone products). Because of states’ reliance on rebates, mandates to remove prior authorization may have the unintended consequence of increasing costs significantly through the loss of rebate negotiating power. In the face of high and rising medication costs, state Medicaid programs are also implementing innovative policy approaches to maintain access and control costs, such as targeted rebate negotiation and value-based pricing. Through participation in state Medicaid program clinical advisory committees, individual clinicians can have a powerful voice. Interested clinicians should consider joining to inform policy and help ensure their patients’ needs are met.