This article explores the relationship between EU internal market law and ambitious tobacco end-game policies, using the United Kingdom’s proposed smoke-free generation measure and its application to Northern Ireland under the Windsor Framework as a focal case. Responding to objections raised by EU Member States through the Technical Regulations Information System (TRIS), the article develops an interpretative framework that situates free movement rules within the EU’s broader constitutional commitment to public health protection. Drawing on a doctrinal analysis of EU primary law, the Tobacco Products Directive, EU Court of Justice case law, and the TRIS submissions themselves, the article challenges claims that generational sales bans are inherently incompatible with EU law. It argues that such claims rely on narrow and selective readings of internal market doctrine that overlook the extent to which health protection is embedded in EU market regulation. The analysis demonstrates that EU law leaves significant regulatory space for national authorities to pursue proportionate, evidence-based tobacco control measures, including end-game strategies. Beyond the immediate UK–Northern Ireland context, the findings have broader implications for innovative public health regulation within the EU, contributing to ongoing debates at the intersection of health policy, regulatory governance, and economic integration.

Reforms to the means tests in England for state-financed long-term care were planned for implementation in 2025. They included a lifetime limit (cap) on how much an individual must contribute to their care, with the state meeting subsequent care costs. We present projections of the costs and distributional impacts of these reforms for older people, using two linked simulation models which draw on a wide range of data. We project that by 2038 public spending on long-term care for older people in England would be about 14% higher than without the reforms. While the main direct beneficiaries of the lifetime cap would have been the better off who currently receive no state help with their care costs, the reforms also treated capital assets more generously than the current system, helping people with more modest incomes and wealth. When analysing the impacts of the reforms it is therefore important to consider the whole reform package. Our results depend on a range of assumptions, and the impacts of the reforms would be sensitive to the levels of the cap and other reformed parameters of the means test on implementation.

Despite the tremendous waste due to Medicaid fraud and abuse, not much scholarly attention has been paid to state variation in the investigations. This study explores the factors influencing variations in Medicaid fraud and abuse investigations across U.S. states, with a focus on the role of All-Payer Claims Databases (APCDs) and state political context. To test the impacts of price transparency and political factors, we built a dataset spanning eight years (2014 to 2021) and covering 49 states, excluding North Dakota. We then conducted a fixed-effects panel data analysis based on the results of a Hausman test. The impact of APCDs is statistically significant, suggesting its association with more fraud and abuse detection. A Democratic governor tends to be associated with fewer Medicaid fraud investigations. The findings of this research demonstrate that the operation of APCDs can influence the number of Medicaid fraud investigations conducted by Medicaid Fraud Control Units (MFCUs). Moreover, political discretion plays a role in the number of state investigations into Medicaid fraud and abuse.

Mixed markets can enhance welfare compared to full public or private provision. However, this welfare gain depends on the extent to which market distortions exist. Recent literature demonstrates distortions in mixed long-term care markets worldwide. Our study explores potential distortions in the Dutch institutional market. While all Dutch residential nursing homes are non-profit, for-profit organisations, including private equity (PE) firms, have increasingly entered the market, offering round-the-clock care provided in home-like settings as an alternative to non-profit residential care.

We analysed claims data from 2017–2021 for dementia patients aged 70 and older using multinomial logit and Cox Proportional Hazards models. Specifically, we compared risk selection, upgrading, and care quality (measured by avoidable hospitalisations and mortality) between for-profit and non-profit providers.

Our findings do not suggest increased risk selection, higher upgrading, or lower care quality by for-profit (PE-owned) providers compared to non-profit providers. Consequently, we did not find evidence of strong market distortions in the Dutch institutional long-term care market. These results contrast with the existing international literature, suggesting that adverse incentives in the Netherlands may be influenced more by the way care is provided (in home-like settings versus in residential nursing homes) and financing structures rather than ownership type alone.

Health policy reforms often fail due to design flaws, implementation gaps, and political barriers. This paper examines the role of government stewardship in addressing these barriers drawing on lessons from healthcare reforms in Sanming, China, a city that has become a nationally recognised model for comprehensive health system reform. Employing a qualitative approach, the analysis traces how six core stewardship functions – strategic visioning, institutional alignment, instrument design, partnership management, accountability reinforcement, and learning facilitation – enabled Sanming’s government to control costs and improve service delivery and health outcomes. Sanming’s experience illustrates the potential for local government stewardship to catalyse reform in the face of constraints. Interviews indicated that strengthened stewardship enabled the government to set strategic direction for the health system, mobilise stakeholders, formulate workable policies, and adapt to changing needs during implementation. However, participants identified persistent challenges, including uneven distribution of capacity across agencies, changes in the external policy environment, and deficient stakeholder feedback loops. While specific to the local context, the core stewardship competencies identified in the paper offer a generalisable framework for strengthening reform governance in other settings. As countries seek to build resilient and equitable health systems, the lessons from Sanming’s stewardship model provide a timely contribution to the global health reform discourse.

Pre-exposure prophylaxis (PrEP) is a critical intervention that greatly reduces the risk of HIV transmission, yet limited access to prescribing providers continues to constrain uptake in the United States. This study examines how geographic access to PrEP providers changed between 2020 and 2023 and identifies areas with limited access, referred to as PrEP deserts. Using the Integrated two-step floating catchment area method, this study finds that despite widespread gains in PrEP access, five states experienced increases in the total population living in PrEP deserts. Additionally, more than 5 million residents in states designated as priority jurisdictions under the Ending the HIV epidemic initiative gained geographic access to PrEP providers between 2020 and 2023. However, improvements were uneven: in some states, communities of colour experienced declining access and remain disproportionately represented in PrEP deserts. These findings highlight persistent geographic and demographic disparities in HIV prevention infrastructure despite recent federal efforts to expand PrEP availability.