Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore.

BACKGROUND: In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process. METHODS: Data were extracted from clinical records provided by  The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data. RESULTS: Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare. CONCLUSIONS: The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies.

A community service doctor's experiences of mental healthcare provision in rural Eastern Cape.

BACKGROUND:  Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. METHODS:  The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. RESULTS:  The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. CONCLUSION:  Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.

Implementation of a strengths-based approach in a traumatic brain injury community service; perspectives of community workers.

Background The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI.

Integrating community service-learning into a dental hygiene curriculum: a document analysis.

Background: Community service-learning (CSL) aims to promote civic engagement among students and deepen their understanding of social issues, connecting students to communities where they may practise as future health care providers. This study's aims were two-fold: first, to determine whether incorporating a non-dental community service-learning experience into a fourth-year behavioural science course can develop abilities related to the dental hygiene baccalaureate competencies; second, to examine the overall student learning experience. Methods: Seven community agencies presented projects to the dental hygiene class, and students individually selected their top 3 choices. Projects were diverse, ranging from literacy tutoring to creating a program plan or hosting a public virtual event with an interprofessional health panel discussing nutrition. Dental hygiene students participated in a 20-hour placement with one community project and completed individual reflection journals that focused on their experience. Using a document analysis approach, the authors examined the reflection journals through an iterative process to identify themes. Results: Ten student reflections were analysed and three themes emerged: 1) increased social awareness; 2) application of dental hygiene core competencies; and 3) the challenges of the learning experience. Students consistently discussed how the project allowed them to apply 5 dental hygiene core competencies and how their learning experience aligned with their future professional role as a dental hygienist. Students articulated increased understanding of their individual privilege and awareness of social issues in their community. Conclusions: Participation in non-dental CSL increased dental hygiene students' social awareness of local communities. Students demonstrated an ability to apply their learning to their developing competencies as future dental hygienists.

Contexte : L'apprentissage axé sur les services communautaires vise à promouvoir l'engagement civique des étudiants et à approfondir leur compréhension des enjeux sociaux, en mettant les étudiants en contact avec les communautés où ils peuvent exercer en tant que futurs fournisseurs de soins de santé. Cette étude avait 2 objectifs : premièrement, déterminer si l'intégration d'une expérience d'apprentissage par service communautaire non dentaire à un cours de quatrième année de science du comportement peut permettre de développer des capacités liées aux compétences du baccalauréat en hygiène dentaire; deuxièmement, examiner l'expérience d'apprentissage globale de l'étudiant. Méthodes : Pour l'étude, 7 organismes communautaires ont présenté des projets à la classe d'hygiène dentaire et les étudiants ont chacun sélectionné leurs 3 premiers choix. Les projets étaient diversifiés, allant du tutorat en alphabétisation à la création d'un plan de programme ou à l'organisation d'un événement public virtuel avec un panel interprofessionnel de la santé qui discutait de la nutrition. Les étudiants en hygiène dentaire ont participé à un stage de 20 heures dans le cadre d'un projet communautaire et ont consigné leurs réflexions dans un journal individuel axé sur leur expérience. À l'aide d'une approche d'analyse documentaire, les auteurs ont examiné les journaux de réflexion lors d'un processus itératif pour cerner les thèmes. Résultats : Les réflexions de 10 étudiants ont été analysées et 3 thèmes sont ressortis : 1) une sensibilisation sociale accrue; 2) l'application des compétences de base en hygiène dentaire; et 3) les défis de l'expérience d'apprentissage. Les étudiants ont systématiquement discuté de la façon dont le projet leur a permis d'appliquer 5 compétences de base en hygiène dentaire et de la façon dont l'expérience d'apprentissage s'harmonisait avec leur futur rôle professionnel d'hygiéniste dentaire. Les élèves ont noté une meilleure compréhension de leurs privilèges individuels et une meilleure sensibilisation aux enjeux sociaux dans leur communauté. Conclusion : La participation à un apprentissage axé sur les services communautaires non dentaires a accru la sensibilisation sociale des étudiants en hygiène dentaire aux communautés locales. Ils ont démontré leur capacité à appliquer leur apprentissage à leurs compétences en développement en tant que futurs hygiénistes dentaires.

Structural and relational factors for successful cross-sector collaboration in home visiting: a multiple case study.

BACKGROUND: Aligning delivery and financing systems across sectors to create broader systems of care can improve the health and well-being of families experiencing adversities. We aimed to identify structural and relational factors for best practices to achieve successful cross-sector collaboration among home visiting programs in the United States. MATERIALS AND METHODS: We used a multiple case study approach to identify best practices for successful cross-sector collaboration between home visitors and other community service providers. We selected five diverse exemplary cases with cross-sector collaboration with variation in implementing agency type and geographic location. Cases were selected using a positive deviance approach based on strong coordination and integration with different community service provider types identified from previous survey data. We conducted in-depth qualitative interviews with home visiting staff, community providers, and clients with a total of 76 interviews conducted from 2021 to 2022. We wrote memos to synthesize themes within each case through data triangulation using interview data, documents, and site visit observations. We compared themes across the five cases to create a cross-case synthesis of best practices for successful cross-sector collaboration. RESULTS: Across the five cases, relational factors including leadership from all levels, champions across sectors, and shared goals between community providers were key factors for successful collaboration. Interpersonal relationships, coupled with the desire and capacity to engage, facilitated effective coordination to address families' needs. At the structural level, shared data systems, written agreements, and co-location enabled care coordination activities. Community Advisory Boards provided a venue for developing partnerships, relationship-building, resource-sharing, and increasing awareness of home visiting. CONCLUSIONS: We identified key elements of successful cross-sector collaboration across five case studies where home visitors coordinate care frequently and/or are structurally integrated with a range of providers. These learnings will inform future interventions to improve home visiting collaboration with other community providers to create a system of care to enhance family well-being.

Caring for older parents in Norway - How does it affect labor market participation and absence from work?

As the population ages, younger generations will increasingly be called upon to provide informal care to their aging parents. To prepare for this development, it is essential to understand how employees combine the dual responsibilities of work and caring for aging parents. By analyzing data collected in Norway in 2022 from a nationally representative sample of 6049 respondents, aged 35 to 67, we investigated how caring for older parents affects labor market participation and work absence. We provide descriptive statistics and conduct analyses with structural equation modeling. These analyses indicated that caregiving had no substantial impact on overall participation in the workforce. However, employees did use work absences to assist their parents. We differentiate between using holidays, compensatory time, and three types of formal leave: paid, unpaid, and sick leave. More than a third of the formal leave was taken as sick leave. Women were moderately more likely to use work absence to care for their parents. We conclude that caregiving for older parents currently has little effect on work participation in Norway and attribute the favorable situation in Norway to its comprehensive public elderly care system. However, a contributing factor is Norway's generous sick leave policy. Although intended for use when employees are sick themselves, sick leave is used by employees to provide care to aging parents. Sick leave seems to act as a safety valve. To mitigate the effects of informal care on work participation, welfare states may create conditions that allow employees to combine work and informal care without resorting to unauthorized sick leave. A solution could be to extend the existing support scheme for employees with young children to those providing care for their aging parents.

Values and economic performance across European welfare state regimes: Direct and indirect effects through social capital, human capital and managerial skills.

The values that people hold are linked to their economic performance. These links can be either direct or indirect, operating through moderating variables such as social network participation, interpersonal trust, trust in institutions, human capital, managerial skills and hours worked. In this paper these effects are studied using structural equation modelling (SEM) methodology applied to European Social Survey data from 28 European countries in 2018. Schwartz classification of values is used, distinguishing between Self-Enhancement (Power, Achievement), Openness to Change (Self-Direction), Conservation (Tradition, Security, Conformity) and Self-Transcendence (Universalism, Benevolence) values. It is found that Power has the strongest positive direct effect on economic performance, further strengthened by a positive indirect structural effect through hours worked. Self-Direction is indirectly positively linked to economic performance through higher managerial skills and hours worked. Tradition has a strong negative direct effect on economic performance. Security is indirectly negatively linked with economic performance, owing to its negative effects on interpersonal trust, management skills and hours worked. Some of the identified effects are context-dependent and vary across European welfare state regimes. For example, Power is statistically significantly linked to economic performance only in the liberal and conservative regime. Values promoted by respective welfare state regimes are not necessarily associated with higher incomes within those regimes, e.g., Tradition and Security values promoted in the conservative and Mediterranean regime are associated with lower incomes. These findings may lead to a range of policy implications, particularly in relation to the policies on immigration, demographics, the labor market, and work-life balance. Unfortunately, due to the cross-sectional character of the dataset, causal relations among the variables of interest could not be identified.

Evaluating the effectiveness of a clinical nurse specialist triage role in a specialist palliative care community service.

BACKGROUND: In 2017, a clinical nurse specialist (CNS) triaging role was created within a specialist palliative care community service (SPCCS) in Ireland to enhance the triage process. The aim of this study is to evaluate the effectiveness of the role regarding data collection and reporting. Structured feedback from healthcare professionals (HCPs) was obtained on the effects, challenges and sustainability of this role. METHODS: This study used a mixed-methods approach. A quantitative analysis of referrals triaged by the SPCCS CNS over 2 years (2018-2019) was performed. Two focus groups with HCP's within the same service were completed in January 2020 and one-to-one interviews were conducted. The quantitative and qualitative results were merged using a triangulation protocol. RESULTS: In 2017, new health service executive (HSE) standards to categorise the urgency of patient assessment were introduced. Quantitatively, an improvement within the triage process was seen, with an increase in compliance with national access standards. In 2018, compliance was 89.1%. In 2019, this was 96.8%, an improvement of 7.7%. A data discrepancy of 9.5% of referrals was noted over the first 9 months of 2018. After this, data documentation and congruency were seen to improve for the final 3 months of 2018 to 100% and remained at 100%. Qualitative data highlighted the benefits and challenges of the Triage CNS role. Mixed-methods correlation revealed corroboration between both using a triangulation protocol. CONCLUSION: The triage CNS role was pivotal as an initial point of referral contact. Increased compliance with national access standards occurred resulting in improvements in case and case-load management, information gathering, documentation, data collection and analysis.

The role of the concept of solidarity for just distribution of bioethical goods in the international area.

This analysis investigates whether solidarity is an appropriate concept for thinking about justifications for a just distribution of bioethical goods in the international arena. This will be explored by looking at the national origins of the idea of justifying solidarity in the form of the health care that welfare states offer. Following that, 'life' and 'health' will be placed within a philosophical context by focusing on the main arguments of John Rawls and Amartya Sen and the role of solidarity in these two theories of justice will be analysed. It will be shown that these theories assume that solidarity is not a prerequisite for just international structures. Finally, the possibility will be discussed, that there is a degree of uncertainty surrounding justifications for fair distribution in the international context that can result when the concepts of solidarity and justice are handled imprecisely.

Efficiency and resilience of cooperation in asymmetric social dilemmas.

Direct reciprocity is a powerful mechanism for cooperation in social dilemmas. The very logic of reciprocity, however, seems to require that individuals are symmetric, and that everyone has the same means to influence each others' payoffs. Yet in many applications, individuals are asymmetric. Herein, we study the effect of asymmetry in linear public good games. Individuals may differ in their endowments (their ability to contribute to a public good) and in their productivities (how effective their contributions are). Given the individuals' productivities, we ask which allocation of endowments is optimal for cooperation. To this end, we consider two notions of optimality. The first notion focuses on the resilience of cooperation. The respective endowment distribution ensures that full cooperation is feasible even under the most adverse conditions. The second notion focuses on efficiency. The corresponding endowment distribution maximizes group welfare. Using analytical methods, we fully characterize these two endowment distributions. This analysis reveals that both optimality notions favor some endowment inequality: More productive players ought to get higher endowments. Yet the two notions disagree on how unequal endowments are supposed to be. A focus on resilience results in less inequality. With additional simulations, we show that the optimal endowment allocation needs to account for both the resilience and the efficiency of cooperation.

Impact of digital services on healthcare and social welfare: An umbrella review.

BACKGROUND: Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. METHODS: The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. RESULTS: A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management. CONCLUSIONS: Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.

Multidisciplinary working in a community HIV specialist service.

OBJECTIVE: A documentation audit was performed to explore the multidisciplinary working of a community HIV specialist service (CHSS). The audit identified the wide range of services to which people living with HIV are referred as part of the care they receive within the CHSS. DESIGN: A retrospective documentation audit was used. SETTING: The CHSS, consisting of three teams covering a wide geographical area across West Sussex and Brighton and Hove. A total of 30 patients' notes were audited, including 10 patients from each team to ensure the results were representative of the service as a whole. RESULTS: The audit showed that, on average, each person received five onward referrals to other health care, social care, or HIV-specific services, with a range of between 1 and 12, as a result of being under the care of the CHSS. The types of referrals varied, with 46% being to HIV specialist services and the remaining 54% to non-HIV specific services, including GPs, social services and other health services. Overall, the audit showed not only the holistic care and assessments completed but also the benefit and increased access to other services and care as a result of community HIV team involvement. CONCLUSION: The audit highlights the importance of continuing to develop HIV community services to cater for this changing population, as well as identifying possible areas of development. The results also demonstrate the vital role that CHSSs have in supporting hard-to-reach patients.

Regional population and social welfare from the perspective of sustainability: Evaluation indicator, level measurement, and interaction mechanism.

Key to regional sustainable development are the development and interplay of population dynamics and social welfare, each playing a significant role. As a representative region with demographic characteristics such as negative population growth and large labor outflow, the development and interaction between population and social welfare in Nanchong deserve in-depth exploration. This article takes the development of population and social welfare in Nanchong as the research object, and constructs an evaluation indicator system of population and social welfare through research backtracking, and uses entropy method and coupling coordination model to measure the development level and interactive effect of population and social welfare in Nanchong from 2010 to 2021. The research results show that: Firstly, the comprehensive evaluation results of population in Nanchong shows a linear upward trend, which indicates the stable positive effect of population structure and distribution, the gradual improvement effect of population quality effectively compensate for the weakening effect of population quantity, thus achieving the positive development of population. Secondly, the comprehensive evaluation results of social welfare in Nanchong shows an exponential upward trend, which indicates the social welfare has maintained a rapid growth momentum in various dimensions and the long-term positive effects have completely absorbed the negative effects, thus achieving the positive development of social welfare. Thirdly, during the sample period, the population and social welfare in Nanchong consistently maintained a high level of interaction strength, with factors diffusing and integrating. On this basis, the diffusion theory is used as an empirical reference to construct three interactive mechanisms between the population and social welfare in Nanchong and the implications are inferred from the empirical results.

Old and new joint characterizations of leximin and variants of rank-weighted utilitarianism.

This paper proposes a new class of efficient and equitable social welfare orderings, a generalized leximin rule that includes rank-weighted utilitarianism, leximin, and their lexicographic compositions. While the famous Deschamps and Gevers' joint characterization theorem shows that a Paretian, anonymous, separable social welfare ordering must be either weak utilitarianism, leximin, or leximax under the assumption of cardinal full comparability, this study provides a new joint characterization theorem in which imposing rank-separability, instead of separability, enables acceptable social welfare ordering to be the generalized leximin rule. This result is proven by an intuitive and easy-to-understand method, which also helps show the mechanism by which a class of Paretian, anonymous, and separable social welfare orderings is limited to weak utilitarianism and leximin.

Health promotion roles shaped by professional identity: an ethnographic study in the Netherlands.

How frontline care professionals interpret and fulfill their health promotion roles is of great importance for the health of the vulnerable clients they work with. While the literature on health promotion is limited to describing the roles of healthcare professionals, this study examines the health promotion roles held by various frontline professionals when working with clients with combined psychosocial problems and how this is associated with professional identity. Based on ethnographic data from Dutch frontline professionals in social welfare, general healthcare and mental healthcare, this article shows how various frontline professionals promote health by reframing and customizing health problems and that this is associated with how they identify as pragmatic or holistic professionals.

Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study.

BACKGROUND: Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants. METHODS: An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice. RESULTS: Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data. CONCLUSIONS: This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.

Aversion to health inequality - Pure, income-related and income-caused.

We design a novel experiment to identify aversion to pure (univariate) health inequality separately from aversion to income-related and income-caused health inequality. Participants allocate resources to determine health of individuals. Identification comes from random variation in resource productivity and information on income and its causal effect. We gather data (26,286 observations) from a sample of UK adults (n = 337) and estimate pooled and participant-specific social preferences while accounting for noise. The median person has strong aversion to pure health inequality, challenging the health maximisation objective of economic evaluation. Aversion to health inequality is even stronger when it is related to income. However, the median person prioritises health of poorer individuals less than is assumed in the standard measure of income-related health inequality. On average, aversion to that inequality does not become stronger when low income is known to cause ill-health. There is substantial heterogeneity in all three types of inequality aversion.

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required.

It has been argued that cost-effectiveness analysis of branded pharmaceuticals only considers static efficiency, neglects dynamic effects and undermines incentives for socially valuable innovation. We present a framework for designing pharmaceutical pricing policy to achieve dynamic efficiency. We develop a coherent framework that identifies the long-term static and dynamic benefits and costs of offering manufacturers different levels of reward. The share of value that would maximise long-term population health depends on how the quantity and quality of innovation responds to payment. Using evidence of the response of innovation to payment, the optimal share of value of new pharmaceuticals to offer to manufacturers is roughly 20% (range: 6%-51%). Reanalysis of a sample of NICE technology appraisals suggests that, in most cases, the share of value offered to manufacturers and the price premium paid by the English NHS were too high. In the UK, application of optimal shares would offer considerable benefits under both a public health objective and a broader view of social welfare. We illustrate how an optimal share of value can be delivered through a range of payment mechanisms including indirect price regulation via the use of different approval norms by an HTA body.

Patient Welfare Implications of Indication-Specific Value-Based Pricing of Multi-Indication Drugs.

OBJECTIVES: Indication-specific value-based pricing (ISVBP) is a mechanism that allows the prices of multi-indication drugs to vary across indications by aligning the drug prices with value. However, the overall impact of ISVBP on patients across indications is uncertain. This study examines the theoretical welfare effects of ISVBP for multi-indication drugs and compares consumer surplus under ISVBP and single pricing, the latter of which is based on the weighted average value. METHODS: We considered a healthcare system with government-negotiated drug prices based on the value of drugs. We assumed a drug with 2 indications and 1 relevant comparator for each indication. The value of the drug was uniformly distributed among the patients of each indication in the base case. We also considered alternative scenarios with exponentially and Pareto distributed drug values. Numerical simulations were conducted to explore potential settings where ISVBP was welfare-improving for patients compared with single pricing. RESULTS: The theoretical analysis showed that the consumer surplus change was strictly non-positive from single pricing to ISVBP. Therefore, it was not welfare-improving for patients in the settings of interest. Numerical simulations confirmed this result across various scenarios of value distributions. CONCLUSIONS: This study provides insights into the patient welfare implications of ISVBP for multi-indication drugs. We did not identify conditions under which ISVBP can enhance overall patient well-being, suggesting that it should be implemented cautiously. Future research should examine dynamic welfare implications related to innovation incentives because they may significantly affect population health in the future.