How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study

BackgroundHaving a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women.MethodsThis cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance.ResultsFollowing hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private).ConclusionsA higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.     

农地产权结构变迁视域下土地增值收益的公平分享

农地产权结构是搭建土地增值收益分配与宪法秩序有效链接的重要桥梁.从农地产权结构变迁的视角看,我国传统土地增值收益的国有化机制实际在很大程度上符合1982年宪法所确立的社会主义地租国有原则及地利共享秩序.然而,由于宪法土地条款一开始就被注入了地利分配具有倾向性的思想基因,长此以往便忽视了农民作为整体分享土地增值收益的"另一半宪法秩序".新型城镇化背景下,国家进行了"同地同权"、赋权于"民"的农村土地管理制度改革,其实质是宪法秩序的延续而非替代,我国土地增值收益分配的主要机制仍是征地补偿制度.要实现我国土地增值收益的公平分享,必须回到社会主义"国家—集体"一元论的完整地利共享秩序中来,并遵循实质平等的要求,通过以"人的城镇化"为目标对区片综合地价进行限定、采取倾向于农村及农业发展的"土地财政"政策、打破城乡户籍二元制实现城乡一体化发展等方案,推动农民全过程参与、共享土地利益.     

Leader-member exchange as a linking pin in the idiosyncratic deals - Performance relationship in workgroups

In the current investigation, idiosyncratic deals (i-deals; individualized work arrangements) are modeled as differentiated resources that shape leader-member exchange (LMX) relationships in workgroups. We integrate literature on leader-member exchange (LMX) with research on i-deals to argue that employee evaluations of i-deals received from the grantor –typically the leader- enhance employee perceptions of LMX, which in turn become instrumental in generating positive performance outcomes. Furthermore, because workgroup characteristics have potential implications on the relationship between a deal grantor and the deal recipient, drawing upon social identity theory of leadership, we reason that the i-deals-LMX relationship is affected by the overall value congruence among the group members. Cross-level moderated mediation analyses on multi source data obtained from 289 employees nested in 60 workgroups showed that the mediational role of LMX in the i-deals to performance outcomes relationship was weaker in high value congruence groups.     

Engaging leader – Engaged employees? A cross-lagged study on employee engagement

The goal of this study is to provide a cross-lagged examination of the relationships between engaging leadership, job resources and employee work engagement. We propose a mediation model and we postulate that engaging leadership can increase perceptions of three specific job resources (i.e. autonomy, support from colleagues and opportunities for learning and development) which theoretically correspond to the three facets of engaging leadership (i.e., inspiring, connecting and strengthening, respectively). Subsequently, in keeping with the extant body of Job Demands-Resources (JD-R) research, we link job resources to employee work engagement. Our hypotheses were tested on data collected at two time-points – T1 (N = 759) and T2 (N = 273) –from employees working for a hotel chain in the Netherlands. In line with our expectations, engaging leadership showed a significant cross-lagged relationship with autonomy and support from colleagues, but did not predict learning opportunities and work engagement across time. While we formulated specific hypotheses, we also tested reversed causation relationships. We found no direct effect from engaging leadership on employee work engagement, however, the reversed effect was significant; employee perceptions of engaging leadership were shaped by their own engagement experiences. Importantly, engaged employees at T1 reported more job resources at T2. By providing a cross-lagged examination of our model, we showed that engaging leaders as well as employees’ positive affective state of being engaged, are essential to shaping a resourceful work context. A comprehensive view on the triggers and outcomes of work engagement and engaging leadership is needed, as the traditional unidirectional cause-effect rationale fails to explain how these concepts relate to one another and to employee experiences of job resources.     

调整和优化我国社会结构的机制路径选择

改革开放以来，我国社会获得前所未有的飞跃发展，而社会结构却明显滞后于经济结构，社会管理中的各种问题和矛盾日益凸显，社会结构基本呈现亚稳态特征。当今社会建设的核心是创新社会管理机制，优化调整社会结构。     

历史变局、国家兴衰与发展之路——三次千年变局叠加下的中国特色社会主义发展道路

每当先进的发展制度开始取代落后的发展制度时，整个世界格局就会进入重大的转换阶段。在中国五千年的发展历史中，有两次重大的历史变局完全改变了中国历史发展轨迹并深远地影响了当前中国的发展模式。新时代下的中国作为前两次历史变局影响的客体，曾经既是先进发展制度取代落后发展制度的受益者，也经历过作为落后发展制度主体而被先进发展制度冲击的过程。目前世界正处于第三次先进发展制度与落后发展制度交替的历史变局阶段，作为第三次重大历史变局的主体，在三次千年历史变局叠加的背景下，能否有效地认识、适应并改造利用前两次历史变局的经验与教训，构建系统性、科学性、可行性、领先性的中国特色社会主义制度，将决定中国在本次历史变局中能否顺利成为先进发展制度的主体从而实现民族复兴。     

Testing equality of two normal covariance matrices with monotone missing data

Abstract

The problem of testing equality of two multivariate normal covariance matrices is considered. Assuming that the incomplete data are of monotone pattern, a quantity similar to the Likelihood Ratio Test Statistic is proposed. A satisfactory approximation to the distribution of the quantity is derived. Hypothesis testing based on the approximate distribution is outlined. The merits of the test are investigated using Monte Carlo simulation. Monte Carlo studies indicate that the test is very satisfactory even for moderately small samples. The proposed methods are illustrated using an example.     

The triggers of local and distant search: Relative magnitude and persistence in explaining acquisition relatedness

Research on problemistic search has assumed negative attainment discrepancy to be the trigger of both local and distant search. Extending this research, we present and compare two additional triggers: (1) relative attainment discrepancy, which reflects how much a firm's attainment discrepancy deviates from its past negative attainment discrepancies; and (2) persistent attainment discrepancy, which reflects how often the firm experiences below-aspirations performance. Our triggers for distant search model a behavioral explanation for the timing and relatedness of acquisitions. We find support for baseline arguments of problemistic search whereby firms increase both industry- and skill-related acquisitions when they perform below aspirations. When they persistently perform below aspirations, however, this likelihood is reduced and firms engage in acquisitions that are more unrelated, thereby providing support for the notion of expanding search boundaries from local to distant search. Of the two triggers of distant search proposed, relative attainment discrepancy does not induce firms to expand search boundaries. Our results indicate that persistent attainment discrepancy is a key construct to consider when studying the expansion of search boundaries.     

Statistical testing strategies for assessing treatment efficacy and marker accuracy in phase III trials

When a candidate predictive marker is available, but evidence on its predictive ability is not sufficiently reliable, all‐comers trials with marker stratification are frequently conducted. We propose a framework for planning and evaluating prospective testing strategies in confirmatory, phase III marker‐stratified clinical trials based on a natural assumption on heterogeneity of treatment effects across marker‐defined subpopulations, where weak rather than strong control is permitted for multiple population tests. For phase III marker‐stratified trials, it is expected that treatment efficacy is established in a particular patient population, possibly in a marker‐defined subpopulation, and that the marker accuracy is assessed when the marker is used to restrict the indication or labelling of the treatment to a marker‐based subpopulation, ie, assessment of the clinical validity of the marker. In this paper, we develop statistical testing strategies based on criteria that are explicitly designated to the marker assessment, including those examining treatment effects in marker‐negative patients. As existing and developed statistical testing strategies can assert treatment efficacy for either the overall patient population or the marker‐positive subpopulation, we also develop criteria for evaluating the operating characteristics of the statistical testing strategies based on the probabilities of asserting treatment efficacy across marker subpopulations. Numerical evaluations to compare the statistical testing strategies based on the developed criteria are provided.