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.     

Using Lean Six Sigma to improve mobile order fulfilment process in a telecom service sector

This study proposes and follows a specific and systematic framework for implementing Lean Six Sigma (LSS) methodology in a telecom company in order to improve customer satisfaction by minimizing the company’s response time to customer requirements. The goal of this study was achieved by utilizing several LSS tools under five phases of the DMAIC methodology. Unlike previous studies in the telecom sector that used only qualitative method, in this study, both qualitative and quantitative methods were utilized to draw meaningful conclusions. As a result of the implementation of the LSS methodology, the average order fulfilment lead time for sales orders (SO) and value-added service (VAS) orders was reduced from 10.3 to 5.9 days and from 1.5 to 0.5 days, respectively. The reduction in lead time resulted in an increase in the sigma level for SO and VAS orders from 0.44 to 1.26 and from 0.73 to 2.66, respectively. These improvements were expected to lead to a financial benefit in savings of over $600,000 per year in operational costs, enhancements to customer experience and an increase in revenue generating opportunities. Moreover, this article enriches the existing literature on the application of LSS concept in the service industry, and helps the company to speed up the response to customer requirements.     

Deaf and disabled? (Un)Employment of deaf people in Belgium: a comparison of eighteenth-century and nineteenth-century cohorts

In this article, the employment characteristics of pre-industrial and industrial cohorts of deaf men and women are compared with each other, as well as with a cohort of non-disabled siblings. The aim is to determine the extent to which the employment patterns of deaf persons lined up with those of non-disabled people and to see how nineteenth-century industrialization processes influenced their employment opportunities. This article challenges the widely held assumption that the nineteenth century constituted a definitive break by arguing that the professional lives of deaf people were not necessarily better before industrialization. Moreover, I demonstrate that the development of deaf schools in the course of the nineteenth century opened a new range of career opportunities for deaf individuals.     

数据驱动下收货方质量偏好与电商配送服务质量优化

针对"互联网+大数据"优化电商配送服务质量问题，明确不同收货方的质量需求稳定性，引导电商根据收货方不同质量敏感性提供相对精准服务，提升配送服务质量。模拟投票结果的形成过程聚类得到收货方对服务质量偏好的记忆性特征：（1）"无记忆"型收货方；（2）"记忆"型收货方；（3）"不确定"型收货方；（4）收货方总体。进一步推导不同规划类型求解空间，设计得到"无记忆"型收货方动态规划精确求解方法，及其他三种类型近似求解粒子群算法。研究过程中，配送资源质量感知度被嵌入到模型约束；"无记忆"型收货方的质量需求规划问题转化为零库存策略最优解问题，进而证明存在精确解；"记忆"型收货方呈现出对质量感知的累积；"不确定"型收货方模型通过赋值即可得总体收货方表达式。结果表明：数据驱动研究框架借助大数据资源，使得电商更易通过收货方的质量偏好设计更加匹配的配送方案；不确定服务需求得到有效满足，投入成本的利用率更高；通过特征分类的方式，尽可能地抽取能够精确最优化的部分，缩小NP范围，提高整体求解的精确度。     

Pathways from workplace flexibility to turnover intention: Role of work–family conflict,family–work conflict,and job satisfaction

This study examined the prevalence of workplace flexibility and the mechanisms that allow workplace flexibility to influence turnover intentions through work–family and family–work conflicts and job satisfaction among low‐wage workers in South Korea. Participants included 250 low‐wage workers whose monthly salary was less than 2 million Korean won (approx. $1,900). The study results indicate that low‐wage workers have limited access to workplace flexibility and that workplace flexibility plays a significant protective role in reducing their turnover intention, indirectly by decreasing work–family conflicts and enhancing job satisfaction. This article also discusses the implications of these findings for labor policy and social work practice.     

Employers' perspectives on benefit conditionality in the UK and Denmark

This article examines the under-explored demand-side of active labour market policies (ALMPs). Based on interview data from a comparative study of the UK and Denmark, the paper analyses employers' perspectives and experiences of ALMPs. In both countries, employers were favourably disposed towards employing unemployed jobseekers but held negative views on conditionality. First, benefit conditionality led to employers receiving large numbers of unsuitable and unfiltered job applications, with associated negative resource impacts. Second, employers perceived this as a product of ‘box ticking' and compliance targets. Finally, employers criticised policy and media rhetoric for focusing solely on the supply-side and for problematizing unemployed candidates. The paper argues that these crucial, but neglected, employer perspectives demonstrate that the current benefit conditionality regime in the UK risks irrevocably ‘tarnishing' candidates, which undermines, rather than enhances, their chances of securing employment through ALMPs. This unique dataset provides further evidence that the current direction of policy requires urgent and radical re-thinking.     

Impact of older adults' mobility and social participation on life satisfaction in South Korea

South Korea has been experiencing rapid population aging. In an aging society, the need for healthy lives is greater. Two of the fundamental factors to enable independent and active life for the elderly are mobility and social participation. The purpose of this study was to examine the relationship between older adults’ mobility, social participation, and quality of life in South Korea. We used data from the 2017 National Survey of Older Koreans conducted by the Ministry of Health and Welfare and the Korea Institute for Health and Social Affairs and applied hierarchical regression. The major finding was that older adults’ mobility had a positive impact on their life satisfaction. After controlling for older adults’ mobility, social participation was positively associated with life satisfaction regardless of the place of residence. The findings of this study not only make a valuable contribution to further research on mobility and social participation but also provide new insight into improving older adults’ quality of life.     

Changes in work and care trajectories during the transition to motherhood

In most mid- and high-income countries, there have been significant demographic, structural, and cultural changes in the past decades. However, we know little about how these changes have shaped women's work patterns during a key life stage: the transition to motherhood. Using longitudinal data from Chile, covering over 30 years of employment histories and three periods of first births (1980–2010), I conduct sequence analysis to identify women's work-care trajectories during an eight-year period of the transition to motherhood. Over time, I find that continuous care work at home has declined, for which education plays a key role, while the chances of working continuously have not changed over time. Instead, I find an increasing trend of unsteady paths that combine paid work with either caretaking or unemployment. I discuss how these changes, as well as their association with education, have important implications for both gender and social inequality.     

就业优先:以"公平而有质量"的教育 在民族地区阻断贫困代际传递

“发展教育脱贫一批”是在民族地区实现共同富裕的重要方针。然而在“教育改变命运”的共识之外，布迪厄认为教育一代代地维持着对社会中下阶层的不公平的“文化再生产”理论，被一些学者应用于对我国少数民族教育的研究。如在“三区三州”等民族地区，代际间的贫困传递难以阻断，因家庭文化资本弱势而造成子女求学、求职受阻，看似可用“贫困文化的再生产”予以概括，但笔者不同意直接套用西方理论认定中国存在“教育不公平”的论述。因为我国社会实际与布氏提出“学校教育再生产社会阶层结构”观点之环境不同，有多项教育政策在切实保障着少数民族通过“教育改变命运”——当前在我国民族地区实现教育公平的主要障碍，并非 “文化再生产”的结构性阻力，而在于就业环节的阶段性困难。教育公平可分为起点、过程和结果三个环节，民族地区经多年教育扶贫，“起点”入学机会和“过程”教育质量已明显改善，而作为“结果”的就业环节亟待改善。以“就业优先”方针多渠道扩大少数民族就业，可激发内生动力、促进市场融入、巩固减贫成效和精准防控返贫，是助少数民族自主掌握教育“社会阶梯”和阻断贫困代际传递的有效路径。