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.     

为什么历史上经营式农业不发展：以无锡为案例

本文基于第一、二次对"无锡、保定农村调查"的资料,分析说明了无锡农村经营式农业的日渐式微,并从出租农地与雇工经营的收益方程、较高工商业发展水平导致的机会成本增加,以及家庭小农场的竞争三个方面分析了经营式农业不发展的原因.我们认为,主要是当地较高但又不足够高的工商业发展水平导致了经营式农业难以发展.较高的工商业发展水平意味着发展经营式农业的高运营成本和高机会成本.不足够高又使得非农产业的需求与人数众多的农业过剩劳动力不相匹配,从而造成了家庭小农场和经营式农场之间的激烈对抗.我们也认为,中国未来的农业农村现代化道路可能会依然呈现出复杂性和特殊性,家庭小农场扮演的角色可能仍然不容忽视.     

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.     

Brazil’s non-indifference: a case for a feminist diplomatic agenda or geopolitics as usual?

At the beginning of the twenty-first century, Brazil took advantage of its economically and politically privileged position to challenge global normative structures. In 2004, the concept of “non-indifference” was integrated into the Brazilian vocabulary of foreign policy, justifying and legitimating the country’s acceptance of the invitation to command the United Nations Stabilization Mission in Haiti (MINUSTAH). On the one hand, non-indifference can be read as a discursive maneuver that enabled Brazil to accommodate its non-interventionist agenda to an old geopolitical game, given the pressure imposed upon “global players” to respond effectively and assertively to threats to international peace and security. On the other hand, the “Brazilian way” could also be seen as an alternative to a highly masculinized geopolitical approach to international security. This paper explores possible limitations, tensions and/or opportunities that emerge from the encounter between a feminist diplomatic agenda and a masculinizing ordering of the international space. It does so by contrasting Brazil’s ambition for a permanent seat on the United Nations Security Council (UNSC), the club of powerful states, with Brazil’s diplomatic and military performance during MINUSTAH, widely evaluated as a success due to characteristics such as solidarity, generosity, flexibility and the “warm conviviality” of Brazilian culture.     

地方高校推行教师学术休假制度的现实意义与实施策略

教师学术休假是促进教师专业发展的重要形式，是教师自我完善的需要，是提升教师理论水平、科研能力和教学技能的主要手段，是提高教学质量的有效途径。探讨地方高校推行学术休假制的必要性，提出地方高校推行学术休假的建议，对地方高校教师队伍建设具有重要的现实意义。在实施策略上，应注重4个方面：（1）明确参加学术休假的对象主要是教师和教学科研人员；（2）根据教师职业发展的阶段性确定学术休假的时间；（3）合理设置学术休假人员遴选条件，首先应考虑为工作满5年以上的青年教师提供学术休假，其次应考虑为高级职称教师提供学术休假；（4）明确学术休假期间的教师待遇，并加强对学术休假人员的管理。     

第一次石油危机后国际能源政治的情境变迁

国际政治的参与情境决定行动者的博弈行为类型，参与情境变迁将导致行动者行为发生变化。能源安全是国家对外政策的核心议题之一。1973年爆发的第一次石油危机，凸显了能源安全问题的重要性，改变了二战后国际能源政治的参与情境，构建了行动者新的博弈类型，调整了国际能源政治行动者的博弈策略。为了有效应对国际能源政治的情境变迁，美国通过协调与其他国家的能源关系，设置能源安全国际议程，最终确定了新的国际能源秩序。当前，我国在积极参与国际能源合作的过程中，第一次石油危机后国际能源政治的情境变迁以及国际社会的应对策略具有十分重要的启示意义。     

双循环发展的改革开放空间试验场——我国开发区的缘起、演进和趋势

开发区是我国改革开放进程中重要的"制度安排",在制度转型、市场机制培育、产业结构升级和带动地区经济增长等方面发挥着引领示范作用,但同时也存在政策效应边际递减、土地资源浪费、创新不足等诸多问题.梳理我国开发区过去三十多年的发展经验和不足,并展望其未来定位是一项重要的研究课题.在详细讨论我国开发区的缘起、动力机制、发展阶段、功能演变、面临问题的基础上,文章从制度安排、比较优势、产业集聚和商业环境四个方面总结了我国开发区取得的成功经验.未来,开发区的发展应实现从生产到生活、从效率到公平、从地的繁荣到人的繁荣、从外围到中心、从专业化到多样化、从高速增长到高质量发展、从对外开放到国内国际双循环等方面的转变.     

清代冕宁司法档案中的“夷兵”及其功能考察

清代冕宁县作为多民族杂居的地区，雍正年间改土归流后，国家治理开始深入基层社会，为了适应当地民族社会管理的特别需要，当地形成了一种特殊的制度——夷兵换班制。“夷兵换班制”是通过招募当地“夷民”到流官衙署中充当“夷兵”，作为地方流官处理涉及少数民族内部事务的辅助人员，保证国家在处理当地少数民族民政、治安、司法等事务时有熟悉当地“夷俗”的衙吏。由于“夷兵”实行定期轮换，所以称为“夷兵换班制”。“夷兵换班制”的核心是“夷兵”，“夷兵”从职能上看，最初是作为地方治安保安人员，但在现实中往往成为流官和夷民之间在民政、治安、司法事务管理中的中介，具有沟通官方与民间信息、促进国家法与民族习惯融合与互动、弥补外来官吏地方民族事务管理能力不足等功能。总之，“夷兵换班制”是清代地方流官衙署在西南地区治理时针对特定地区设置的一种变通制度，这种制度对于国家在少数民族地区基层社会的治理发挥着十分重要的积极作用。     

基于质量意识的复杂产品质量控制激励策略

激励在复杂产品供应链中对主供协同合作关系及质量控制发挥了重要作用。本文研究基于主制造商在复杂产品生产研发前按照客户要求形成的质量意识的激励策略是否可以实现复杂产品质量控制问题。考虑具有质量意识的主制造商和其系统供应商组成的两级供应链，建立以主制造商为领导者的Stackelberg博弈模型，分别讨论无激励和存在激励时的主供生产最优决策。基于激励方式的不同，将激励策略分为根据供应商产品质量水平激励以及根据主制造商质量意识水平激励两种方式。研究结果表明激励是供应商加强协同合作、改进产品质量的内在动力，主制造商根据质量意识激励供应商可以进一步促使双方协同合作，提高产品质量，使双方获得更高的利润从而实现供应链整体利润最大化。此外用灵敏度分析发现提高主制造商质量意识水平可以增加双方协同合作努力程度，有效提升产品质量水平并实现帕累托改进。