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.     

类型化视域下自然保护地立法的制度建构

自然保护地在维持生态平衡,实现生态系统服务功能中可以发挥重要作用,但不同类型自然保护地的主导生态系统服务功能供给存在一定差异.《自然保护地法》立法工作须依赖理论上对自然保护地的类型化,并在此基础上建构对应型的规划建设、运营管理等方面的具体制度.因此,基于生态系统服务功能供给的空间差异,可以将当前相互重叠、缺乏体系的自然保护地划分为国家公园、自然保护区、自然公园、自然保护小区等四种类型,搭建"1部基础法律+4部类型化条例(或法律)"的自然保护地法律体系,并可以通过体系化公法、私法制度工具强化自然保护地的有效治理.     

高校哲学社会科学研究评价的本质要求及其制度建设

建设具有中国特色、中国风格、中国气派的哲学社会科学,一直是我国哲学社会科学繁荣发展的根本目的.提升高校哲学社会科学繁荣发展水平,离不开科学有效的哲学社会科学研究评价.坚持党的领导、"二为"方向和"双百"方针是哲学社会科学繁荣发展的根本保障,坚持"质量为本"和"创新至上"是哲学社会科学繁荣发展的必然要求,坚持科学权威和公开透明是哲学社会科学研究评价的现实需要.结合当前高校哲学社会科学研究评价中"量化评价下数量与质量的关系论辩","学术评价与科研管理评价的边界异化"和"学术权力和行政权力的制度规制"三大问题聚讼,文章建议通过强化学术成果质量保障机制、优化学术共同体工作机制、构建学术争鸣长效机制和完善学术成果转化应用机制等制度建设,推动构建科学权威、公开透明的哲学社会科学研究评价体系,以期进一步改善新时代高校哲学社会科学研究评价工作.     

随机需求环境下联产品系统价格与产量决策研究

基于固定比例生产技术和多产品随机需求的情形,研究了联产品制造商的两阶段产量和价格联合优化模型。通过反向倒推的优化求解,得到了联产品制造商的最优产量和价格决策以及变化规律。同时研究了需求服从均匀分布时,需求波动对均衡的影响。研究结果表明,在订货成本较低和一种产品的需求波动性较大时,当另外一种产品的波动增大,则该产品的最优订货量增大,同时价格下降。借助数值仿真,分析了价格敏感度和产出比例对最优决策和利润的影响。结果表明,在给定一种产品的价格敏感度时,另外一种的价格敏感度越大,那么该产品的价格就越低,制造商的订货量就下降。当一种产品的产出比例固定时,另一种产品的产出比例上升时,则该产品的价格下降,制造商的订货量下降,总利润上升。     

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.     

农户地权诉求视角下农地制度的创新

目前我国农户的地权诉求已经发生了很大的变化，即由地权稳定、自主经营向农地资源的优化配置和高效利用转化。这一变化的内在动力是农户急切希望改变承包地过于细碎化以及改善农业生产经营基本条件。考察我国农地制度的发展史可以发现，我国农地制度变迁的基本逻辑就是农户的地权诉求决定农地制度的发展方向，这一点在当下一些地方的农地制度创新试验和经验中再次得到证明。今后我国农地制度创新必须遵循这一逻辑，根据我国农户地权诉求的变化，实施农户自愿前提下的承包地连片重划,争取国家对承包地重划制度的支持,强化农民集体民主决策制度,地方政府也要给予必要的支持。     

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。