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.     

中古道教仙传中的"食桃修仙"母题研究

中古道教仙传中,"食桃修仙"母题的产生有其相应的时代背景和文化背景。在探究该母题产生的基础上,从内外两方面分析了"桃"被仙化的多重原因。就外因而言,桃被仙化与神仙信仰的广泛流传有关。就内因而言,桃被仙化与桃特殊丰富的文化内涵紧密相连。进而以"食王母桃"这一母题为中心梳理"食桃修仙"母题的流变。该母题的流变与桃被赋予的神效和异形密切相关,由此导致"食桃修仙"母题呈现出神异浪漫的美学风格。     

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.     

政府动态奖惩机制下绿色建筑供给侧演化博弈研究

从绿色建筑供给侧角度出发，构建消费者效用函数、开发商利润函数和政府与开发商的演化博弈模型，分析消费者绿色偏好、建筑绿色度、成本等因素对建筑价格、需求和利润的影响以及政府动态奖惩政策下系统的演化稳定策略。结果表明：消费者绿色偏好支付系数和建筑绿色度的增大有利于绿色建筑价格、需求和利润的提高，但高成本却使需求和利润降低；政府采用静态补贴与静态税收政策时，博弈系统不存在演化稳定策略，采用动态补贴与静态税收、静态补贴与动态税收、动态补贴与动态税收三种政策组合时，系统存在演化稳定策略；动态补贴与静态税收的政策组合在推动绿色建筑发展方面优于其他政策；开发商开发绿色建筑的概率与补贴上限值呈负相关，与税收上限值呈正相关。     

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.     

货币政策反应函数渠道对金融周期影响时变机制的实证研究

在关于货币政策影响经济主体风险承担水平,进而影响金融周期波动机制的研究中,基于风险承担渠道的相关研究较为成熟.区别于以往相关研究多关注货币政策实际采取的立场,文章基于货币政策反应函数渠道探讨了数量型与价格型货币政策反应函数对金融周期波动影响的时变机制.滚动回归的实证结果显示:无论数量型货币政策规则还是价格型货币政策规则,货币政策对信贷波动反应的敏感性主要影响金融周期的波动,但在价格型货币政策规则下,基于信贷视角观察金融周期波动时,货币政策信贷敏感性与货币政策资产价格敏感性对金融周期影响差异较小;较之于价格型货币政策规则,货币政策对信贷波动反应的敏感性在数量型货币政策规则下,对金融周期波动的影响更显著,并在一定程度上表现出随时间扩大的趋势.文章的创新之处在于:强调了货币政策通过政策反应函数渠道而非以往研究中较多关注的狭义风险承担渠道影响金融周期波动的事实,并构建计量模型对货币政策反应函数渠道影响金融周期波动的时变机制进行了详细刻画.     

Improved Transferability of Data‐Driven Damage Models Through Sample Selection Bias Correction

Damage models for natural hazards are used for decision making on reducing and transferring risk. The damage estimates from these models depend on many variables and their complex sometimes nonlinear relationships with the damage. In recent years, data‐driven modeling techniques have been used to capture those relationships. The available data to build such models are often limited. Therefore, in practice it is usually necessary to transfer models to a different context. In this article, we show that this implies the samples used to build the model are often not fully representative for the situation where they need to be applied on, which leads to a “sample selection bias.” In this article, we enhance data‐driven damage models by applying methods, not previously applied to damage modeling, to correct for this bias before the machine learning (ML) models are trained. We demonstrate this with case studies on flooding in Europe, and typhoon wind damage in the Philippines. Two sample selection bias correction methods from the ML literature are applied and one of these methods is also adjusted to our problem. These three methods are combined with stochastic generation of synthetic damage data. We demonstrate that for both case studies, the sample selection bias correction techniques reduce model errors, especially for the mean bias error this reduction can be larger than 30%. The novel combination with stochastic data generation seems to enhance these techniques. This shows that sample selection bias correction methods are beneficial for damage model transfer.     

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.     

“一带一路”相关文件政策强度与省域经济开放度关系研究——“一带一路”沿线18个省份实证分析

文章的特色和理论意义在于,尝试量化"一带一路"沿线18个省份"一带一路"相关政策文件,以设计政策效力、政策措施与政策保障的评判要点为基础,确定政策措施强度和政策保障强度.细致讨论"一带一路"文件的政策强度与经济开放度提升之间的关系,并讨论该关系在东西部地区的差异以及政策保障强度在政策措施强度与经济开放度关系之中的调节效应.研究发现:政策措施强度能够正向促进省域经济开放度的提升;在经济开放度高于10％的省份中,政策保障强度正向调节政策措施强度与经济开放度提升之间的关系,政策措施强度和政策保障强度之间存在互补关系;政策措施强度中资金融通强度对于沿线省域经济开放度的提升有着最显著的正向影响,政策沟通强度对于沿线省域经济开放度的提升影响不显著;政策措施强度对省域经济开放度的提升存在地区差别,西部地区更注重"一带一路"倡议所带来的机会.建议:"一带一路"沿线省份在政策设计上,不仅要对政策沟通、设施联通、贸易畅通、资金融通和民心相通等内容作出合理规划和布局,还应对保障机制作出可操作性的安排.