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.     

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.     

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.     

Leader-employee congruence of expected contributions in the employee-organization relationship

Employees' expected contributions can be incongruent with those of their leader. We examine the congruence effect of leaders' and employees' expected contributions on job satisfaction. Results of cross-level polynomial regressions on 947 employees and 224 leaders support the congruence effect. When expected contributions are congruent, employees are more satisfied with their job. Our findings suggest that employees enjoy high challenges, as long as these challenges are in harmony with the expected contributions of their leaders. Employees are less satisfied with their jobs both when their expected contributions were higher than their leaders' and when their expected contributions were lower than those of their leaders. Beyond the relevance of having high expected contributions, the findings highlight the crucial role played by the congruence of expected contributions of leaders and employees.     

客户生命周期模式研究

客户关系具有周期性,可划分为考察期、形成期、稳定期和退化期四个阶段.交易额和客户利润被选作特征变量来描述客户关系水平,理论分析表明:两者均随生命周期阶段的发展而不断提升,考察期最小,形成期次小,稳定期最大.实证研究检验了该结论的正确性.根据客户关系退出时所处的阶段,客户生命周期模式被分成早期流产型、中途夭折型、提前退出型、长久保持型四种基本类型,每种类型均有不同的成因.     

CRM的理念与实施中关键因素分析

随着市场环境、竞争环境的快速变化 ,企业的管理理念、服务观念开始发生重大转变 ,使得CRM(CustomerRelationshipManagement,客户关系管理 )成为当前热点。本文试从CRM在国内外的应用情况、CRM体现的管理理念、服务宗旨以及实施中应考虑的一些重要因素进行分析     

陶渊明的诗化人格

作家的人格是其作品风格的内在因素 ,往往决定着其作品的风格。我们在研究作品风格的时候 ,不能不关注作家的人格。只有对作家的人格进行全面深入的审视 ,才能更准确地理解和把握其作品的风格。探讨陶渊明的人格魅力及其特征 ,是深入研究陶渊明作品风格的至关重要的途径。从陶渊明的作品中 ,从他的言行中 ,我们可以领悟到他的情趣和胸襟 ,领悟到一种具体的人格。陶渊明自然率真平和旷达的个性特征构筑了他的诗化人格 ,即未经世俗异化的高尚贞洁的人格。这种人格的内在思想根源是自然化迁的宇宙观和委运自然的人生观。这种人格的外在表现形式是他任真自得和固穷守节的行为方式。他的作品中常见的酒与菊、孤松、孤云与归鸟等艺术形象组成了陶渊明诗化人格的象征系列     

供应链与海尔的战略调整

供应链是现代工商业的一种新的业态形式 ,它通过有效的客户和市场管理、对客户需求的准确预测和迅速反应以及最大程度地降低从原材料到生产、再到销售整个过程的库存和运转费用 ,为终端顾客提供最大的让渡价值 ,提高供应链成员整体的竞争力。海尔集团以超前性的战略眼光对公司的组织管理结构和经营方式进行了战略性的调整 ,为推行供应链管理和经营创造了条件。     

The Best and Worst Times of Life: Narratives and Assessments of Subjective Well-Being by Anamnestic Comparative Self Assessment (ACSA) in the Eastern Cape,South Africa

The Anamnestic Comparative Self Assessment (ACSA) measure of subjective well-being (SWB) aims to reduce the problems of cultural bias and relativity to external standards by allowing people to define the endpoints or ‘anchors’ of the measurement scale. In medical terminology anamnestic denotes ‘based on memory’. The ACSA uses subjects’ memories of the best and worst periods in their lives to define the anchors of the scale. They then assess their current quality of life relative to these personal anchors. The South African pilot study tested the match between self-assessment of SWB with ACSA and the conventional single-item measures of life satisfaction and happiness used in the South African Quality of Life Trends Study and analysed the narratives of the best and worst times of life. The quota sample of 46 consisted of 26 residents of Makana district in the Eastern Cape Province, South Africa, and 20 patients undergoing treatment in the local TB hospital. Mean SWB ratings with all three measures of life satisfaction, happiness and ACSA were between 5 and 6 on a 0–10-point scale. Ratings on all three scales were positively correlated. However, on ACSA the TB patients rated their current SWB 1.84 points lower than the community respondents, suggesting a greater sensitivity of this measure. It was observed that the starting points of the life stories produced by respondents to define the anchor periods for ACSA were related to their current assessment of SWB. A typology was developed that combined the starting point of the life stories with current SWB. The majority of community respondents matched the ‘Achiever’ type who scored positively on ACSA (i.e., above the mid-point of the scale) and whose life stories started with the worst period of their lives and proceeded to the best period. The TB patients were the only respondents to represent the ‘Survivor’ type whose morale had recovered after misfortune in life. ‘Survivors’ started their narratives with the best period in their lives, then moved to the worst (often health-related) one, and gave positive ACSA ratings. Based on the qualitative analysis of narratives, it is concluded that ACSA is a sensitive measurement instrument and therefore particularly useful for monitoring the effects of treatments and social interventions in longitudinal studies. However, further research is required to verify its cross-cultural validity.