Competition and The Operational Performance of Hospitals: The Role of Hospital Objectives

We examine the effect of a hospital's objective (i.e., non‐profit vs. for‐profit) in hospital markets for elective care. Using game‐theoretic analysis and queueing models to capture the operational performance of hospitals, we compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and patient costs from waiting and hospital payments. In the first setting, a monopoly, patients are served exclusively by a single non‐profit hospital; in the second, a homogeneous duopoly, patients are served by two competing non‐profit hospitals. In our third setting, a heterogeneous duopoly, the market is served by one non‐profit hospital and one for‐profit hospital. A non‐profit hospital provides free care to patients, although they may have to wait; for‐profit hospitals charge a fee to provide care with minimal waiting. A comparison between the monopolistic and each of the duopolistic settings reveals that the introduction of competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. Moreover, the presence of a for‐profit sector may be desirable only when the hospital market is sufficiently competitive. A comparison across the duopolistic settings indicates that the choice between homogeneous and heterogeneous competition depends on the patients' willingness to wait before receiving care and the reimbursement level of the non‐profit sector. When the public funder is not financially constrained, the presence of a for‐profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. Finally, our analysis suggests that the public funder should exercise caution when using policy tools that support the for‐profit sector—for example, patient subsidies—because such tools may increase patient costs in the long run; it might be preferable to raise the non‐profit sector's level of reimbursement.     

How Employed Mothers in Australia Find Time for Both Market Work and Childcare

Time use studies find that employed mothers reduce their parental childcare time by much less than an hour for every hour they spend in market work. This paper uses data from the Australian Bureau of Statistics Time Use Survey 1997 (4,059 randomly selected households) to investigate how employed mothers manage to avoid a one-for-one trade-off between work and childcare. It compares the time allocation of employed fathers, employed mothers and non-employed mothers and finds that parents use non-parental childcare to reschedule as well as to replace their own childcare, that employed mothers reschedule activities from weekdays to weekends or to earlier or later in the day, and spend less time than other mothers in housework, childfree leisure and personal care.

孤残儿童的机构照顾与社会融合

机构照顾是我国目前孤残儿童福利服务的主要模式,对孤残儿童的衣、食、住、行、医有了较全面的保障,并为这些特殊儿童提供了安全、健康的集体环境。但随着我国改革开放的不断深入,儿童福利照顾的理念和照顾模式也在发生新的变革,跟很多发达国家的发展经历相似,在照顾模式中,改革、变化的趋势是:从大机构到小机构的转变,从机构照顾到家庭寄养和家庭收养模式的转变。本文重点探讨国外孤残儿童机构照顾的实践及其反思,以及我国孤残儿童机构照顾模式存在的问题,特别在社会融合方面存在的缺陷。试图分析孤残儿童走向社会融合的可能途径,并以上海市儿童福利院为例,从现实操作层面来看这些途径的有效性。     

Does the availability of child care influence the employment of mothers? Findings from western Germany

There is a vast empirical literature investigating the effects of child care costson female employment. Day-care costs are usually treated as a reduction infemale wages and are supposed to reduce a woman's propensity to participatein the labor market. In this paper we argue that an analysis of the effects ofchild care on the employment of mothers in Germany should focus on theavailability rather than the affordability of care, due to peculiarities of theGerman day-care regime. Our empirical findings cast doubt on the effectivenessof the current German day-care regime. Specifically, we question the extent towhich it enables mothers to participate in the labor market.     

Self-Stigma of seeking help and job burnout in mental health care providers: the comparative study of Lithuanian and the USA samples

This study aimed to explore the correlation between job burnout and self-stigma of seeking help among nonmedical mental health care providers (psychologists, social workers, and counselors) in two countries – Lithuania and the US. The study included 234 professionals (111 social workers and 123 psychologists) from Lithuania and 93 professionals (33 counselors, 23 social workers, and 37 psychologists) from the US on a voluntary basis (93% females, mean age – 39.81?years). They completed a self-reported questionnaire with the Self-Stigma of Seeking Help Scale (SSOSH) and the Maslach Burnout Inventory-General Survey (MBI-GS). The results revealed a statistically significant positive correlation between self-stigmatization and burnout in the Lithuanian sample, but only weak positive correlation between depersonalization and self-stigma of seeking help in the US sample. The relationship between the self-stigma of seeking help and burnout was stronger in the Lithuanian sample of professionals when compared to their colleagues in the US.     

Design of ISD-1: an instrument for social diagnosis in care homes for older persons*

This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries.     

Parents’ perspectives of social support and social cohesion in urban contexts of diversity

Although provisions for young children are increasingly considered as ideal places to foster an inclusive and socially just society by embracing issues of social support and social cohesion, there is no in-depth understanding of the role these provisions can play in enabling supportive and cohesive encounters in contexts of diversity. Even more striking is the absence of parents’ voices in this discussion. Based on an analysis of qualitative interviews with 18 parents who use childcare services in urban contexts of diversity, our findings show the relevance of ephemeral contacts with diverse people that could offer bridging opportunities in terms of social connectedness to familiarise within diversity while decoding the other in urban contexts of diversity. However, neither bonding nor bridging contacts appear as self-evident. Our research shows that the role of childcare services might be vital in creating light and temporal communities as the prerequisite for social cohesion to flourish, in both individual as well as collective dimensions.     

The Mediating Effect of Resilience Between Social Support for Exercise and Resident Satisfaction in Assisted Living

This study examined whether residents' level of resilience mediated the relationship between social support for exercise from staff and resident satisfaction in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from four assisted living facilities. Using structural equation modeling, we found that mood and social support for exercise from staff were the only variables associated with resilience. Mood, gender, cognition, and social support for exercise from staff directly influenced resident satisfaction and explained 31% of the variance in the model. Implications for future research and practice are discussed.     

Health insurance literacy: A mixed methods study of college students

Objective: This study examines the health insurance literacy, or the ability to use health insurance effectively, of college students. Participants: A total of 455 students from a large, public university completed an online questionnaire in November 2016. Methods: A questionnaire examined students’ knowledge of commonly encountered health insurance terms and ability to apply that knowledge to determine cost-sharing in a clinical setting. Results: The majority of students were able to correctly identify the most commonly encountered terms, but could not identify terms related to plan types and options. Eighty-eight percent of students could not determine their cost-sharing for two presented scenarios. Approximately half of the students indicated they had been confused about their health insurance plan, with one-quarter of students stopping or delaying medical care due to confusion. Conclusions: Outreach and education for students should target specific deficits in knowledge such as those identified in this study.     

Population aging and long-term care policies in the Gulf region: a case study of Oman

Population aging is a phenomenon occurring across the globe including in countries traditionally exhibiting population dividends and “youth bulges.” The Gulf Corporation Council countries are no exception as they currently experience a process of population aging, albeit at a different stage from many developed countries. However, due to historically high fertility rates and fast-paced epidemiological transition, some of these countries will experience population aging at a higher pace than what has been observed in Europe and the United States. This article reviews recent developments in long-term care policies in the Gulf region with a focus on Oman as an example of a high-income Arab country that is experiencing population aging while still being governed by traditional family aged-care norms. Utilizing existing data and published research complemented by policy analysis and field visits, we analyze the process of population aging in Oman and neighboring countries and its policy implications.