Social health protection in Cambodia: Challenges of policy design and implementation

The Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance.     

Stakeholder perceptions of contextual factors related to PBIS implementation in high need schools

Positive behavior intervention and supports (PBIS) is a thoroughly researched three-tiered framework for preventing and treating challenging behavior in schools. While more than 20 years of research contribute to the literature base, less is known about PBIS implementation in high-needs school settings, particularly those that serve students predominantly from low-income families and majority minority student populations across urban and rural districts. This study investigated the critical contextual factors of PBIS implementation from the stakeholder perspective. Specifically, we surveyed 161 participants including teachers, school staff members, and administrators who were PBIS team members and had received technical assistance in PBIS implementation. The completed surveys were analyzed with participants and their schools coded for district type, Title I funding, and position in order to determine how the perceptions of issues such as buy-in, administrator support, PBIS in secondary school settings, and poverty affect PBIS implementation and team needs. The factor analysis and resulting structure along with statistically significant results for each factor are presented along with implications.     

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.     

Trajectory of problem behaviours of Korean adopted children: using piecewise hierarchical linear growth modelling

This study examined the trajectory of problem behaviours in domestically adopted children in South Korea as they aged. This study used the Panel Study on Korean Adopted Children's longitudinal, three‐wave data (2006, 2008 and 2010). Although data were collected at three time points, our data consisted of six time points, which covered the 5–10 years age range of the adopted children at the time of survey. One hundred sixty‐four children were included in the analysis, 75 of whom contributed to one time point, 74 to two time points and 15 to three time points. The trajectory of the problem behaviours of adopted children was examined using a piecewise hierarchical linear growth model. Because the initial exploration of the data suggested non‐linear changes in behaviour problems over time, we split the growth trajectory into two time periods: Time 1 (5–7 years) and Time 2 (7–10 years). A two‐rate model was used to estimate separate slopes for the two time periods. Results showed that the externalizing and internalizing problems of adopted children have different trajectories. Internalizing problems did not show significant changes after 5 years of age, while externalizing problems increased until 7 years of age and decreased significantly thereafter.     

Application of an imputation method for variance estimation under pseudo-likelihood when missing data are NMAR

When data are outcome-dependent non response, pseudo-likelihood yields consistent regression coefficients without specifying the missing data mechanism. However, it is onerous to derive parameter estimators including their standard errors from the regression coefficients under pseudo-likelihood (PL). The present study applies an imputation method to compute the asymptotic standard errors of parameter estimators. The proposed method is simpler than Delta method and it showed similar effect size of the standard errors to bootstrapping in simulation and application studies.     

Slope-rotatable designs with equal maximum directional variance for second order response surface models

The concept of sloperotaiability with equal maximum directional vari ance for second order response surface models is introduced as a new design property. This requires that the maximum variance of the estimated slope over all possible directions be only a function of p, which is the distance from the design originif is shown that a rotatable design satisfies this property Also, minimization of tiie maximum variance of the estimated slope over all possible directions is proposed as a new design optirnality criterion, and op¬timal designs are called slope-directional minirnax designs. For the class of cquiradial designs, the slope-directional minirnax designs are compared with D— optimal designs.     

Investment in Shared Suppliers: Effect of Learning,Spillover, and Competition

We investigate the optimal strategies for firms to invest in their suppliers when the benefits of such investments can spillover to other firms who also source from the same suppliers. We consider two Bayesian firms that can invest in improving the quality of their shared supplier; the firms do not have complete information on the true quality of the supplier, but they update their beliefs based on the supplier's performance. We formulate the problem as an investment game and obtain Markov perfect equilibria characterized by the investment thresholds of both firms. The equilibrium investment strategies of the two firms are characterized by a region of preemption and a region of war of attrition. We also examine how the interplay between spillover, competition, and returns from the investment at shared suppliers affect the investment threshold and the time to the leader's investment, and identify the conditions under which competition delays or hastens the first investment in a shared supplier.     

Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?

In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self–employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self–employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self–employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare.     

A comprehensive approach to sexual and transgender prejudice

Prejudice and discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals continues to have a detrimental impact on the mental health of this population. Research examining commonalities and uniqueness among negative attitudes toward specific sexual and gender minority groups is extremely limited. The authors propose that research examining sexual prejudice include attitudes toward diverse subgroups within the larger LGBTQ community in order to facilitate development of underlying constructs and identify unique contributing factors. Common and unique factors identified within existing research are organized into categorical themes, which are delineated in a conceptual factor model of sexual and transgender prejudice.     

Accommodating diverse clients' needs in evaluation capacity building: A case study of the Tobacco Control Evaluation Center

In this case study, we detail and analyze how the Tobacco Control Evaluation Center (TCEC), an evaluation technical assistance center that serves approximately 100 local tobacco control organizations in California, endeavors to build capacity among the state-funded local providers it serves by using evaluation capacity building activities with an utilization-focused evaluation framework. We call this a "blended approach" and describe these methods. Satisfaction and demand for TCEC services are documented to provide measurements for evaluation capacity building. Final evaluation report scores from two intervention cycles (2004-2007 and 2007-2010) submitted to the California Health Department, Tobacco Control Division are also assessed and compared. These measures demonstrate an increase in evaluation capacity by local projects under TCEC's purview.