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.     

全球化与当代马克思主义中国化

全球化是人类社会发展的一个必然过程。马克思主义是全球化的产物,在全球化和马克思主义的共同作用下,结合中国具体实际,形成了中国化的马克思主义。全球化不仅对马克思主义传入中国和马克思主义中国化的推进产生了深刻的影响,而且对当今中国共产党的指导思想和社会政治现实产生了巨大的作用。     

Two-stage Huber estimation

In this paper we propose a new robust estimator in the context of two-stage estimation methods directed towards the correction of endogeneity problems in linear models. Our estimator is a combination of Huber estimators for each of the two stages, with scale corrections implemented using preliminary median absolute deviation estimators. In this way we obtain a two-stage estimation procedure that is an interesting compromise between concerns of simplicity of calculation, robustness and efficiency. This method compares well with other possible estimators such as two-stage least-squares (2SLS) and two-stage least-absolute-deviations (2SLAD), asymptotically and in finite samples. It is notably interesting to deal with contamination affecting more heavily the distribution tails than a few outliers and not losing as much efficiency as other popular estimators in that case, e.g. under normality. An additional originality resides in the fact that we deal with random regressors and asymmetric errors, which is not often the case in the literature on robust estimators.     

Generalized Laplacian approximations in Bayesian inference

This paper presents a new Laplacian approximation to the posterior density of η = g(θ). It has a simpler analytical form than that described by Leonard et al. (1989). The approximation derived by Leonard et al. requires a conditional information matrix R_η to be positive definite for every fixed η. However, in many cases, not all R_η are positive definite. In such cases, the computations of their approximations fail, since the approximation cannot be normalized. However, the new approximation may be modified so that the corresponding conditional information matrix can be made positive definite for every fixed η. In addition, a Bayesian procedure for contingency-table model checking is provided. An example of cross-classification between the educational level of a wife and fertility-planning status of couples is used for explanation. Various Laplacian approximations are computed and compared in this example and in an example of public school expenditures in the context of Bayesian analysis of the multiparameter Fisher-Behrens problem.     

Test for homogeneity in Hardy–Weinberg normal mixture model

The phenotype of a quantitative trait locus (QTL) is often modeled by a finite mixture of normal distributions. If the QTL effect depends on the number of copies of a specific allele one carries, then the mixture model has three components. In this case, the mixing proportions have a binomial structure according to the Hardy–Weinberg equilibrium. In the search for QTL, a significance test of homogeneity against the Hardy–Weinberg normal mixture model alternative is an important first step. The LOD score method, a likelihood ratio test used in genetics, is a favored choice. However, there is not yet a general theory for the limiting distribution of the likelihood ratio statistic in the presence of unknown variance. This paper derives the limiting distribution of the likelihood ratio statistic, which can be described by the supremum of a quadratic form of a Gaussian process. Further, the result implies that the distribution of the modified likelihood ratio statistic is well approximated by a chi-squared distribution. Simulation results show that the approximation has satisfactory precision for the cases considered. We also give a real-data example.     

Generalized quasi-likelihood

The quasi-score function, as defined by Wedderburn (1974) and McCullagh (1983) and so on, is a linear function of observations. The generalized quasi-score function introduced in this paper is a linear function of some unbiased basis functions, where the unbiased basis functions may be some linear functions of the observations or not, and can be easily constructed by the meaning of the parameters such as mean and median and so on. The generalized quasi-likelihood estimate obtained by such a generalized quasi-score function is consistent and has an asymptotically normal distribution. As a result, the optimum generalized quasi-score is obtained and a method to construct the optimum unbiased basis function is introduced. In order to construct the potential function, a conservative generalized estimating function is defined. By conservative, a potential function for the projected score has many properties of a log-likelihood function. Finally, some examples are given to illustrate the theoretical results. This paper is supported by NNSF project (10371059) of China and Youth Teacher Foundation of Nankai University.     

The analysis of incomplete data using stochastic covariates

In the development of many diseases there are often associated random variables which continuously reflect the progress of a subject towards the final expression of the disease (failure). At any given time these processes, which we call stochastic covariates, may provide information about the current hazard and the remaining time to failure. Likewise, in situations when the specific times of key prior events are not known, such as the time of onset of an occult tumour or the time of infection with HIV-1, it may be possible to identify a stochastic covariate which reveals, indirectly, when the event of interest occurred. The analysis of carcinogenicity trials which involve occult tumours is usually based on the time of death or sacrifice and an indicator of tumour presence for each animal in the experiment. However, the size of an occult tumour observed at the endpoint represents data concerning tumour development which may convey additional information concerning both the tumour incidence rate and the rate of death to which tumour-bearing animals are subject. We develop a stochastic model for tumour growth and suggest different ways in which the effect of this growth on the hazard of failure might be modelled. Using a combined model for tumour growth and additive competing risks of death, we show that if this tumour size information is used, assumptions concerning tumour lethality, the context of observation or multiple sacrifice times are no longer necessary in order to estimate the tumour incidence rate. Parametric estimation based on the method of maximum likelihood is outlined and is applied to simulated data from the combined model. The results of this limited study confirm that use of the stochastic covariate tumour size results in more precise estimation of the incidence rate for occult tumours.     

Stochastic Modelling of Times to Temperature for Furnaces Supplying Titanium Blooms to a Rolling Mill at TIMET

In conjunction with TIMET at Waunarlwydd (Swansea, UK) a model has been developed that will optimise the scheduling of various blooms to their eight furnaces so as to minimise the time taken to roll these blooms into the finished mill products. This production scheduling model requires reliable data on times taken for the various furnaces that heat the slabs and blooms to reach the temperatures required for rolling. These times to temperature are stochastic in nature and this paper identifies the distributional form for these times using the generalised F distribution as a modelling framework. The times to temperature were found to be similarly distributed over all furnaces. The identified distributional forms were incorporated into the scheduling model to optimise a particular campaign that was run at TIMET Swansea. Amongst other conclusion it was found that, compared to the actual campaign, the model produced a schedule that reduced the makespan by some 35%.     

Estimating ordered parameters by linear programming

There are many models that require the estimation of a set of ordered parameters. For example, multivariate analysis of variance often is formulated as testing for the equality of the parameters versus an ordered alternative. This problem, referred to as isotonic inference, constrained inference, or isotonic regression, has led to the development of general solutions, not often easy to apply in special models. In this expository paper, we study the special case of a separable convex quadratic programming problem for which the optimality conditions lead to a readily solved linear complementarity problem in the Lagrange multipliers, and subsequently to an equivalent linear programming problem, whose solution can be used to recover the solution of the original isotonic problem. The method can be applied to estimating ordered correlations, ordered binomial probabilities, ordered Poisson parameters, ordered exponential scale parameters, or ordered risk differences.     

Bayesian analysis of outlier problems using divergence measures

A Bayesian approach is presented for detecting influential observations using general divergence measures on the posterior distributions. A sampling-based approach using a Gibbs or Metropolis-within-Gibbs method is used to compute the posterior divergence measures. Four specific measures are proposed, which convey the effects of a single observation or covariate on the posterior. The technique is applied to a generalized linear model with binary response data, an overdispersed model and a nonlinear model. An asymptotic approximation using Laplace method to obtain the posterior divergence is also briefly discussed.