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.     

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.     

随机需求环境下联产品系统价格与产量决策研究

基于固定比例生产技术和多产品随机需求的情形,研究了联产品制造商的两阶段产量和价格联合优化模型。通过反向倒推的优化求解,得到了联产品制造商的最优产量和价格决策以及变化规律。同时研究了需求服从均匀分布时,需求波动对均衡的影响。研究结果表明,在订货成本较低和一种产品的需求波动性较大时,当另外一种产品的波动增大,则该产品的最优订货量增大,同时价格下降。借助数值仿真,分析了价格敏感度和产出比例对最优决策和利润的影响。结果表明,在给定一种产品的价格敏感度时,另外一种的价格敏感度越大,那么该产品的价格就越低,制造商的订货量就下降。当一种产品的产出比例固定时,另一种产品的产出比例上升时,则该产品的价格下降,制造商的订货量下降,总利润上升。     

网络服务提供者著作权侵权中的双重注意义务

《民法典》侵权责任编对原有通知删除规则进行了科学修正，但事前保护缺位与事后救济程序失范的问题仍然存在。随着网络服务提供者完成角色转型和技术升级，其作为网络侵权风险的控制者和参与者，有必要且有能力承担未通知阶段的主动预防义务和已通知阶段的证明材料审查义务，以弥补著作权保护和用户利益保护的漏洞。双重注意义务应分别与网络服务提供者对侵权危险的预期和控制能力以及材料审查能力相适应。未通知阶段之注意义务以技术措施为主要履行方式，其注意标准的认定应综合考量技术水平、服务类型、内容介入程度、是否直接获取收益等要素，未尽该注意义务仅为过错认定的考量因素而非唯一标准，并不必然导致侵权责任。已通知阶段之注意义务仅限于对提交的证明材料进行形式审查和有限的实质审查，尽到此注意义务的，可以免于承担侵权责任。     

Caring for families experiencing stillbirth: Evidence-based guidance for maternity care providers

BackgroundEvidence-based guidance is needed to inform care provided to mothers and families who experience stillbirth. This paper focuses upon how meaningful and culturally appropriate care can be provided to mothers and families from when they are informed that their baby will be stillborn to many years after the experience. Avoidable suffering may be occurring in the clinical setting.AimsTo promote and inform meaningful and culturally appropriate evidence-informed practice amongst maternity care providers caring for mothers and families who experience stillbirth.MethodsA comprehensive systematic review was conducted which primarily synthesised relevant qualitative research studies. An expert advisory group comprised of stillbirth researchers, clinicians, and parents who have experienced stillbirth provided guidance for the review and the development of implications for practice.FindingsGrieving parents want staff to demonstrate sensitivity and empathy, validate their emotions, provide clear, information, and be aware that the timing of information may be distressing. Parents want support and guidance when making decisions about seeing and holding their baby. Sensitivity, respect, collaboration, and information are essential throughout the experience of stillbirth. Culturally appropriate care is important and may require staff to accommodate different cultural practices.ConclusionThe findings of the review and expert consensus inform the provision of meaningful and culturally appropriate care for mothers and families that have experienced stillbirth. Evidence informed implications for practice are provided to guide the actions, communication, and behaviours of maternity care providers.     

Catering to sex,sexual, and gender diversity: An exploratory study on the effects of LGBTI awareness training on aged care staff in Tasmania,Australia

The Australian National LGBTI Ageing and Aged Care Strategy seeks to address the lack of recognition of older lesbian, gay, bisexual, transgender, and intersex (LGBTI) adults living in aged care. Awareness training for aged care staff forms a crucial part of this strategy, but the impact of such educational programs are yet to be examined. In this article, we examine the effects of LGBTI awareness training on staff working in an Australian aged care facility. These staff perceived the awareness training as valuable, but the outcomes from it were limited. Therefore, we indicate changes that are necessary to support the translation of training into practice.     

丹巴土司制度发展历史考证

丹巴位于“藏彝走廊”的核心区域，其对汉藏民族关系、中央政权与边疆地区的稳定均具有重要影响。自忽必烈时期开始丹巴即开始实行土司制度直至新中国成立，研究丹巴的土司制度发展历史对梳理“藏彝走廊”民族关系及社会发展历史具有重要作用。本文对丹巴土司制度的发展历史进行了考证，并对其境内的四个土司的管辖范围、权力地位进行了梳理，以期对该地区历史发展研究提供一些参考与借鉴。     

农村互助型社会养老:中国特色与发展路径

农村互助型社会养老是具有中国特色的社会养老的发展形式，是对农村传统家庭养老的重要补充。它扎根于农村传统的亲邻互助网络，其本质在于经济互助，表现为有组织地发动邻里、志愿等社会力量，充分利用以老年人为主的各类人力资源的闲置时间、资源低成本地相互帮助和服务。社会各界应将其作为重要实施方略，纳入积极应对人口老龄化战略和乡村振兴战略之中。其发展路径可以概括为：以资金互助为基础，以组织动员为抓手，以服务互助为重点，以社区居家养老为主要阵地，创新各类互助养老模式，着力形成稳定多元的资金来源，培育互助队伍，增加互助内容，从无偿到无偿、低偿相结合，探索建立标准规范的服务管理评估制度，机构养老与社区居家养老互联互通，最终尝试建立圈层化、整合化、网络化、制度化的农村互助型社会养老体系。     

China’s Choice of Analytical Models for Its Anti-Monopoly Law

Modern analytical models for anti-monopoly laws are a core element of the application of those laws. Since the Anti-Monopoly Law of the People’s Republic of China was promulgated in 2008, law enforcement and judicial authorities have applied different analytical models, leading to divergent legal and regulatory outcomes as similar cases receive different verdicts. To select a suitable analytical model for China’s Anti-Monopoly Law, we need to consider the possible contribution of both economic analysis and legal formalism and to learn from the mature systems and experience of foreign countries. It is also necessary to take into account such binding constraints as the current composition of China’s anti-monopoly legal system, the ability of implementing agencies and the supply of economic analysis, in order to ensure complementarity between the analytical model chosen and the complexity of economic analysis and between the professionalism of implementing agencies and the cost of compliance for participants in economic activities. In terms of institutional design, the models should provide a considered explanation of the legislative aims of the law’s provisions. It is necessary, therefore, to establish a processing model of behavioral classification that is based on China’s national conditions, applies analytical models using normative comprehensive analysis, makes use of the distribution rule of burden of proof, improves supporting systems related to analytical models and enhances the ability of public authorities to implement the law.     

影子银行、地方政府债务及金融发展动态关系研究——基于省级面板VAR模型

基于2004—2017年中国省级面板数据,运用面板向量自回归(PVAR)模型,使用系统GMM估计、脉冲响应函数、方差分解以及格兰杰因果关系检验等方法分析了影子银行、地方政府债务及金融发展之间的动态关系.结果表明:影子银行、地方政府债务与金融发展水平三者之间存在动态耦合关系.在地方政府融资能力受到约束的情况下,影子银行为地方政府提供了多元的融资方式,在增加政府融资能力的同时提升了政府债务水平;而地方政府债务需求显著推动了影子银行规模的快速发展.同时,影子银行过度扩张危害了金融市场的健康发展,降低金融发展水平,继而使地方政府的融资渠道受到约束.但金融发展并不能有效约束影子银行规模,原因在于,政府融资需求是影子银行的主要动力,若不能控制地方政府的借贷行为则无法从源头解决问题.监管机构在去杠杆的过程中,应该综合考虑影子银行与地方政府债务、金融发展之间的动态关系,如此才能够实现预期的政策效果.