Hospital management practices in county-level hospitals in rural China and international comparison

Background Although management is important in healthcare, low- and middle-income countries (LMICs) have little experience measuring the competence of hospital management. While improving hospital management is the main focus of hospital reform in China, few studies have empirically documented the baseline situation to inform policy design. Methods We assessed the management practices of county-level hospitals in Guizhou in southwest China during 2015. We used the Development World Management Survey (D-WMS) instrument to interview 273 managers in 139 hospitals. We scored the management practices of the sampled hospitals, overall and in four dimensions (operations, monitoring, targets, personnel management) and three processes (implementation, usage, monitoring). We then converted the scores to the WMS scale and compared these with data from two other LMICs and seven high-income countries (HICs). Results On a scale of 1 (‘worst practice’) to 5 (‘best practice’), the mean (SD) hospital D-WMS scores were 2.57 (0.46) overall; 2.71 (0.48), 2.64 (0.58), 2.40 (0.64), and 2.56 (0.40) for operation, monitoring, target, and personnel, respectively; and 2.43 (0.48), 2.62 (0.48), and 2.66 (0.47) for implementation, usage, and monitoring, respectively. After conversion to WMS scores, China ranked seventh of 10 countries, after six HICs and higher than one HIC and two other LMICs (Brazil and India). China ranked higher than the two LMICs in each of the four dimensional scores. Conclusions Chinese county-level hospitals should improve their low quality of management by prioritizing target-setting and process implementation, particularly in personnel management. Meanwhile, modern management training should be given to most clinical managers.

Place-Specific Corona Dashboards for Health Policy: Design and Application of a ‘Dutchboard’

Since the outbreak of the corona virus in the end of 2019, many worldwide attempts have been made to monitor and control the COVID-19 pandemic. A wealth of empirical data has been collected and used by national health authorities to understand and mitigate the spread and impacts of the corona virus. In various countries this serious health concern has led to the development of corona dashboards monitoring the COVID-19 evolution. The present study aims to design and test an extended corona dashboard, in which—beside up-to-date daily core data on infections, hospital and intensive care admissions, and numbers of deceased people—also the evolution of vaccinations in a country is mapped out. This dashboard system is next extended with time-dependent contextual information on lockdown and policy stringency measures, while disaggregate information on the geographic spread of the COVID-19 disease is provided by means of big data on contact intensity and mobility motives based on detailed Google Mobility data. Finally, this context-specific corona dashboard, named ‘Dutchboard’, is further extended towards the regional and local level so as to allow also for space-specific ‘health checks’ and assessments.

“A Free-Range Chicken that Can Run Wherever the Majority Wants It To”: Budget Reconciliation and the Contemporary U.S. Senate

Since its early uses in the early 1980s, the budget reconciliation process has played an important role in how the U.S. Congress legislates. Because the procedures protect certain legislation from a filibuster in the Senate, the reconciliation rules both shape, and are shaped by, the upper chamber in significant ways. After providing a brief overview of the process, I discuss first how partisanship in the Senate has affected the use of the reconciliation procedures. Next, I describe two sets of consequences of the contemporary reconciliation process, on negotiation and on policy design. I conclude with some observations about the relationship of reconciliation to the prospects for broader procedural change in the Senate.

Policy integration, problem-solving, and the coronavirus disease crisis: lessons for policy design

The coronavirus disease pandemic has exposed differences in the capacity of governments around the world to integrate and coordinate different policy instruments into a coherent response. In this article, we conceptualize and empirically examine policy integration in responses to the coronavirus disease crisis in 35 countries. We then discuss how the interplay between restrictions, health protection, and economic policy has been articulated between, on the one hand, a policy design based on the complementarity of pro-public health and pro-economy measures, implying an integrated response, and, on the other, a policy design based on the perception of an inherent trade-off between the two. Finally, we discuss three implications from our analysis of policy integration against the coronavirus disease crisis for the post-COVID state: (a) the normalization and adaptation of integrated crisis responses; (b) the possible acceleration and “catching up” of problem-solving capacity as governments may use the crisis as an instance to put into place new social policies; and (c) policy integration as an accelerator of policy complexity and resistance against technocracy in the post-COVID state.

Integrated Carbon Policy Design for Achieving Net-Zero Targets

Several countries have set net-zero targets, and many more will announce in the next few years. Countries have used carbon pricing as an instrument to cut Greenhouse Gas (GHG) emissions and provide a price signal to attract private investments to achieve net-zero targets. However, current carbon policy in countries with net-zero targets remains inadequate and asymmetrical to overcome net-zero challenges; there are visible gaps in the carbon price level, sectoral coverage, and mechanism to reward carbon-neutral initiatives. This paper proposed an integrated carbon policy design covering economic, technical, and social dimensions and discussed how an integrated policy design approach could be effective in helping countries achieve net-zero objectives. The paper makes recommendations for net-zero policymakers. First, a stable and appropriate carbon price must be in place to attract private investments in carbon offset measures and commercialize clean technologies. Second, governments should use an effective revenue recycling mechanism to engage firms and citizens in mitigating the side effects of the carbon price regime and win their trust. Third, countries should promote behavioral changes and carbon footprint reduction measures through citizen participation. 

Identifying archetypal cannabis consumers to inform drug policy design: a Q-sort assessment of young adults’ attitudes in Mexico City’s metropolitan area

Background As the legalization of cannabis moves forward in many countries, it is important to highlight the potential harm that excessive use can cause on young consumers. Crafting effective policy interventions to reduce the harm stemming from excessive use requires an understanding of the attitudes and motivations of young consumers. Methods This article uses Q methodology to study four aspects of cannabis use among young adults from Mexico City’s metropolitan area: motivations for use, perceived consequences of use, reasons that would increase willingness to reduce consumption, and attitudes towards government regulation. A total of 110 cannabis users between 18 and 21 years old were recruited using chain-referral sampling. Using a Q methodology, we captured the relative importance that participants assigned to a series of statements and identified archetypal profiles of young adults who use cannabis for each of the four aspects mentioned above. Results The sample for this research study included 76 men and 34 women. The average age of participants was 20 years old, and the average age when cannabis consumption started was 15 years old. For each of the four Q-sort factor analyses, we identified 4 distinct factors based on explained variance and interpretability. The Q factor analysis indicated that attenuation of a negative affect (i.e., anxiety, stress) and relaxation were primary motivations for cannabis use. Understood consequences of cannabis use ranged across aspect-archetype, reflecting legal (i.e., interacting with law enforcement), financial, familial (i.e., disappointing family members), and educational performance concerns. Participants indicated that finding alternative relaxation strategies, receiving credible evidence of the health harms of cannabis use, increased financial burden of purchasing, and increased inaccessibility of cannabis products would motivate reductions in use. Across archetypes, participants indicated a willingness to comply with cannabis policies which are simple and easy to understand, which do not lead to discrimination or law enforcement involvement, and which provide for legal places to purchase and use safe (i.e., free of adulterants) cannabis products. Conclusions We posit that these archetypes could be useful to inform cannabis policy design. As the study reveals, participants’ cannabis use was primarily motivated by perceived improvements to mental health. Furthermore, participant responses indicated that they viewed cannabis use as a health matter, not a criminal one. Policies which aim to promote alternative mental health wellness and relaxation mechanisms, which aim to improve communication of potential health harms of cannabis, and which allow for the safe and legal purchase and use of cannabis may be effective in reducing cannabis-associated harms. Though our findings shed light on important aspects of cannabis users’ attitudes and perspectives, the sample size does not allow for a generalization of the findings and the drawing of conclusions about the population under scrutiny. Further research should consider the application of the Q methodology used in this article to a larger and more representative sample of cannabis users.

Endogenous viral mutations, evolutionary selection, and containment policy design

How will the novel coronavirus evolve? I study a simple epidemiological model, in which mutations may change the properties of the virus and its associated disease stochastically and antigenic drifts allow new variants to partially evade immunity. I show analytically that variants with higher infectiousness, longer disease duration, and shorter latent period prove to be fitter. “Smart” containment policies targeting symptomatic individuals may redirect the evolution of the virus, as they give an edge to variants with a longer incubation period and a higher share of asymptomatic infections. Reduced mortality, on the other hand, does not per se prove to be an evolutionary advantage. I then implement this model as an agent-based simulation model in order to explore its aggregate dynamics. Monte Carlo simulations show that a) containment policy design has an impact on both speed and direction of viral evolution, b) the virus may circulate in the population indefinitely, provided that containment efforts are too relaxed and the propensity of the virus to escape immunity is high enough, and crucially c) that it may not be possible to distinguish between a slowly and a rapidly evolving virus by looking only at short-term epidemiological outcomes. Thus, what looks like a successful mitigation strategy in the short run, may prove to have devastating long-run effects. These results suggest that optimal containment policy must take the propensity of the virus to mutate and escape immunity into account, strengthening the case for genetic and antigenic surveillance even in the early stages of an epidemic.

Evolutionary Game Analysis of Responding to the EU’s Carbon Border Adjustment Mechanism

The European Union (EU) views the carbon border adjustment mechanism (CBAM) as a measure to tackle carbon leakage, which will have a profound impact on non-EU countries’ exports. Policymakers are faced with the question of how to deal with the CBAM. In contrast to previous studies, we explore the effects of the CBAM on non-EU countries from a dynamic game perspective. This study analyzed the potential effects of the CBAM on China and found that the government and export companies are the two main stakeholders. We found that they can both choose whether to respond actively or passively. Based on their interactive relationship, we adopted an evolutionary game to model the nexus between the government and export companies. We analyzed the evolutionary stable state of each stakeholder and the whole game with the replicator dynamic equation system. To make the system evolve to the optimal state where the government reacts actively and export companies implement low-carbon production, we provide a policy mechanism for how to set key parameters’ values. We used numerical simulation to verify the policy design and to conduct sensitivity analyses of the key parameters. Our results show that, when two stakeholders positively react to the CBAM, it is necessary to increase their profits and to reduce their costs. Therefore, some suggestions are proposed, including optimizing the trade structure, strengthening cooperation with the EU, improving the current carbon market, and adopting carbon tax.

Modeling of Wages and Prices Behavior: System Dynamic Approach

The economies of almost every country in the whole word have been suffered from coronavirus pandemic consequences. The damage was especially hard for labor markets. The large magnitude of demand and production shocks that was caused by COVID-19 significantly disturbed the dynamics of output, wages and prices. The research problem addressed in this paper focuses on dynamic properties of wages and prices behavior influenced by shocks with different magnitudes and types. We apply a system dynamic approach to conduct the simulations of economic variables and investigate the possibility of their convergence to some stable path. We examine the impact of demand and production shocks on the output and prices as well as on wage and inflation behavior. It is proved that values of models parameters are crucial for existing of new steady state and convergence of economic variables. The paper determines the bifurcation points that separate different modes of transition period in moving towards or away from equilibrium. The research includes the investigation of the impact of economy’s original state and emphasizes the importance of initial point of the system for the next its dynamics after shock. The research results derived in the paper serves as a useful learning tool to develop a discussion of the policy design issues related to reduction of negative impact of severe and unanticipated disturbance like COVID-19.