Understanding the institutional challenges and impacts of higher education reforms in Indonesia

ABSTRACT

This paper contributes to the academic literature on policy-making at the global level by empirically showing the nature and institutional challenges of higher education reforms under NPM principles. The authors explain the key strategies adopted by Indonesia’s government and the problems it faced in reforming its higher education system. The overall result was negative. The Indonesian reforms will not bring about meaningful outcomes unless the existing institutions, and the environment in which they operate, are also reformed.     

Epidemics and macroeconomic outcomes: Social distancing intensity and duration

We analyze the determination of the optimal intensity and duration of social distancing policy aiming to control the spread of an infectious disease in a simple macroeconomic–epidemiological model. In our setting the social planner wishes to minimize the social costs associated with the levels of disease prevalence and output lost due to social distancing, both during and at the end of epidemic management program. Indeed, by limiting individuals’ ability to freely move or interact with others (since requiring to wear face mask or to maintain physical distance from others, or even forcing some businesses to remain closed), social distancing has on the one hand the effect to reduce the disease incidence and on the other hand to reduce the economy’s productive capacity. We analyze both the early and the advanced epidemic stage intervention strategies highlighting their implications for short and long run health and macroeconomic outcomes. We show that both the intensity and the duration of the optimal social distancing policy may largely vary according to the epidemiological characteristics of specific diseases, and that the balancing of the health benefits and economic costs associated with social distancing may require to accept the disease to reach an endemic state. Focusing in particular on COVID-19 we present a calibration based on Italian data showing how the optimal social distancing policy may vary if implemented at national or at regional level.     

Co-commissioning of public services and outcomes in the UK: Bringing co-production into the strategic commissioning cycle

Commissioning as a planning, resource mobilization and prioritization activity needs to harness user and community co-production of public services and outcomes. Based on a public value model, we map how commissioners can go beyond traditional consultation and participation processes to achieve co-commissioning with citizens. Moreover, we discuss how public sector organizations can use their strategic commissioning process to support and embed citizen voice and action in their problem prevention, treatment and rehabilitation strategies to achieve the quality of life outcomes desired by both citizens and public service commissioners.     

Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery

Objectives:

This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders.

Methods:

Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider’s (Recovery Markers Inventory [RMI]) and patient’s (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI.

Results:

A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p?<?0.05), an overall increase (p?<?0.01), and an increased rate of change (p?<?0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period.

Limitations:

This study contained a retrospective, non-comparative design, and did not adjust for multiplicity

Conclusions:

The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug’s use as schizophrenia treatment from a recovery-oriented perspective.     

Enter the Dragon: Have Imports from China Hurt Wages in Manufacturing?

While it is often argued that imports from China are depressing manufacturing wages in recipient countries, this has never been tested using cross‐country data. This article investigates the effect of increased import penetration from China on the wages of workers (total, skilled and unskilled) in the manufacturing sector of 100 economies from 1976 to 2008. The econometric analysis finds no evidence suggesting that import penetration of manufactured goods from China has a statistically significant effect on real manufacturing wages (skilled, unskilled and total) in either developed or developing economies. This may be because Chinese exports are too heterogeneous to strongly affect any particular industry in recipient economies or because foreign consumers are differentiating products made in China from those made locally based on country and brand loyalty and preconceived notions of quality.     

Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis

Abstract

Aims: This study aimed to evaluate all-cause economic outcomes, healthcare resource utilization (HRU), and costs in patients with Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) using commercial claims from a large database representing various healthcare settings.

Materials and methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus database was conducted for patients aged 18–64 years with CDI episodes requiring inpatient stay with CDI diagnosis code or an outpatient medical claim for CDI plus a CDI treatment. Index CDI episodes occurred between 1 January 2010 and 30 June 2017, including only those where patients were observable 6 months before and 12 months after the index episode. Each CDI episode was followed by a 14-d claim-free period. rCDI was defined as another CDI episode within an 8-week window following the claim-free period. HRU, all-cause direct medical costs and time to rCDI were calculated over 12 months and stratified by number of rCDI episodes.

Results: A total of 46,571 patients with index CDI were included. Mean time from one CDI episode to the next was approximately 1 month. In the 12-month follow-up period, those with no recurrence had 1.4 inpatient visits per person and those with 3 or more recurrences had 5.8. Most patients with 3 or more recurrences had 2 or more hospital admissions. The mean annual, total all-cause direct medical costs per patient were $71,980 for those with no recurrence and $207,733 for those with 3 or more recurrences.

Limitations: The study included individuals 18–64 years only. A stringent definition of rCDI was used, which may have underestimated the incidence of rCDI.

Conclusions: CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. Timing of recurrences can be predictable, providing a window of opportunity for interventions. Prevention of multiple rCDI appears essential to reduce healthcare costs.     

Adapting the Asthma Life Impact Scale (ALIS) for use in Southern European (Italian) and Eastern European (Russian) cultures

Abstract

Background:

The Asthma Life Impact Scale (ALIS) is a disease-specific measure used to assess the quality-of-life of people with asthma. It was developed in the UK and US and has proven to be acceptable to patients, to have good psychometric properties, and to be unidimensional.

Objective:

This paper reports on the adaptation and validation of the ALIS for use in representative Southern European (Italian) and Eastern European (Russian) languages.

Methods:

The ALIS was translated for both cultures using the dual-panel process. The newly translated versions were then tested with asthma patients to ensure face and content validity. Psychometric properties of the new language versions were assessed via a test–re-test postal survey conducted in both countries.

Limitations:

It is possible that some cultural or language differences still exist between the different language versions. Further research should be undertaken to determine responsiveness. Further studies designed to determine the clinical validity of the Italian ALIS would be valuable.

Results:

Linguistic nuances were easily resolved during the translation process for both language adaptations. Cognitive debriefing interviews (Russia n?=?9, male?=?11.1%, age mean (SD)?=?55.4 (13.2); Italy n?=?15, male?=?66.7%, age mean (SD)?=?63.5 (11.2)) indicated that the ALIS was easy to read and acceptable to patients. Psychometric testing was conducted on the data (Russia n?=?61, age mean (SD)?=?40.7 (15.4); Italy n?=?71, male?=?42.6%, age mean (SD)?=?49.5 (14.1)). The results showed that the new versions of the ALIS were consistent (Russian and Italian Cronbach’s alpha?=?0.92) and reproducible (Russian test–re-test?=?0.86; Italian test–re-test?=?0.94). The Italian adaptation showed the expected correlations with the NHP and the Russian adaptation showed strong correlations with the CASIS and CAFS and weak-to-moderate correlations with %FEV1 and %PEF. In both adaptations the ALIS was able to distinguish between participants based on self-reported general health, self-reported severity, and whether or not they were hospitalized in the previous week.     

“The mother of all political problems”? On asylum seekers and elections

As immigration to Europe has increased, so has support for extremist parties. While many studies have examined the effect of immigration on election outcomes, few have probed the effect of asylum seekers – those fleeing strife and persecution – on voting, nor has there been much research on the mediating role of local economic conditions. Drawing on county level panel data from Germany, our study fills both gaps. We find that economic circumstances, as measured by the unemployment rate and the level of disposable income, condition voters’ responses to the presence of asylum seekers, but the effects for parties on the far right and left diverge markedly. Under economic prosperity, immigration increases support on both sides of the political spectrum. As economic conditions worsen, however, the effect of asylum seekers on the vote share for the far right remains stable, but weakens for the left, eventually becoming negative. This divergence – which has not yet been reported in the literature – suggests that an influx of asylum seekers, particularly when coupled with an economic downturn, could tilt a political system rightwards. From a policy perspective, these results suggest that heterogeneity arising from local economic conditions has important implications for the regional allocation of asylum seekers.     

Does public expenditure management matter for education outcomes?

This paper examines the significance of public expenditure management for primary education outcomes in public schools in two South African provinces (Gauteng and North West). Using cross-sectional data from 175 public primary schools and 13 local education offices, the analysis finds that while misappropriation of education funds (leakages) is not strongly associated with poor education outcomes, delays on the part of the government in disbursing funds to schools are correlated with Grade 5 dropout rates. The paper finds no evidence that public expenditure and total resource wealth (including public and private contributions) are significantly associated with education outcomes. Increased spending on learning and teaching support materials is associated strongly with lower Grade 1 and Grade 7 repetition rates. The paper also finds that repetition rates are driven strongly by poverty indicators at the district level, while dropout rates are driven strongly by district and school inefficiency.