The future of the Affordable Care Act: will we abandon health care reform?

With obstacles to the Affordable Care Act (ACA) growing, nurses need to continue to educate themselves about the ACA and the issues it is designed to address. While it has many shortcomings, the ACA invests in creating a new infrastructure that holds the potential to improve care quality and contain costs. Health economist Victor Fuchs suggests three areas must change if we are to have a health care system that is quality focused: information, infrastructure, and incentives. The current health care legislation is noble and lays a basis for future structural cost containment. The health care system continues to unravel as our politicians remain polarized over reform efforts. We must engage or we will never find solutions, never see reform.     

Next generation workforce

The health care industry has become a very complex business. CQsts are rising and resources such as funding and human capital are diminishing. Human capital resources are about to reach true crisis proportions. The vital workforce we have counted on is expected to begin thinning as large numbers of Boomers retire. Not only does this deplete the workforce from a pure numbers perspective, but it also affects intellectual capital and institutional memory. Generational trends and characteristics have affected the workforce environment and will continue to do so as another generation continues to enter the workforce. Generation Y, also tagged Nexter, offers core values that can bring positive changes to the health care workforce. Technology continues to change at lightning speed. Embracing new technology and using it to refine the way we do business will help deliver success. Meaningful strategic plans are needed to change the model of business delivery and employee care in our future workforce.     

Public health infrastructure and growth: Ways to improve the inferior equilibrium under multiple equilibria

This paper develops an endogenous growth model in which public health infrastructure, specified as a stock, plays an important role in economic growth. A notable feature of the model is that it employs a non-separable utility function for consumption, leisure, and the level of public health. In addition, increasing the level of health infrastructure contributes to the production of goods through labor augmentation. With these settings, our model is found to have a unique equilibrium or multiple equilibria, depending on the magnitude of the intertemporal elasticity of substitution. For the case of multiple equilibria, we numerically study the ways to avoid the low-growth state in developing countries. From this, we identify two feasible policy implications. The results indicate that public health infrastructure has a vital role in the development policies of low-income countries. Lastly, we show that there are two possibilities in regard to the local dynamics of the model.     

北京地区不同农田类型及种植模式的生态系统服务价值评估

城郊农田生态系统是垅市生态环境的重要保障之一.本文在借鉴前人方法的基础上.结合田间试验与农户调查,选择北京城郊农田生态系统的产品价值、调节大气,净化空气、消纳废弃物、净化污水,土壤保育、蓄水功能、景观功能、生物多样性等价值作为指标进行测算.结果表明:2005年北京郊区农田生态系统服务总价值为1 757 350万元/a.影响各类型农田及种植模式的生态系统服务价值的因素主要是生物量大小、生育期长短以及覆盖度等.     

“三位一体”农民工健康服务体系及其保障机制研究

分割型城乡二元劳动力市场与弱健康人力资本的交互累积效应、健康服务支出的沉没成本效应、伦理价值观的惯性约束效应、农民工主体的弱健康服务诉求及信息传递障碍的制约,使我国农民工健康服务供给明显不足,难以形成一个完善的农民工健康服务体系。因此应当构建一个以政府为中心、企业广泛参与的农民工健康服务体系的"三位一体"模式,并设立以企业为核心的制度保障机制,发挥政府的主导性作用。     

Compliance leadership: the 17th century model that doesn't work

The world of health care has changed. We can't operate on 17th century models and be successful. We don't have to argue for the movement to committed, inspired leadership models, and the death of compliance leadership. There is abundant research to document this is the way we must go. In reality, we have a moral obligation to provide the kind of work environment that provides the meaningful work that Maslow (1998) tells us makes life meaningful. No one has the right to make people miserable at work because we have failed to create the cultures that create commitment, inspiration, and transformation for our patients, their families, and our staff. It is unfortunate that in times of staff shortages, this message is heard louder. We should be equally committed no matter what the situation, because it is the right thing to do. We do not have the right to be abusive to others in any context.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

Delphi as a tool for identifying future appropriate technologies in India

The concept of appropriate technologies with particular reference to developing countries like India is discussed. It is suggested that appropriate technologies should: (1) include the entire range of technologies from very primitive to very modern, (2) be available when required, and (3) have the maximum impact on the largest fraction of the poorest sections of the population, especially through increasing employment. The problem of identifying appropriate technologies that would meet these criteria has also been discussed. In this article we have attempted to use the Delphi technique of technology forecasting for identifying future appropriate technologies in the areas of food, health, and energy using respondents in India. Subsequently, we have analyzed our results in terms of the criteria previously assigned to appropriate technologies and have thereby evaluated our experiment.It is concluded that the Delphi is an adequate first step in identification of such technologies; however, it must be followed by more rigorous techniques (possibly quantitative) for assigning further priorities within the technologies identified by the Delphi. This will help in arriving at suitable policy decisions and allocation of funds to a few of the most important areas.Finally, two alternate scenarios have been presented (using the Delphi results as well as our own perceptions and observations of the Indian society), depending on whether appropriate technologies and policies are adopted.     

A detail-free mediator

We present a cheap talk extension to any two-player, finite, complete information game, and ask what correlations over actions are implementable in Nash equilibria of the extended game. In the extension, players communicate repeatedly through a detail-free mediator that has been studied in Lehrer (1991) and in Gossner and Vieille (2001). The extension captures situations in which people can observe the opponentʼs face during the conversation. While Gossner and Vieille (2001) prove that no correlation can be securely implemented by using only this mediator, we prove a result closer to Lehrer (1991), namely, that the Nash equilibrium payoffs of the extended game essentially coincide with the correlated equilibrium payoffs of the underlying game. The contrasting results can be explained with our additional assumptions that the players can also communicate directly and, more importantly, the private messages sent to the mediator can be recorded and revealed later in the conversation.     

人口健康测量与大数据标准研究回顾

建立健全健康信息标准体系是医疗健康体制改革中的重要一环,其中数据标准是重要组成部分。主要从健康数据标准与模型和医学术语系统两大部分对世界发达国家和国际组织的健康数据标准方法进行梳理,并从大数据研究视角进行探讨,以期为我国的健康数据标准化提供借鉴。     

防治外来生物入侵的法律对策思考

外来入侵物种是指从自然分布区通过有意或无意的人为活动而被引入,在当地的自然或半自然生态系统中形成了自我再生能力、给当地的生态系统或景观造成明显的影响的物种。外来入侵物种在当地定植、①扩展并产生一定影响的过程称为生物入侵。它们对入侵地的生态安全、经济发展以及人类健康造成了巨大的生态灾难和经济损失,因此,引起了人们广泛的关注。然而,由于缺乏对入侵生物的综合性认识,对于控制入侵生物措施的研究也才刚刚起步,还没有系统的控制外来入侵生物的有关程序与法规。为了保护中国的生物多样性,维护生态安全,亟须加快中国在这一领域的立法步伐。     

Growth and multiple equilibria: A unique local dynamics

The paper investigates the local dynamics of a simple growth model with a public health factor. A notable feature of the model is that it employs a non-separable utility function between consumption and the level of public health infrastructure (publicly provided health environment). In addition to the effects on utility, an increase in the public health level contributes to labor productivity growth. From a three-dimensional dynamic system that includes physical capital, public health infrastructure and consumption, our model is found to have multiple equilibria (dual steady states) if the deep parameters of the utility function satisfy certain conditions. Then, numerical computations demonstrate that each equilibrium exhibits local saddle-path stability. This result deserves careful attention, as it indicates that the economy experiences a relatively undiversified growth pattern when converging on high- and low-growth equilibria. Our striking result has important implications in the study of growth and development.     

The transparent organization: leadership in an open organization

The impersonal approach to health care leadership is over. Specialization, hierarchies, and impersonal decisions have led the public to distrust health care organizations. The charges of unnecessary cardiac surgery and abuses led the public to question our integrity. Annison and Wilford (1998) note that the character of a person and the character of an organization lead one to trust or distrust. They note that openness is one of the most important characteristics upon which we judge the character of a person or an organization. As the operating framework of partnerships and transparency becomes one that our staff and patients expect, our ability to handle openness will be an important way in which we are judged.     

The impact of scientific research on health care: Evidence from the OECD countries

This paper investigates the impact of scientific research on health care productivity in a set of OECD countries, in the years from 1960 to 2008. To this end, we have matched information collected from the OECD Health Data 2010 with data gathered from the Scopus database on the papers published and their relative citations. Our empirical results suggest that medical research plays an important role in explaining health care productivity, although various countries are characterized by different velocities in assimilating scientific knowledge. Another important result that emerges from our work is that countries characterized by a faster absorption of academic science, such as the US, have on average a milder impact of scientific research on health productivity, compared with countries with slower absorption. As one would expect, we also find that countries absorbing more scientific research also bear higher health costs.Results from this study may support policy makers in designing incentive mechanisms to improve the impact of medical research on the health care system.     

The effects of COVID-19 containment measures on the Asia-Pacific region

As the COVID-19 pandemic spread across the world, governments introduced significant containment measures to control the spread of the virus. In this paper, we leverage inputs from IMF desk economists to construct a novel narrative index of containment measures for 11 countries in the Asia-Pacific region. A key innovation in our index is that it distinguishes between economic sectors (services, industry, retail), thus providing a more granular view of restrictions related to economic activity. Using this index, along with other high-frequency data, we find that containment measures have been successful in reducing the spread of the virus (though with some heterogeneity) but have also been associated with large short-term economic costs. Furthermore, exploiting the granularity of our index, we find that differences in strategies across countries regarding the closing of the industrial sector have mattered: imposing less severe restrictions on industry has been associated with lower economic costs without leading to worse health outcomes, possibly reflecting the less contact intensive nature of industrial activity.     

城镇基本医疗保险中逆向选择的检验

本文利用城镇居民基本医疗保险试点评估调查的数据,实证检验了我国城镇居民和职工基本医疗保险中的逆向选择问题。本文的实证结果证实了逆向选择的存在:在未被城镇职工基本医疗保险覆盖的城镇人群中,健康状况较差的个体更倾向于参加城镇居民基本医疗;城镇居民基本医疗保险的参保者接受门诊和住院服务利用率的概率更高;保险对住院服务利用率的影响大于对门诊的影响。另一方面,我们还发现在已被城镇职工基本医疗保险覆盖的人群中,健康状况较差的职工也更倾向于购买补充商业医保,但是健康状况最差的个体购买补充商业医保的概率最低,而购买商业医保后住院率显著增加。     

Tax effort performance in sub-Sahara Africa and the role of colonialism

Governments in sub-Sahara Africa (SSA) have tended to rely unduly on foreign aid and debt financing for the provision of public goods such as health, basic education and infrastructure. Domestic tax revenue could play a significant role in funding such expenditures. However, to date tax revenue collection in SSA has only averaged about 15% of GDP. In this paper we employ cluster analysis to enhance our understanding in the variations in tax effort performance amongst SSA countries. Past studies of tax effort performance in SSA have resorted to economic events or factors to explain the tax effort performance. We argue here that it is necessary to consider historical events to provide a fuller explanation. We provide evidence to show that the different colonial policies pursued in SSA have had a long lasting and profound effect on the countries' tax revenue performance.     

Thinking Critically: The Case of Health Policy Research

In this paper, we focus upon the recent work of one of health policy's leading academics. We then explore policy developments and show that where 'mainstream' health policy analysis implicitly supports the managerialization of health services, our critical perspectives reveal the existence of four male power blocs: management, medicine as science, medicine as practice, and the academic discipline of political science. Finally we suggest how the use of our perspectives enhances the possibility for bringing about meaningful change in health policy.     

Remittances and healthcare expenditure: Human capital investment or responses to shocks? Evidence from Peru

This paper estimates the effect of international remittances on healthcare expenditures, taking into account both the interdependence with other consumption goods and the effects of health shocks. More precisely, we assess whether the budget allocation decisions of remittance‐receiving households reveal different preferences to invest in health capital, even when the simultaneous effect that health shocks may have on the demand of remittances and on other types of nondurable expenditures is accounted for. Using data from the “Peruvian National Survey of Households,” we find that remittances have a positive impact on healthcare budget shares, net of the remittance‐related income effect and independently of the occurrance of a health shock. They also have a positive impact on housing and a negative one on other expenditure items, that is, clothing, transport, and education. Hence, our results indicate a “pure” tendency of remittance‐receiving households to devote larger shares of their budget to health capital investment, rather than to other types of consumption goods.     

The market as a social space: On the meaningful extraeconomic conversations that can occur in markets

Prominent economic sociologist Richard Swedberg has argued that economists have failed to develop a theory of the market that recognizes it as a “social phenomenon in its own right.” While this may be true of mainstream economics, the Austrian school’s theory of the market is much richer than the standard view. For Austrians, the market has always been a central concern. And Austrians have always argued that the market is a social structure where both exchange and competition occurs. Still, Austrians give little more than scant attention to the noneconomic sociality that occurs in markets. The market, however, is both a conversation and an arena where meaningful conversations can occur. This paper is an effort to focus attention on the market as a social space where social activity (beyond competition and exchange) takes place and where noneconomic relationships and economic relationships develop.