Multi-criteria evaluation of medical waste management process under intuitionistic fuzzy environment: A case study on hospitals in Turkey

Waste management has come to the fore in the whole world with the increasing impact of the Covid-19 pandemic along with concerns about human health, environmental threats, and socio-economic factors, etc. Medical waste is one of the waste types that need special management processes including particularly collection, storage, separation, and disposal. Healthcare activities create a great amount of medical waste deriving from the hospitals. This study aims to determine the hospital that carries out medical waste management in the most effective way in Erzurum, Turkey. To handle intense uncertainty in the evaluation process, the case is analyzed by Intuitionistic Fuzzy Multi-Criteria Decision-Making (IFMCDM) methods. The present study contributes to the literature by focusing on a real case problem under IF environment in a Group Decision-Making (GDM) framework. Additionally, based on the literature review and expert judgments, the evaluation criteria relevant to the case are defined in this paper. To this end, a four-phased integrated methodology that involves Intuitionistic Fuzzy Weighted Averaging (IFWA), IF Analytical Hierarchy Process (IFAHP), IF Technique for Order Preference by Similarity to Ideal Solution (IFTOPSIS) and One-Dimensional Sensitivity Analysis, is conducted. Firstly, IFWA is aimed to express the significance levels of decision makers (DMs) based on their knowledge, qualifications and experiences. Secondly, IFAHP is used to calculate the importance weights of the decision criteria and IFTOPSIS is preferred to rank the available hospitals. Then, sensitivity analysis is employed to display robustness. According to the results, the most important criteria are Qualified personnel, Health institution infrastructure, and Control of waste, respectively and the most efficient hospital is determined.     

中国对非援助的出口贸易效应——基于出口增加值的视角

基于Eora26投入产出表数据和全球中国官方金融数据库，本文检验了中国对非援助与中国对非出口增加值的因果关系及机制。研究结果显示：(1)中国对非援助可以显著提升中国对非出口增加值，在进行了一系列的稳健性检验和处理了内生性问题后，该结论依然成立；(2)提高非洲国家的交通和通信设施质量是中国对非援助影响出口增加值的主要机制；(3)中国对非援助的出口增加值效应会随产业分类、援助类型的不同而产生差异；(4)进一步研究表明，非洲接受的DAC发展委员会国家和国际多边组织援助的“碎片化”会削弱中国对非援助的出口增加值的促进作用，这种影响在经济实力和政府治理能力较弱的非洲国家更为明显。本文的结论为中国对非援助的贸易效应提供了进一步的经验支持，并揭示了中国对非援助影响中国对非出口增加值的内在规律。这对于加强中非经贸关系，构建“中非命运共同体”具有重要意义。     

公立医院 “成本病” 与医疗负担——兼论 “药品零加成” 政策的影响

公立医院是我国医疗卫生体系的主体,是新医改成功的关键,但多年来缺乏完善的成本核算体系,也加重了患者和政府的医疗负担。文章利用2013-2018年中部某省658家公立医院数据,基于Baumol"成本病"理论,构造新的"调整的鲍莫尔变量",首次从微观视角检验公立医院"成本病"的存在性,并考察了"成本病"是否加重了患者和政府负担;进一步结合"药品零加成"政策的实施,探究了其对公立医院"成本病"效应的影响。研究发现,我国公立医院系统同样存在"成本病"现象,且是加重患者与政府医疗负担的重要原因;"成本病"对患者医疗负担的影响并无医院等级差异,对政府医疗支出的影响在二级医院更为明显。结合样本期内"药品零加成"政策的实施发现,政策有效降低了患者负担,但加重了政府医疗支出,也未能缓解公立医院的"成本病"问题,但有助于医技成本支出的降低。研究具有重要的政策启示:"成本病"已经成为制约公立医院可持续发展的重要影响因素,亟需建立有效的成本核算管理工具和机制,健全公立医院薪酬制度,促进公立医院管理向精细化、规范化转型,抑制"成本病"问题,保障公立医院健康、可持续发展。     

A multiple criteria sorting method for supporting the maintenance management of medical ventilators: The case of Hospital da Luz Lisboa

Medical equipment is characterized by a constant flow of innovations, which is transforming the delivery of healthcare. This creates the need for healthcare organizations to incorporate methodologies to support the maintenance management of these equipment. Within this context, Luz Saúde, the holding company of one of the largest healthcare groups in Portugal, intends to complement the medical equipment maintenance management program of the biggest hospital in its network, Hospital da Luz Lisboa. To this aim, we develop a decision aiding tool for assessing the maintenance condition of medical ventilators and recommend a plan of action. For that, we apply a multicriteria decision aiding methodology, utilizing the Electre Tri-nC method. In interaction with the decision makers, we construct a model using twelve criteria for assigning ventilators to one of the five ordered categories representing the current condition (excellent, very good, good, adequate, and poor). Most of the medical ventilators in the analysis were considered in adequate or good maintenance conditions, which was consistent with the decision makers’ expectations. A detailed analysis of the results evidenced the robustness of the model. This study constitutes the first step toward the use of multicriteria methodologies for supporting decision processes in Hospital da Luz Lisboa.     

A dual-clustering algorithm for a robust medical grid partition problem considering patient referral

The medical grid including hospitals at all levels is a new hierarchical diagnosis and treatment system. It is assumed to provide health services for residents in a certain area, allowing free referral of patients, so as to effectively utilize medical resources. Therefore, from the perspective of the government, the key issue is how to divide the medical grid in a robust and balanced manner. In this paper, various deterministic factors, such as hospital level, location and department, as well as uncertain factors, including patient distribution or population density, are considered in decision-making. To solve this problem, a dual-clustering algorithm based on K-means and K-medoids (DCKK) is developed with local search methods to minimize the average patient waiting and travelling time. The experimental results show that DCKK algorithm can generate better and more robust grid partition solutions than the existing mainstream algorithms in different scenarios. In addition, the rules between the number of medical grids and the number of patients, as well as the hospital sharing between medical grids, are also studied. Finally, a real medical grid partition case of Ji'nan, China, with forty hospitals in four urban areas, is studied, and five medical grids are recommended.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

How to improve IFRS for intangible assets? A milestone approach

This study focuses on the decreasing relevance of financial information associated with current financial reporting standards for intangible assets. We summarize and compare three approaches to improving financial reporting standards for internally generated intangibles—the recognition approach, the fair value approach and the disclosure approach, among which we focus on the recognition approach. We investigate the impact of current International Accounting Standard 38 on the R&D capitalization policies of the high-tech industry, particularly among medical device firms in China. We conclude that the current recognition criteria are so stringent that they disincentivize firms from capitalizing their R&D investments. A large variation exists in capitalization timing within the medical device industry. Accordingly, we propose the milestone approach to revising financial reporting standards for intangible assets. We suggest that determining the capitalization criteria for intangibles based on the R&D cycle and capitalization timing should be moved forward.     

Partner country selection between development narratives and self-interests: A new method for analysing complex donor approaches

Partner country (PC) selection lies in the centre of development policy decision-making of donor countries and institutions, and plays a significant role in shaping aid patterns. This paper proposes a comprehensive analysis contrasting donor intentions in PC selection with actual aid flows. Having analysed selected members of the Development Assistance Committee of the Organization for Economic Cooperation and Development, namely, the European Union, France, Germany, Japan, Netherlands, Sweden, the United Kingdom and the United States of America, we suggest that (1) donors might not only be either altruistic or self-interested but also motivated by an intention to contribute to the provision of global public goods; (2) self-interest in aid provision can be an explicitly-stated strategy, contrary to what has been argued in the majority of the literature, which often treats self-interest as a non-stated donor intention; and (3) donors' self-interested intentions do not always lead to a less development-oriented donor approach.