Technologies in caregiving: professionals’ strategies for engaging with new technology

This article explores the adoption of new technology in organisations that provide senior citizen care. Inspired by Niklas Luhmann’s systems theory, we study how technology reduces complexity by identifying client needs and ensuring predictability in service delivery. However, how technologies are adopted in practice is not determined by technology since it is also structured by care-workers' continuous decision-making. Against this backdrop, we explore how technologies alter the conditions for decision-making in two settings of elderly care, and we describe how care workers seek to adapt technologies to their practical needs as well as conception of care ethics. Developing a systems theory approach, the article eschews a priori assumptions of technological constraint on care-workers’ professional autonomy, offering a more open-ended exploration of diversified strategies for coping with new technology. Our case studies show that employees develop diversified strategies for technology adoption, including both non-usage, heated resistance, excessive embrace, and creative adaption.     

智慧居家养老服务协同供给的优化路径研究——以广西钦州市智慧居家养老项目的实践经验为例

智慧居家养老服务的协同供给可以形成社会联动效应，降低公共服务成本。运用公共服务协同供给分析框架，通过交叉分类方法从协同主体的利益与目标两个变量的耦合性出发分析广西钦州市智慧居家养老项目中养老服务主体间不同种类的协同关系，可以从加强政府领导、形成合作联盟、建立市场标准、创新扶持政策4个方面完善政府、企业、社会组织之间不同类型的协同供给，实现社会资源的高效利用以及向智慧居家养老服务的发展和转变。     

Policy induced increases in private healthcare financing provide short-term relief of total healthcare expenditure growth: Evidence from OECD countries

Healthcare reforms have long been advocated as a cure to the increasing healthcare expenditures in advanced economies. Nevertheless, it has not been established whether a market solution via private financing, rather than public financing, curb aggregate healthcare expenditures. To our knowledge, this paper is the first that quantifies the impact of reforms that significantly increases (decreases) the private (public) share of healthcare financing on total healthcare expenditures relative to income in 20 OECD countries. Our reform measure is based on structural break testing of the private share of total expenditures, and verification using evidence of policy reforms. To quantify the effect of these reforms we apply Propensity Score Matching and Inverse Probability Weighted regression analysis. Over a 5-year evaluation period the reforms lead to an accumulated cost saving 0.45 percentage points of GDP. The yearly effects of the reforms are largest in the first years in the post-reform period and decreases in size as a function of time since the reform. Our findings suggest that the investigated healthcare reforms have a relatively short-lived effect on aggregate health spending relative to GDP. The findings are robust to various sensitivity tests.     

“Going natural”: Black women’s identity project shifts in hair care practices

Hair care, a seemingly mundane consumption practice, is packed with sociocultural meanings and constitutes an important realm of identity work for consumers. Drawing upon existing literature on consumer identity projects, this paper investigates the experiences of urban, Black women in Kenya as they disengage from the normative practice of altering their natural hair texture using chemical straighteners (a practice that conforms to Eurocentric beauty ideals of straight, flowing hair), and adopt the non-normative hair care practice of “going natural,” in which they embrace their natural hair texture and hairstyles. This paper traces the historical, sociocultural, and political events that underpin the normative ideology associated with the identity marker of natural Black hair, and how this ideology influences the women’s “going natural” experience. Findings reveal tensions that emerge in the women’s identity project disengagement and reconstruction process, and how the women navigate their position as they reimagine their embodied identity quest.     

Efficiency outcomes of market concentration and managed care

The paper examines how hospital cost efficiency has reacted to extensive horizontal integrations of hospitals and rapid growth of managed care in the US health care industry. Cost efficiency is estimated by using panel data approaches to relax the assumptions for the hospital effects imposed in earlier studies. The paper shows that higher managed care penetration over time is associated with greater hospital efficiency, and higher market concentration is positively associated with efficiency when markets are highly competitive or highly concentrated.     

Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

A note on “Bed allocation techniques based on census data”

Capacity planning and resource allocation are crucial to the cost-effective delivery of health care services. In this paper, we present an analytic approach based on a modified version of the Holt-Winters multiplicative seasonality forecasting model to determine the frequency distribution associated with a hospital care unit's census. This paper is a follow-up to the census frequency distribution simulation model described in Lapierre et al. (Socio Econ. Plan. Sci. 33 (1999) 25). We demonstrate that our model can provide census frequency distributions equivalent to the simulation model of Lapierre et al. [1], but without the computational effort common to simulation models.     

关于上海地区屋顶绿化的思考

在上海市平面绿化工作已初见成效,大型公共绿地越来越多,城市越来越美之时,构建立体绿化 成为当务之急。本文通过对上海地区屋顶绿化的现状及存在的问题的阐述,结合绿化植物的选择和维护的一 些基本理论,展示了屋顶绿化广阔的发展前景。     

对中国农村正规金融低效问题的实证分析

中国农村正规金融虽然近年来有了很大的改善,但仍然存在较多的问题,成为影响农业发展以及农村经济的重要因素之一。本文首先对农村正规金融系统组成机构进行了客观的描述,分析农村正规金融的现状,通过比较突出中国农村正规金融的特性和存在的问题。其次运用计量经济模型对农村正规金融与农村经济的关系进行实证分析,结果显示中国的农村金融借贷对农业发展具有长期正关系。最后针对中国农村正规金融存在的问题,提出了改善农村正规金融的相应措施。     

莆田市发展“医养一体化”服务模式的对策研究

随着银色浪潮来袭,如何养老已成为我国各城市重点关注的问题。将医疗机构、养老机构、社区医疗服务中心当中的医疗资源与养老资源进行共享交流,搭建“医养一体化”平台,是我国养老服务的发展趋势。论文研究了莆田市如何突破传统养老方式的局限性,推行“医养一体化”服务模式,探讨“医养一体化”平台的搭建对策。