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。     

An innovation to improve health outcomes in Amajuba district,KwaZulu-Natal,South Africa

Systems’ thinking places high value on understanding the context. This study focused on the collection of disaggregated data in order to understand the context, to facilitate improvement of health outcomes. The aim of this article was to assess the implementation of municipal ward-based health data collection (disaggregated data) and health care workers’ perceptions of this data collection process. This cross-sectional study used mixed methods in Amajuba district. The participants were professional nurses at the Primary Health Care level. Of the 131 respondents, 123 (93.9%) collected municipal ward-based health data, and found it useful. Opportunities for improving data collection were identified. Disaggregation of the data at ward level contributes to a better understanding of the target population’s health, assists planning for health needs and enables provision of targeted interventions in order to improve health outcomes, to prevent financial regression and waste of health resources.     

Pharmaceutical cost‐sharing systems and savings for healthcare systems from parallel trade

This paper studies the consequences of parallel trade in a two‐country model. It compares a coinsurance scheme (consumers pay a percentage of the drug price) and an indemnity insurance scheme (reimbursement is independent of the drug price) with respect to changes in copayments and public health expenditure. In the destination country, copayments for patients decrease to a larger extent under indemnity insurance, whereas reductions in public health expenditure occur only under coinsurance. In the source country, copayments increase less under coinsurance, whereas health expenditure is reduced more under indemnity insurance. In both countries, total expenditure under parallel trade is lower.     

Health screening strategies for international air travelers during an epidemic or pandemic

Air travelers can carry an infectious disease's pathogenic microorganism in their bodies and spread the disease from one country to another in a few days. To delay the spread, health screening stations may be set up at airport terminals to screen travelers. This research tested three different health screening strategies, each with a different combination of screening stations at trip origins, destinations and connecting airports. Discrete event simulations were performed, based on the 2014 to 2016 Ebola virus epidemic, with special focus on travelers from the West African countries traveling to the United States, including travelers who transferred flights at airports in European Union member states. The effectiveness of the screening strategies was analyzed in terms of correct detection, missed detection and false alarm rate. The results showed that exit screening at trip origins brought big improvements in the performance measurements compared to no screening. However, additional screening at the destinations and connecting airports contributed marginal benefits.     

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.     

Unemployment insurance benefits and income smoothing

Labor unemployment insurance reduces unemployment concerns. We argue that these benefits moderate incentives to smooth earnings to reduce employees’ concerns about unemployment risk. Using exogenous variations in unemployment insurance benefits, we find evidence consistent with this argument. We also find that the link between unemployment insurance benefits and income smoothing is stronger when there is higher unemployment risk and when the firm is likely to employ more low-wage workers, who find unemployment insurance benefits especially useful. Our paper contributes to the literature by showing that public policy decisions such as unemployment insurance have significant, albeit probably unintended, externalities on corporate financial reporting.     

Audit Firm Attributes and Auditor Litigation Risk

This study examines the association between auditors' litigation risk and audit firm attributes. Using professional liability insurance premiums as a proxy for auditors' litigation risk, we present evidence that the risk is lower in audit firms having: (1) separate non-audit and audit divisions; (2) a higher proportion of partners; and (3) a higher annual growth in number of CPAs employed. Additionally, we find that the risk is higher in audit firms having: (1) operating losses; and (2) high revenue growth. Our results are consistent with the idea that audit firms' financial condition and organizational structure affect their independence/ expertise, and, in turn, their litigation risk. Our results are broadly supportive of the PCAOB's (2015) and US Department of Treasury's (2008) views that investors, audit committees, management, and other regulators could benefit from having access to financial and organizational information about audit firms.     

我国救济性投资的现状、问题及对策

我国救济性投资的救济力度远远低于救济需求,在社会救济意识、救济管理、资金来源、投资形式等方面存在不足,投资增长缓慢,且存在城乡失衡和地区失衡.应创新公民的社会保障观念和思维模式,建立健全救济性投资的管理机制,着力解决救济性投资的不平衡问题,并且投资形式要向着多元化、多层次的方向发展.