Elizabeth Maitland

Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China

BackgroundChina’s recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconomic status is increasing. We investigate inequality in service utilization among the mid-aged and elderly, with a special attention of health insurance.MethodsThis paper measures the income-related inequality and horizontal inequity in inpatient and outpatient health care utilization among the mid-aged and elderly in two provinces of China. The data for this study come from the pilot survey of the China Health and Retirement Longitudinal Study in Gansu and Zhejiang. Concentration Index (CI) and its decomposition approach were deployed to reflect inequality degree and explore the source of these inequalities.ResultsThere is a pro-rich inequality in the probability of receiving health service utilization in Gansu (CI outpatient = 0.067; CI inpatient = 0.011) and outpatient for Zhejiang (CI = 0.016), but a pro-poor inequality in inpatient utilization in Zhejiang (CI = −0.090). All the Horizontal Inequity Indices (HI) are positive. Income was the dominant factor in health care utilization for out-patient in Gansu (40.3 percent) and Zhejiang (55.5 percent). The non-need factors’ contribution to inequity in Gansu and Zhejiang outpatient care had the same pattern across the two provinces, with the factors evenly split between pro-rich and pro-poor biases. The insurance schemes were strongly pro-rich, except New Cooperative Medical Scheme (NCMS) in Zhejiang.ConclusionsFor the middle-aged and elderly, there is a strong pro-rich inequality of health care utilization in both provinces. Income was the most important factor in outpatient care in both provinces, but access to inpatient care was driven by a mix of income, need and non-need factors that significantly differed across and within the two provinces. These differences were the result of different levels of health care provision, different out-of-pocket expenses for health care and different access to and coverage of health insurance for rural and urban families. To address health care utilization inequality, China will need to reduce the unequal distribution of income and expand the coverage of its health insurance schemes.

Flexible Footprints: Reconfiguring MNCs for New Value Opportunities

Powerful technological, regulatory, and economic forces compel the senior executives of multinational corporations (MNCs) to repeatedly re-evaluate and reconfigure value chains in the search for ongoing competitive advantage. However, releasing assets from existing activities and redeploying them to new opportunities is a challenging and poorly understood task. In particular, the standard strategic management concepts of use- and firm-flexibility overlook the crucial international dimension of location. Utilizing examples from GM, Qantas, and a mining MNC, this article argues that strategic flexibility should be consciously measured along all three dimensions. By using the decision tool set out in this article, MNC executives can map their worldwide footprint of strategic roadblocks and opportunities to expand into new markets, divest redundant businesses, and build flexibility to adapt to future challenges.

Subsidiaries in motion: Assessing the impact of sunk versus flexible assets

This chapter addresses an unresolved theoretical issue in international business: the impact of existing, committed assets in a host location on parent and subsidiary decisions regarding the configuration of future value-adding activities for the location. We develop a measure of investment committedness, or the degree of flexibility versus specificity of existing assets in a host location, to explore this issue. The measure assesses whether assets, such as brands, human capital, process technologies, and supplier relations, retain only scrap value outside their current application or they can be redeployed to alternative value-adding activities in the host location or shifted offshore, either within the multinational enterprise (MNE) or to another user. The measure is a key step in developing a model of strategic choice for the future configuration of value-adding activities by MNEs in host locations. Drawing on firm-specific data from 237 MNE subsidiaries operating in Australia, we first present a traditional integration-responsiveness classification of subsidiary activities. This static snapshot of the subsidiaries’ current profiles is then compared with the measures preliminary findings on the levels of investment committedness and strategic flexibility available to the sample MNEs and how this may shape strategic allocation decisions, including divestment and withdrawal.

Primary Care Quality among Different Health Care Structures in Tibet, China

Objective. To compare the primary care quality among different health care structures in Tibet, China. Methods. A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. Results. The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. Conclusions. This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development.

Regional Learning Networks: Evidence from Japanese MNEs in Thailand and Australia

Japanese firms have been depicted as ‘learning organizations’, with regional governments implementing incentives regions to attract Japanese multinational enterprises (MNEs). To test for regional learning networks, firm-specific surveys were undertaken of Japanese subsidiaries in Thai and Australian manufacturing and Japanese parent investment decisions in Southeast Asia, Australia, China and the EU. Japanese parents regionalized their investment decisions, treating Australia and Southeast Asia as different investment regions. Further, regional networks were created. For both Australia and Thailand, Japanese buyers established regional networks when parent B2B know-how was transferred to their Thai and Australian subsidiaries, and when Australian and Thai-based subsidiaries implemented B2B pre and post-contractual practices with indigenous suppliers. There was no evidence that experienced and large size Japanese MNEs learned from these regional subcontracting networks.

Internationalization of Australian Firms in Asia

Australia is a small, open economy. Its industries and firms have been shaped by its large natural resource endowments and openness to migration, capital flows, and world prices. Yet, in contrast to the similarly small and highly developed Nordic economies and their high rates of outward foreign direct investment (FDI), few Australian firms have ventured beyond the bounds of the domestic market. Easy and popular explanations appeal to the tyranny of distance, which depict Australia as marooned in a psychically distant Asian region, isolated from the richer markets of Europe and North America. This article presents an alternative view: Multinational growth by Australian firms was constrained primarily by domestic factors, rather than the lack of external opportunities. The scale of inward technology flows, which were largely controlled by foreign-owned affiliates, constrained the evolution of domestic technologies and brands that could be taken out to the world market. The dominance of foreign multinational enterprises (MNEs) in leading industrial sectors both blocked opportunities for Australia-based firms to learn about foreign markets, and pushed Australian firms into niche sectors that were unattractive to foreign MNEs, or sectors protected from foreign entry. It is firms from these sectors that have abandoned the traditional reluctance to internationalize and have expanded into the emerging markets of Asia. Our article analyzes Australian MNEs in three of the largest and most challenging Asian economies China, Indonesia, and India. Data on the FDI decision, and the operation and performance of subsidiaries, were drawn from mail surveys of Australia-based MNEs. The first section of the article describes the

Hepatitis B birth dose vaccination rates among children in Beijing: A comparison of local residents and first and second generation migrants

ABSTRACT Providing hepatitis B vaccine to all neonates within 24 hours of birth (Timely Birth Dose, TBD) is the key preventative measure to control perinatal hepatitis B virus infection. Previous Chinese studies of TBD only differentiated between migrant and non-migrant (local-born generation-LG) children. Our study is the first to stratify migrants in Beijing into first generation migrants (FGM) and second generation migrants (SGM). Based on a questionnaire survey of 2682 people in 3 Beijing villages, we identified 283 children aged 0–15 years, from 246 households, who were eligible for a TBD. Multinomial logistic regression and statistical analyses were used to examine factors explaining TBD rates for LG, FGM and SGM children. Surprisingly, the TBD for LG Beijing children was not significantly different from migrant children. But after stratifying migrant children into FGM and SGM, revealed significant TBD differences were revealed across LG, FGM and SGM according to domicile (p-value < 0.001, OR = 3.24), first vaccination covered by government policy (p-value < 0.05, OR = 3.24), mothers knowledge of hepatitis B (p-value < 0.05, OR = 1.01) and the governments HBV policy environment (p-value < 0.05, OR = 2.338). Birthplace (p-value = 0.002, OR = 6.21) and better policy environments (p-value = 0.01, OR = 2.80) were associated with higher TBD rate for LG and SGM children. Compared with FGM children, SGM had a significantly poorer TBD rate (Fisher exact test of chi-square = 0.013). We identified SGM as a special risk group; proposed Hukou reform to improve SGM TBD; and called for Beijing health authorities to match TBD rates in other provinces, especially by improving practices by health authorities and knowledge of parents.

Factors associated with adults' perceived need to vaccinate against hepatitis B in rural China.

ABSTRACT Hepatitis B virus (HBV) infection is a serious public-health issue in China. While the hepatitis B vaccine is effective in preventing HBV infection, the HBV vaccination coverage rates among Chinese adults remain low. From a survey of rural adults from 7 provinces in China, we identified a unique HBV at-risk group: rural adults who had no history of HBV vaccination and had no plan to HBV vaccinate in the future. We divided this ‘no history-no plan’ group into those who identified No-need to vaccinate and those that perceived a Need to vaccinate (even if they had no plan to do so). We found age, marital status, health status, perceived HBV infection environment, perceived HBV infection risk and perceived HBV infection severity explained differences between the ‘No-need’ and ‘Need” to HBV vaccinate groups. Education, occupation and knowledge of hepatitis B and HBV transmission were not associated with HBV vaccination need. Our results showed that free HBV vaccinations and reimbursement for vaccinating could significantly increase the HBV vaccinate take-up rate for both Need and No-need rural adults. A tailored public health HBV campaign, especially targeting the No-need subgroup, would increase vaccination rates by better informing rural adults about HBV transmission routes, the dangers of HBV infection, the effectiveness of HBV vaccinations and the safety of HBV vaccinations.

Comparison of patient perceived primary care quality in public clinics, public hospitals and private clinics in rural China

BackgroundIn rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients’ rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness.MethodsThis was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey’s post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics.ResultsThe distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains.ConclusionsRural public clinics, which share many characteristics with the optimal primary care delivery model, should be strongly strengthened to respond to patients’ needs. Better doctor-patient interaction training would improve respect, confidentiality, autonomy and, most importantly, health care quality for rural patients.

Yesterday's Friends, Tomorrow's Foes? Offshoring, Rents and Institutional Settings

Despite sustained public debate about the current wave of offshoring, there has been limited international business research on its strategic implications. We examine the generation, appropriation and sustainability of economic rents that flow from competitive advantage in the face of offshoring. Digitization and I.T. have allowed the scope of offshoring to expand to cover finance and accounting, business analysis, R&D, HR and customer service. At the same time, across borders, institutional differences associated with intellectual property rights regimes, market regulation, lobbying and corruption create additional distortions that can threaten rents. Our analysis of rent generation suggests that innovation (Schumpeterian) rents and asset utilization (Ricardian) rents are threatened by offshoring, while rents based on market power (monopoly rents) are only weakly impacted. This places Schumpeterian rents at risk in a manner they never have been before.