Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan.

BACKGROUND: Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia. METHODS: The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process. RESULTS: There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators. CONCLUSIONS: Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

Latent profile analysis on the decent work of Chinese employees: applying the Psychology of Working theory.

Background: This study used a person-centered approach to identify the specific performance of decent work in various groups to determine the heterogeneity of its five dimensions. Method: The Decent Work Scale, Work Need Satisfaction Scale, Socioeconomic Status Scale, Job Satisfaction Scale, and Life Well-being Scale were used to conduct a network survey of organizations in various industries in Mainland China. A total of 1,000 questionnaires were distributed, and 780 valid responses were obtained. Results: The results showed that the decent work of participants could be divided into three types: low salary, low free time, and high decent work. The results showed no significant difference in age among the groups, whereas the differences in socioeconomic status were significant. Welch's test was used to determine differences in the positive outcomes of the three potential types of decent work, and the results showed significant differences in work need satisfaction, job satisfaction, and life well-being among all groups. Conclusion: This study examined the characteristics of decent work more realistically, showing that decent work is not an all-or-nothing structure and that its intrinsic components should be flexibly combined according to the research background and purpose.

Public welfare donation, rent sharing, and income gap within enterprises.

This study utilizes data from A-share listed companies between 2011 and 2020 to empirically investigate the impact and mechanism of public welfare donations on the internal income gap of enterprises. The research findings indicate that public welfare donations significantly increase the per capita salary of management, while their impact on the per capita salary of ordinary employees is not significant, thus leading to an expansion of the internal income gap within enterprises. The results from mechanism testing reveal that the income tax benefits resulting from charitable donations and the rise in corporate operating income have contributed to an increase in excess rent shared by enterprises and employees. Due to a stronger bargaining power, management shares more excess rents, thereby widening the income gap within the enterprise. Heterogeneity analysis demonstrates that public welfare donations have a greater impact on the internal income gap of non-state-owned enterprises; however, limiting executive compensation and enhancing employees' bargaining power can mitigate this widening effect caused by public welfare donations on enterprise's internal income gap. The research value of this study is threefold. Firstly, there is a scarcity of studies on the impact of public welfare donations on the income gap within enterprises, and this study contributes to enriching the research in this area. Secondly, this paper examines the effect of tax incentives for public welfare donations on the internal income gap of enterprises, thereby deepening the research on the impact of tax reduction and fee reduction, as well as expanding our understanding of corporate income tax preferential policies. Thirdly, it offers insights into improving enterprise compensation systems and enhancing corporate governance. Senior executives can potentially allocate more excess rent through their strong bargaining power. If their compensation remains unrestricted, it may lead to a widening internal income gap and negatively affect company operational efficiency.

Patient partner perspectives on compensation: Insights from the Canadian Patient Partner Survey.

INTRODUCTION: There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one-time honorarium, salary) and amount. Further, broad-based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. METHODS: This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self-identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open-text comments in addition to menu-based and scaled response options. Basic frequencies were performed for all questions and open-text comments were analyzed through inductive qualitative content analysis. RESULTS: A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open-text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. CONCLUSIONS: Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. PATIENT CONTRIBUTION: Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co-authors of this manuscript. The survey was co-designed and pilot tested with patient partners and survey participants were patient partners.

Impact of eliminating retirement earnings test on labor supply and pension benefit claims.

This study explores the hypothetical elimination of Japan's retirement earnings test (ET) for public pensions, focusing on its implications for older workers' labor supply and pension-claiming behaviors. The ET currently reduces public pension benefits for individuals aged 65 and older if their earnings exceed specified thresholds, potentially discouraging employment in this demographic. Notably, the Japanese ET influences both immediate and future pension benefits, thus diminishing current payouts for working pensioners and foregoing beneficial actuarial adjustments-adjustments based on actuarial calculations that would otherwise increase future benefits to account for delayed pension claims. This dual impact may discourage the labor supply and influence pension-claiming behavior among older workers. Through a survey-based experiment with male workers aged 40-59 years expected to face the ET upon retirement, we assess three reform scenarios as the first study in the literature: (1) eliminating future benefit reductions through actuarial adjustments, thereby enhancing the value of deferred pension claims; (2) removing immediate benefit suspensions to increase current pension payments directly; and (3) a comprehensive reform combining both approaches. Our findings reveal that eliminating reductions through actuarial adjustments increases the intensive margin (labor hours and income) and encourages delayed pension claims. Conversely, removing immediate benefit suspensions influences both the extensive margin (decision to work) and the intensive margin but leads to earlier pension claims. By highlighting the importance of differentiating between immediate and future benefit components in designing ET reforms, this study demonstrates their significant impact on labor supply and pension-claiming decisions.

The dilemma between fertility and work: How did the Universal Two-Child policy affect Chinese women's labor income?

Based on China Family Panel Studies (CFPS) data from 2012 to 2020, we estimate the effect of the "Universal Two-Child" (UTC) policy on women's employment income in China by the Difference-in-Difference (DID) model. Our results show that the UTC policy leads to an average decrease of 20.86% in women's employment income. Moreover, we reveal the mediation effect in the impact of the UTC policy on women's income and find that the UTC policy leads to a decrease in women's income by reducing their working hours and hourly wages. Furthermore, we find that the negative impacts of the UTC policy on women's employment income are greater among women under 35 years old and those without a bachelor's degree.

Transforming Advanced Practice RN Compensation: Strategies for Equity in Total Pay.

As the advanced practice RN (APRN) workforce rapidly expands, nursing leaders are grappling with the challenge of establishing equitable and competitive compensation models. This column explores the lessons learned by 2 pioneering APRN leaders who navigated these workforce and compensation challenges within their own healthcare organizations. By sharing their experiences building sustainable APRN infrastructure and addressing pay discrepancies, the authors provide valuable insights and strategies that can help other nursing leaders transform their APRN compensation approaches and ensure their advanced clinicians are appropriately valued and rewarded.

Steady undermining of the UK National Health Service underlies industrial action by doctors and other staff.

Erosion of standard of healthcare in the United Kingdom underlies the industrial action taken recently by staff in the publicly provided National Health Service. Underfunding and understaffing, largely as a consequence of neoliberal government "austerity" policies implemented following the 2007-08 banking crisis, together with lack of long-term planning and a drive towards outsourcing, have led to a deterioration in the quality of services. Reduction in bed numbers and neglect of community and social support have compounded problems by making it more difficult both to admit and to discharge patients in a timely fashion. Access to services has been compromised with negative consequences for the sick. Reduction of doctors' real wages together with stress at work, moral injury caused by feelings of not being able to do the best for patients, burnout from the Covid-19 pandemic and uncertainty about the future have led to the longest ever strike action by junior doctors in England.

The Potential of Minimum Wage Increases to Reduce Youth Homicide Disparities: Diminishing Returns for Black Youth.

We examine and compare the relationship between minimum wage increases and youth homicide rates in three groups: all youth, White youth only, and Black youth only. Using 2001-2019 mortality data from the National Vital Statistics System (NVSS) for all 50 states and Washington DC, we apply a difference in differences (DD) design to compare the change in youth homicides across states with varying changes in the state-specific minimum wage. With the inclusion of state-specific linear time trends, we find that a $1 increase in minimum wage leads to a significant 4% reduction (RR = 0.96, 95%CI [0.92, 0.99]) in homicides among White youth, but no significant reduction among Black youth (RR = 0.98, 95%CI [0.91, 1.04]). Findings are consistent with research on marginalization-related diminished returns for Black youth. While minimum wage increases are a promising step to reduce youth homicides overall, reducing homicide disparities experienced by Black youth requires additional components. Future research should examine policies with the specific intention to dismantle structural racism.