Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China.

Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.

Occupational stress, distributive justice and turnover intention among public hospital nurses in China: A cross-sectional study.

AIM: To examine the mediating role of distributive justice on the relation between occupational stress and turnover intention, and the regional role in moderating the relationship between distributive justice and turnover intention. BACKGROUND: Turnover intention is an effective indicator of job departure and has been widely studied. Identification of methods to reduce turnover intention among nurses is a focus of the new round of medical and health system reform in China and in the realization of the "Healthy China 2030" policy. However, few studies have examined the present situation of Chinese nurse's turnover intention and corresponding influencing factors. METHODS: Data were collected on-site by using questionnaires designed by anonymous researchers. A total of 718 effective questionnaires were allocated from representative public hospitals. Data were collected for the "Challenge and Hindrance-Related Self-Reported Stress Scale", "Distributive Justice Scale" and "Turnover Intention Scale". RESULTS: Challenge stress was significantly inversely correlated with turnover intention, while hindrance stress was significantly positively correlated with turnover intention. Moreover, there was a significant inverse correlation between the two types of occupational stress and distributive justice and an inverse correlation between distributive justice and turnover intention. Regional role had a moderating effect on the correlation between distributive justice and turnover intention. CONCLUSIONS: Chinese nurses' turnover intention is directly or indirectly influenced by occupational stress and distributive justice. Managers should set reasonable goals to cope with challenging stress. Proper intervention measures should be designed such as reducing barrier pressure, increasing remuneration, and promoting the matching between workload and job value to reduce the turnover intention. Finally, balancing the treatment towards nurses in different regions may help achieve relative fairness.

How does social support affect public service motivation of healthcare workers in China: the mediating effect of job stress.

BACKGROUND: This study aimed to examine relations between social support, job stress, and public service motivation (PSM), also assessed how social support and job stress affect PSM in China based on the job demands-resources (JD-R) theory. METHODS: The survey investigated a sample of 973 healthcare workers employed in public hospitals in Beijing, Xiamen, and Guangzhou in 2017 (including doctors, nurses, medical technicians, and administrators). Correlation analysis and Structural equation modeling (SEM) were used. RESULTS: Challenge stress and hindrance stress were directly negatively associated with PSM. Supervisor support was significantly positively associated with PSM, and the path from coworker support to PSM was significant. Supervisor support was significantly negatively associated with hindrance stress, and coworker support was significantly negatively associated with challenge stress. Hindrance stress and challenge stress significantly mediated the relations between supervisor support and PSM, and between coworker support and PSM respectively. PSM might be raised by increasing supervisor support and coworker support and by limiting hindrance stress and challenge stress. CONCLUSION: Our study suggests that administrators of public hospitals should be mindful of the intense job stress of healthcare workers and undertake interventions targeting challenge stress and hindrance stress. Also, public hospital administrators should encourage and assist supervisors in their leadership functions. Besides, administrators of public hospitals should emphasize coworker support and good employee relationships.

Effect of Discrimination on Presenteeism among Aging Workers in the United States: Moderated Mediation Effect of Positive and Negative Affect.

This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers.

Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Sense of Control.

With the rapid increase of aging workforces, companies worldwide are concerned with improving the health and working status of older workers. Sense of control is an important psychological variable in sociology but has attracted less attention in studies of occupational health and management. This study examined the association of sense of control with presenteeism among aging workers in the United States. Data from the Health and Retirement Survey were analyzed, specifically, 2308 observations in 2012. Structural equation modeling was used to assess work environment, sense of control (measured in relation to personal mastery and perceived constraints), and associations with presenteeism. The moderating effect of subjective social status on the association between sense of control and presenteeism was examined with a moderated mediation model. In the final structural equation modeling model, work environment was directly inversely associated with presenteeism, and work environment was significantly inversely associated with perceived constraints. There was a direct positive association between work environment and personal mastery, a direct positive association between perceived constraints and presenteeism, and a significant inverse association between personal mastery and presenteeism. The significant indirect effects between work environment and presenteeism were significantly mediated by sense of control. Subjective social status inversely moderated the relation between presenteeism and perceived mastery, a dimension of sense of control. To increase the performance of aging workers in the United States, managers should create a work environment that facilitates access to job resources, as this might improve personal sense of control, particularly among those with high subjective social status.