The effect of performance-related pay of hospital doctors on hospital behaviour: a case study from Shandong, China.

BACKGROUND: With the recognition that public hospitals are often productively inefficient, reforms have taken place worldwide to increase their administrative autonomy and financial responsibility. Reforms in China have been some of the most radical: the government budget for public hospitals was fixed, and hospitals had to rely on charges to fill their financing gap. Accompanying these changes was the widespread introduction of performance-related pay for hospital doctors--termed the "bonus" system. While the policy objective was to improve productivity and cost recovery, it is likely that the incentive to increase the quantity of care provided would operate regardless of whether the care was medically necessary. METHODS: The primary concerns of this study were to assess the effects of the bonus system on hospital revenue, cost recovery and productivity, and to explore whether various forms of bonus pay were associated with the provision of unnecessary care. The study drew on longitudinal data on revenue and productivity from six panel hospitals, and a detailed record review of 2303 tracer disease patients (1161 appendicitis patients and 1142 pneumonia patients) was used to identify unnecessary care. RESULTS: The study found that bonus system change over time contributed significantly to the increase in hospital service revenue and hospital cost recovery. There was an increase in unnecessary care and in the probability of admission when the bonus system switched from one with a weaker incentive to increase services to one with a stronger incentive, suggesting that improvement in the financial health of public hospitals was achieved at least in part through the provision of more unnecessary care and drugs and through admitting more patients. CONCLUSION: There was little evidence that the performance-related pay system as designed by the sample of Chinese public hospitals was socially desirable. Hospitals should be monitored more closely by the government, and regulations applied to limit opportunistic behaviour. Otherwise, the containment of government financing for public facilities may result in an increase in the provision of unnecessary care, an increase in health costs to society, and a waste in social resources

The role of regulation in influencing income-generating activities among public sector doctors in Peru.

OBJECTIVE: To examine in Peru the nature of dual practice (doctors holding two jobs at once - usually public sector doctors with private practices), the factors that influence individuals' decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area. METHODS: The study entailed qualitative interviews with a sample of twenty medical practitioners based in metropolitan Lima, representing a cross-section of those primarily employed in either the private or public sectors and engaged in clinical practice or policy making. The interviews focused on: 1. individuals' experience with dual practice; 2. the general underlying pressures that influence the nature and extent of such activities; and 3. attitudes toward, and the influence of, regulation on such activities. RESULTS: Dual practice is an activity that is widespread and well-accepted, and the prime personal motivation is financial. However, there are also a number of important broad macroeconomic influences on dual practice particularly the oversupply of medical services, the deregulated nature of this market, and the economic crisis throughout the country, which combine to create major hardships for those attempting to make a living through medical practice. There is some support among doctors for tighter regulation. CONCLUSION: Research findings suggest appropriate policy responses to dual practice involve tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations. Further research into this issue in rural areas is needed to ascertain the geographical generalizability of these policy responses

Who Do You Think You\u27re Border Patrolling? : Negotiating Multiracial Identities and Interracial Relationships

Research on racial border patrolling has demonstrated how people police racial borders in order to maintain socially constructed differences and reinforce divisions between racial groups and their members. Existing literature on border patrolling has primarily focused on white/black couples and multiracial families, with discussions contrasting “white border patrolling” and “black border patrolling,” in terms of differential motivations, intentions, and goals (Dalmage 2000). In my dissertation research, I examined a different type of policing racial categories and the spaces in-between these shifting boundaries. I offer up “multiracial interracial border patrolling” as a means of understanding how borderism impacts the lives of “multiracial” individuals in “interracial” relationships. In taking a look at how both identities and relationships involve racial negotiations, I conducted 60 in-depth, face-to-face qualitative interviews with people who indicated having racially mixed parentage or heritage. Respondents shared their experiences of publicly and privately managing their sometimes shifting preferred racial identities; often racially ambiguous appearance; and situationally in/visible “interracial” relationships in an era of colorblind racism. This management included encounters with border patrolling from strangers, significant others, and self. Not only did border patrolling originate from these three sources, but also manifested itself in a variety of forms, including benevolent (positive, supportive); beneficiary (socially and sometimes economically or materially beneficial); protective, and malevolent (negative, malicious, conflictive). Throughout, I discussed the border patrolling variations that “multiracial” individuals in “interracial” relationships face. I also worked to show how people’s participation in border patrolling encouraged their production of colorblind discourses as a strategy for masking their racial attitudes and ideologies about “multiracial” individuals in “interracial” relationships

Shattering Silence and Stereotypes: Rihanna's Lyrical Reaction to Spectacular Violence

In this article, I take up the charge of exploring how the celebrity status of Rihanna allowed audiences to see her humanity, even amidst the dehumanization of her through an objectification supported by media and society.  In the wake of that 2009 incident, Rihanna was denied her privacy specific to these events, largely because of her celebrity status.  In this way, her celebrity proved a double-edged sword, exposing her as a figure provoking the public’s attention and generating cognitive dissonance.  This dissonance stemmed from the illusion that celebrities remain untouched by the harsh realities of everyday life, including intimate partner violence.   That Rihanna became “every woman” even as she remained a superstar held in tension this reality.  This tension speaks to the normalized violence that pervades this society.  Ironically, it is this very celebrity status that helped to shatter the silence of violence

Cooking with Love : Food, Gender, and Power

This work explores the complex relationships between women, food, and power. Engaging the literature of feminist food studies allowed me to record the narratives and examine the experiences of women living in the United States. I take a close look at how women solidify and strengthen their social relationships to family and community through the use of food, or compromise and weaken these relationships through the denial or refusal of food, in the form of cooking or eating. I also consider both local and global contexts for understanding food, in terms of consumption and chores. Finally, I demonstrate how imagery of food allows women to participate in processes of commodification and fetishism

Embodied precarity: the biopolitics of AIDS biomedicine in South Africa

This thesis centres on the lives of women who live in Khayelitsha and who receive AIDS biomedicines through South Africa’s public health system. It is tiered across five ethnographic chapters to elucidate a single overarching argument: biopolitical precarity is networked into the permeable body. This argument is based on ethnographic research and seeks to challenge the discursive construction of distance that divorces women’s lives and bodies from the governance of AIDS biomedicines as life-­giving technologies. The multi-­sited ethnography underpinning this thesis was configured to follow the networked threads that weave women’s embodied precarity into the governance of technologies and the technologies of governance. To this end, fieldwork was conducted in South Africa from October 2010 – July 2011 in order to understand the embodied and political dimensions of access to AIDS biomedicine. Thereafter, fieldwork was conducted in Brazil from August 2011 – September 2011 to explore the networked connections spanning activist organisations, government coalitions and economic blocs to move out from the intimate spaces of women’s lives and bodies to locate them in the regional and global spaces of biomedical developments and health policy dynamics. This thesis argues that although it is crucial to anchor technologies in people’s lives, it is also analytically and politically necessary to link people’s lives - and the technologies that sustain them - back into the global assemblage that is networked around the governance of medicine. Therefore, I locate biomedical technologies in social and political contexts of lives of the people with whom I worked in Khayelitsha, and I argue further that their lives also need to be understood as part of a complex network of actors (spanning international organisations, regional coalitions and national governments) and actants (HIV and ARVs) that assemble in dynamic configurations and that are woven into and through the body