Key features, Challenges and Prospects of Shanghai Pilot Program

학위논문(석사) -- 서울대학교대학원 : 국제대학원 국제학과(국제지역학전공), 2022. 8. Jeehwan Park.현재 여러 사회가 고령화로 인한 노인 돌봄의 문제에 직면하고 있으며 이에 따라 장기요양보험제도(LTCI)의 도입의 필요성이 커지고 있다. 특히 급속하게 발전하는 중국도 노인 돌봄에 있어서 다른 나라들 보다 더 심각한 상황에 부딪히고 있다. 이에 중국 정부는 2016년에 15개 도시에서 장기 요양보험 파일럿 프로그램을 시행했다. 최근 이를 전국적으로 확대, 적용하면서 중국의 상황에 맞는 장기 요양보험 제도를 수립하고자 모색 중이다. 이전의 연구는 중국의 LTCI의 실현과 효과를 거시적으로 검토하는 데 집중한 반면, 특정 지역의 파일럿 프로그램을 구체적으로 분석한 바 없으며, LTCI에 대한 수혜자 또는 미래 수혜자의 이해방식은 파악하지 못했다. 이에 이 논문은 상하이에 도입된 LTCI 파일럿 프로그램에 대한 사례 분석을 통해, 이론적 및 경험적 관점에서 장기 요양보험의 영향을 연구하려고 한다. 본 논문은 중국 중앙정부의 LTCI 도입 과정 및 정책 지침에 대한 개요로 시작하여 상하이의 설계와 중국 장기 요양보험 파일럿 프로그램의 주요 특징, 과제 및 전망에 대한 자세한 설명으로 시작한다. 또한 이 LTCI 파일럿의 장점과 한계, 실시, 도전 및 미래의 전망도 포함한다. 본 연구는 기존 문헌, 정부 공식 웹사이트 및 문서, 설문조사, 개별 인터뷰 등 방식을 통해서 상하이를 중심으로 중국 내 장기 요양보험제도에 대한 보험 수혜자의 이해방식과 이 제도가 미칠 사회적 영향을 밝히는 것을 목표로 했다. 장기 요양보험 프로그램은 아직 개발 초기 단계에 있지만, 스스로 생활하기 어려운 노인들의 신체 건강과 삶의 질에 긍정적인 영향을 미칠 것으로 기대된다. 다만 이 프로그램은 개별 가정이 돌봄에 지출하는 경제적 비용을 덜어주는 데는 한계가 있을 수 있다. 그리고 파일럿 프로그램이 각 지역에 노인들의 의료 시장의 발전에 미치는 영향도 여전히 불분명하며 더 많은 연구가 필요하다. 이 연구를 통해 파악한, LTCI 파일럿 프로그램의 실시 결과가 정책 입안자들이 중국 전체로 이 제도를 확대 시행하는 데 도움이 되기를 바란다.With aging populations, individuals are facing increasing longevity and long-term care (LTC) risks, especially for China, as a rapidly developing nation, has also started to suffer from the same problem, or even more serious than others. As a response, China launched its public long-term care insurance (LTCI) pilots in 15 cities in 2016, which have recently been expanded to further regions across the country, signaling a policy move towards a public social insurance model of long-term care financing. Previous studies in the literature have concentrated on the implementation and effectiveness of China’s LTCI in a big picture, but to a less extent on the analysis on one specific region and thoughts from the receivers or future receivers. This thesis studies the effects of LTCI from both theoretical and empirical perspectives. This thesis starts with an overview of the general evolvement and policy guideline from the central government, followed by a more detailed description of a local (Shanghai) design, and key features, challenges and prospects of China’s LTCI pilot program. It also includes the strength and constraint, implementation, challenging tasks and future prospects of LTCI pilots. The review was conducted to reveal the effectiveness of the LTCI system in China, focusing on Shanghai as representative by reviewing existing literature, government official websites and documents, a survey conduction and several personal interviews as case study. Generally speaking, the LTCI program is still in the beginning stage of development. Although the results show that the LTCI system casts a positive impact on the physical daily health and life quality of the disabled seniors. However, the role of LTCI in alleviating the financial burden on families with disabled elderly maybe limited. And the impact of these ongoing LTCI pilots on the development of local aged care markets also remain unclear and warrants more research. Hope this study will help to identify the outcomes of the LTCI in pilot cities so as to assist policymakers in their further implementation in China.I. Introduction 1 1. Research Background and Structure 1 2. Literature Review 3 3. Significance of Research 8 4. Methodology 9 II. China's Exploration and Pilot Program of LTCI 11 1. An overview of LTCI in China 11 2. Evaluation of Current Pilot LTCI 24 3. The Future of Long-term Care Insurance: Beyond the Initial Pilots 30 III. Practice of LTCI Pilots in Shanghai 32 1. Aging Background in Shanghai 32 2. Development of LTCI in Shanghai 34 3. Evaluation of LTCI in Shanghai 41 IV. LTCI Survey and Interviews 45 V. Conclusion 54 VI. Appendix 58 VII. Bibliography 67석

Parameter design oriented analysis of the current control stability of the weak-grid-tied VSC

This paper studies the dynamic behaviors of weak-grid-tied VSCs with simplified transfer functions, which provides an accurate stability analysis and useful indications for tuning system parameters. A reduced-order multi-input multi-output (MIMO) transfer function that contains four single-input single-output (SISO) transfer functions for the weak-grid-tied VSC is first presented. It is found that the four SISO transfer functions share the same equivalent open-loop transfer function, i.e., the same stability conclusion. The Bode plots of the equivalent open-loop transfer function show that the inner current loop behaves as a band-pass filter whose maximum gain is approximately at the frequency of the PLL's bandwidth. By stability criterion, the harmonic amplification and instability occur when its maximum gain exceeds 0dB caused by high PLL's bandwidth, large grid impedance or high active power. It is also found that the target system is less stable when it works as an inverter than as a rectifier, due to the risk of the local positive feedback in the inverter mode. An effective criterion is further proposed to guide the selection of a proper PLL's bandwidth to ensure the stability of the VSC system. Simulation results validate the correctness of the analysis and the efficacy of the criterion

Untangling operational performance implication of ambidextrous blockchain initiatives: An empirical investigation of Chinese manufacturers

Purpose Blockchain has been considered as a disruptive technology and every industry stands to benefit from it. According to Deloitte, increasing number of managers claim that their firms will suffer loss in competitive advantage if they do not adopt blockchain. Despite this motivation, insufficient knowledge on how can blockchain add value inhibits the commitment to its adoption. To better understand the possible influence of blockchain, two dimensions (exploitation and exploration) of blockchain initiatives are distinguished. This research aims to examine the impact of ambidextrous blockchain initiatives on firms' operational efficiency, as well as the moderating role of unabsorbed slack and environmental munificence. Design/methodology/approach In this paper, secondary panel data were collected from multiple sources to test the proposed hypotheses. Content analysis was adopted to operationalise ambidextrous blockchain initiatives from firms' official announcements. Findings The authors find that firms' ambidexterity in blockchain initiatives have significantly positive impact on operational efficiency. Furthermore, when firms have lower unabsorbed slack or in more munificent environments, they may benefit from managing a balance between exploration and exploitation. Originality/value This research offers some insightful theoretical and managerial implications of ambidextrous blockchain initiatives. The findings of this study contribute to blockchain literature by providing theory-driven empirical research

Association between long-term exposure to fine particulate matter constituents and progression of cerebral blood flow velocity in Beijing: Modifying effect of greenness

Few studies have explored the effects of fine particulate matter (PM2.5) and its constituents on the progression of cerebral blood flow velocity (BFV) and the potential modifying role of greenness. In this study, we investigated the association of PM2.5 and its constituents, including sulfate (SO42−), nitrate (NO3−), ammonium (NH4+), organic matter (OM), and black carbon (BC), with the progression of BFV in the middle cerebral artery. Participants from the Beijing Health Management Cohort who underwent at least two transcranial Doppler sonography examinations during 2015–2020 were recruited. BFV change and BFV change rate were used to define the progression of cerebral BFV. Linear mixed effects models were employed to analyze the data, and the weighted quantile sum regression assessed the contribution of PM2.5 constituents. Additionally, greenness was examined as a modifier. Among the examined constituents, OM exhibited the strongest association with BFV progression. An interquartile range increase in PM2.5 and OM exposure concentrations was associated with a decrease of −16.519 cm/s (95% CI: −17.837, −15.201) and −15.403 cm/s (95% CI: −16.681, −14.126) in BFV change, and −10.369 cm/s/year (95% CI: −11.387, −9.352) and −9.615 cm/s/year (95% CI: −10.599, −8.632) in BFV change rate, respectively. Furthermore, stronger associations between PM2.5 and BFV progression were observed in individuals working in areas with lower greenness, those aged under 45 years, and females. In conclusion, reducing PM2.5 levels in the air, particularly the OM constituent, and enhancing greenness could potentially contribute to the protection of cerebrovascular health

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014–2019

Background: Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM). Methods: We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference. Results: Per 10 ug/m3 increase of particles with an aerodynamic diameter \u3c 2.5 μm (PM2.5), particles with an aerodynamic diameter \u3c 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO) and ozone (O3) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients’ admissions. Among the six pollutants, particulate pollutants (PM2.5 and PM10) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m3 increase in PM2.5 and PM10, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM2.5 and PM10, respectively. Given WHO 2021 air quality guideline as the reference, PM2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM. Conclusion: PM2.5 and PM10 are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS

Causal effect of PM1 on morbidity of cause-specific respiratory diseases based on a negative control exposure

Background: Extensive studies have linked PM2.5 and PM10 with respiratory diseases (RD). However, few is known about causal association between PM1 and morbidity of RD. We aimed to assess the causal effects of PM1 on cause-specific RD. Methods: Hospital admission data were obtained for RD during 2014 and 2019 in Beijing, China. Negative control exposure and extreme gradient boosting with SHapley Additive exPlanation was used to explore the causality and contribution between PM1 and RD. Stratified analysis by gender, age, and season was conducted. Results: A total of 1,183,591 admissions for RD were recorded. Per interquartile range (28 μg/m3) uptick in concentration of PM1 corresponded to a 3.08% [95% confidence interval (CI): 1.66%–4.52%] increment in morbidity of total RD. And that was 4.47% (95% CI: 2.46%–6.52%) and 0.15% (95% CI: 1.44%-1.78%), for COPD and asthma, respectively. Significantly positive causal associations were observed for PM1 with total RD and COPD. Females and the elderly had higher effects on total RD, COPD, and asthma only in the warm months (Z = 3.03, P = 0.002; Z = 4.01, P \u3c 0.001; Z = 3.92, P \u3c 0.001; Z = 2.11, P = 0.035; Z = 2.44, P = 0.015). Contribution of PM1 ranked first, second and second for total RD, COPD, and asthma among air pollutants. Conclusion: PM1 was causally associated with increased morbidity of total RD and COPD, but not causally associated with asthma. Females and the elderly were more vulnerable to PM1-associated effects on RD

Low-frequency converter-driven oscillations in weak grids: explanation and damping improvement

Low-frequency oscillations have been reported in several weak-grids-connected voltage-source-converter(VSC) systems. Although efforts have been devoted to understand the parametric and sensitivity impact of the VSC controller gains, a general formulation of the oscillation mechanism is still missing. Using transfer function dynamic modelling approach, we find that the outer loop active power control's bandwidth mainly determines the oscillation frequency. The PLL introduces a large phase lag around the frequency of the PLL bandwidth in weak grids conditions which decreases the oscillation damping. A simple but effective PI+Clegg integrator (CI) compensator is proposed to replace the standard outer loop active power controller compensating the PLL's phase delay and increase the oscillation damping. The results are verified in a real time digital simulator

Irisin Is Controlled by Farnesoid X Receptor and Regulates Cholesterol Homeostasis

ObjectiveThe aim of this study was to investigate whether the nuclear receptor farnesoid X receptor (FXR) could regulate FNDC5/Irisin expression and the role of Irisin in hyperlipidemia and atherosclerosis in ApoE-/- mice.Methods and ResultsWe treated primary human hepatocytes, HepG2 cells, and Rhesus macaques with FXR agonist (CDCA, GW4064, and ivermectin). FNDC5 expression was highly induced by CDCA and GW4064 in hepatocytes, HepG2 cells, and the circulating level of Irisin increased in Rhesus macaques. Luciferase reporter and CHIP assays were used to determine whether FXR could regulate FNDC5 promoter activity. Irisin-ApoE-/- and ApoE-/- mice were used to study the metabolic function of Irisin in dyslipidemia and atherosclerosis. Irisin-ApoE-/- mice showed improved hyperlipidemia and alleviated atherosclerosis as compared with ApoE-/- mice. Irisin upregulated the expression of Abcg5/Abcg8 in liver and intestine, which increased the transport of biliary cholesterol and fecal cholesterol output.ConclusionActivation of FXR induces FNDC5 mRNA expression in human and increased the circulating level of Irisin in Rhesus macaques. FNDC5/Irisin is a direct transcriptional target of FXR. Irisin may be a novel therapeutic strategy for dyslipidemia and atherosclerosis