Alliance Policy Research Articles

A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China.

To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality. Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs. In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030). Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a "patient health-centered" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.

Has the Operational Control Transfer of the ROK‐US Alliance Come to the Cul‐de‐sac? International and Domestic Factors That Explain Delays in an Alliance Policy

Strategic effects of military alliances notwithstanding, to assume that their policy will proceed without difficulties is problematic. The ROK‐US alliance began transferring the wartime operational control (OPCON) to the ROK in early 2003. However, the transfer did not proceed as planned, experiencing two delays in June 2010 and October 2014 with a significant format change to the Condition‐based OPCON Transition Plan (COT‐P), meaning the addition of prerequisites for the transfer and the death of the original parallel command structure. What have been the causes of these phenomena and resulting stagnation? This article argues that the allies' strategic consensus over the transfer and the policy coordination in the initiating ally are the main causes of the lethargy. Additionally, this study finds that the impact of the strategic consensus is greater than that of the ROK's policy coordination, as the former is demonstrated in all three indicators of the progress: timeliness, post‐transfer command structure, and the certification assessment through exercises.

Safeguarding South African schools: Civil society action against alcohol sales in educational settings

The Southern African Alcohol Policy Alliance (SAAPA) in South Africa vehemently opposed Clause 8 of the Basic Education Legislation Amendment Bill (BELA) allowing alcohol sales at schools. This stance was grounded in the 2016 National Liquor Policy, advocating for distance between schools and liquor outlets. SAAPA's multifaceted approach included engaging government, experts, media advocacy, social mobilisation, and active participation in the legislative process. Their efforts, culminating in over 5000 submissions and an oral presentation, led to the removal of Clause 8 in September 2023. This success underscores the pivotal role of civil society in shaping evidence-based policies for public health and child welfare.

Medical staff evaluation on 'the effect of medical alliance policy on hierarchical diagnosis and treatment'.

Medical alliances are essential for constructing an hierarchical diagnosis and treatment (HDT) system; therefore, it is crucial to promote such alliances and evaluate their effectiveness in this regard from the medical staff perspective. This study thus investigated and analyzed the evaluations of medical staff in China concerning the effect of medical alliances on promoting HDT with the intention to encourage further establishment of medical alliances and HDT under China's new medical reform. A total of 616 medical staff personnel from 3 medical alliances in Fujian Province were surveyed, and data were analyzed using SPSS 20.0 software. The level of medical institutions, posts and satisfaction with their medical alliances influenced the evaluation of medical alliance effectiveness in resolving the problem of expensive medical services. Primary medical institutions are more inclined toward policy formulation and related work; thus, the interests of primary hospitals can be guaranteed. However, tertiary hospitals must provide additional workforce, material, and financial resources to support primary hospitals. Therefore, it is necessary to coordinate the interests of the medical staff at different levels of medical institutions. The study makes a significant contribution to the literature because it highlights the effect of medical alliances in promoting hierarchical diagnosis and treatment.

Alcohol policy development in Sierra Leone: An assessment of the role of civil society

Objective: To assess the value addition of civil society collaboration with Government in the development of Sierra Leone’s National Alcohol Policy (NAP). Policy Development Process: We reviewed the entire process of lobby, advocacy, and support for the development of the NAP from 2015 when the Siera Leone Alcohol Policy Alliance (SLAPA) was formed to the launch of the NAP in 2023. It also assesses the level of collaboration between FoRUT, SLAPA and Ministry of Health of Health and Sanitation (MoHS). The MoHS coordinated the policy formulation process with substantive technical support from civil society. Results: The quality of the NAP was rated high as it reflected appropriate policy areas and interventions from the Global Strategy to Reduce the Harmful Use of Alcohol, the WHO SAFER initiative, and the Global Action Plan for Alcohol Control (202-2030). The NAP is a solid reference material for the development of a new alcohol bill. MoHS recognized FoRUT and SLAPA as the national champions for alcohol control in the country. FoRUT, directly and through SLAPA influenced the process of developing the NAP and its quality through advocacy, collaboration and technical and financial support. Conclusions: The development of the NAP in Sierra Leone truly reflects civil society-government collaboration, built on mutual trust and a common health and development agenda. Connecting national level lobby and advocacy with regional global advocacy actions to prioritize, influence, support, and monitor the alcohol control agenda is a critical catalyst for civil society to advancing the development of NAPs.

Pricing and Capacity Allocation in Opaque Selling

To solve the supply and demand mismatch problem, intermediaries have emerged as an opaque channel for service providers to dispose of leftover capacity. This paper focuses on pricing and capacity allocation in opaque selling. We develop a Stackelberg game model, where two capacity-constrained service providers first decide the capacity allocated to an intermediary who then determines the opaque price based on its capacity. We examine the conditions under which the service providers should cooperate with the intermediary, and find that the opaque price and capacity allocation decisions are affected by product type, service providers’ capacity, and commission rate. Moreover, we find that the service providers may fall into the prisoner's dilemma when distributing through the intermediary. It indicates that although opaque selling can bring service providers more profit, it may not help them achieve the optimal profit. In view of this, we propose an alliance policy to eliminate the prisoners’ dilemma and examine when the service providers should ally. Results show that this policy can improve the profits of the service providers and the whole supply chain if the commission rate is adequately low. Our findings suggest that opaque selling can be less beneficial than previously shown and demonstrate the importance of an alliance policy.

Recriminalization of drugs in Oregon: The latest backlash

Liberal policies are good for drug users, and good for addiction treatment, but what happened in Oregon last week – the governor signing into law the recriminalization of possession of small amounts of drugs – was inevitable because of poor implementation of those policies. When Oregon promised to decriminalize possession of small amounts of drugs three years ago, following a well‐financed campaign by the Drug Policy Alliance, the goal was to make treatment more accessible. Nobody made treatment more accessible. Drug users flocked to the state for its reputation of easy access. Overdose deaths soared. The only position lawmakers saw for themselves, in the face of constituent horror at the dissolution of the formerly beauty of Portland, was to go back on the decision they themselves made. This is called backlash, and it's not good for people who need treatment. The same thing is underway in San Francisco, which also created a landscape that was appealing to drug users – and lo and behold, the overdose rate soared, and businesses shut their doors in the face of littering and excrement on the streets and children having to step over overdosed drug users on their way to school. These icons of liberal policy need to do something other than reverse course, but it's understandable that they don't know what that is. In San Francisco, the overdose prevention center (OPC) was closed because fewer than 1% of users went to treatment. At least the OPC created a place for people to use drugs without dying. Now, in San Francisco, there is new housing and shelters for drug users, but these just provide a place for people to overdose out of the sight of passersby with naloxone. Do we have an answer? No. But a backlash isn't it. Stay tuned.

Gulf Affaris: Saudi Arabia and the United Arab Emirates: Foreign Policy and Strategic Alliances in an Uncertain World, by Robert Mason

Saudi Arabia and the United Arab Emirates: Foreign Policy and Strategic Alliances in an Uncertain World, by Robert Mason. Manchester: Manchester University Press, 2023. 320 pages. $85.00 cloth, e-book.

RESET Alcohol: A Global Alcohol Policy Initiative

RESET Alcohol: A Global Alcohol Policy Initiative

In Case You Haven't Heard…

Last week, the federal Centers for Disease Control and Prevention (CDC) issued state‐by‐state overdose data, and the state with the biggest increase in deaths is Oregon, which decriminalized drug possession three years ago (see Drug decriminalization measure in Oregon would not increase treatment funding, ADAW Dec. 7, 2020; https://onlinelibrary.wiley.com/doi/10.1002/adaw.32905). That measure was supported by the Drug Policy Alliance and others who have been silent on whether there is a connection. The CDC's interactive dashboard contains useful information for all states. Go to https://www.cdc.gov/nchs/nvss/vsrr/drug‐overdose‐data.htm.

Prisoners of Impunity: What the Global Community Should Know about and Learn from the Russo-Ukrainian War

While the world awoke to the horrors of Russia’s full-scale invasion of Ukraine on February 24, 2022, Russia’s military intervention into Ukraine’s internal affairs had its roots in 2014 with the annexation of Crimea and the war in Donbas. Long before 2014, Russia had sought to influence Ukraine’s electoral outcomes, foreign policy and political alliances, as well as exert economic coercion through trade wars. The overarching imperialist vision of Ukraine has long been evident in political addresses delivered by Russia’s leadership and the narratives projected by state-controlled media. Much of the world community, however, perceived these actions through the lens of Ukraine as a post-Soviet country presumed to belong to the so-called Russian sphere of influence. Despite numerous historic and modern-day atrocities against those perceived to be part of its geopolitical periphery, Russia enjoyed political, economic and moral impunity. Too often, Western powers prioritized regional stability and trade with Russia over upholding the rule of law and respect for Ukraine’s sovereignty. This was evident in the tepid reaction to Russia’s annexation of Crimea and the instigation of war in Donbas. Settling for a state of ‘negative peace’ in the case of Minsk accords (2014, 2015) – rather than holding Russia accountable for its actions, revealed a lack of holistic understanding of Russia, Ukraine, and what it truly takes to achieve “positive peace”. This essay offers a broader historical context for Ukraine’s nation building and Russia’s enduring and centuries-long colonial drives toward Ukraine. It argues that the Russo-Ukrainian war, beginning with the annexation of Crimea, marks a unique moment in the post – World War II international world order. This event poses a challenge to the current international legal framework while also presenting an opportunity to draw lessons for preserving the liberal world order.

The Policy Alliance Between Hospitals and Debt Collection Agencies: Content Analysis of Public Comments on Regulations on Billing and Collections.

Significant debate persists about the obligations of nonprofit hospitals toward low-income patients. Many issues pertaining to this subject were discussed during the rulemaking process following the passage of the Affordable Care Act of 2010, which set forth rules for hospital billing and collection. In public comments, hospitals, debt collectors, and patient advocates debated what constituted "reasonable efforts" to determine whether a patient qualified for hospital financial assistance before resorting to extraordinary collection actions including lawsuits, wage garnishments, and adverse credit reporting. This study analyzes public comments to the proposed Internal Revenue Service rule on section 501(r)(6). After an initial review of the data, 5 commonly mentioned issues were identified. Respondents were organized into commenter types, and the opinion of each respondent to each issue was coded by 2 separate reviewers. Discrepancies between reviewer determinations were resolved by consensus during follow-up discussions. This analysis revealed a set of common concerns: whether reporting delinquent medical debt to credit bureaus and selling debt to third party buyers should be considered extraordinary collection actions; whether hospitals should be able to use presumptive eligibility to rule patients either eligible or ineligible for financial assistance; and whether hospitals should be held legally liable for the actions of third-party debt collectors. Hospitals and debt collection agencies were allied on most issues, particularly in their shared belief that reporting debt to credit bureaus and selling debt to third parties should not be tightly regulated. Patient advocacy organizations and hospitals had divergent opinions on most issues. The alliance of hospitals and debt collectors in advocating for fewer regulations around collections is part of a history of hospital lobbying to maintain tax-exemption with fewer charity care mandates. This alignment helps explain why third-party debt collection agencies, and aggressive collection tactics, have become commonplace in hospital billing.

The Racial Politics of the Alliance Israélite Universelle

Abstract: Despite the extensive literature on the Alliance Israélite Universelle (AIU), scholars have yet to apply race as an explicit analytic in examining its work across the Ottoman Empire, North Africa, and Iran. I argue that the AIU racialized the Beta Israel as subjects in need of aid through overtly physiognomic descriptions, notions of time, and ethnographic descriptions of cultural practices that rest on underlying racial logics. Further, I argue that the AIU was driven by racial notions, anxieties, and aspirations around whiteness. These racial politics come to the fore through a case study of the ethnographic expeditions that the AIU sponsored to the Beta Israel in Ethiopia. The Alliance first sent Joseph Halévy in 1867–1868, and forty years later, dispatched a second expedition led by Rabbi Haim Nahum in 1909. While accounts of the AIU tend towards a paradigm of Orientalism, thinking with race accounts for the role that racial theory played in the development of Alliance policy, emphasizes multidirectional constructions of Blackness and whiteness, reveals analytic connections linking groups within a global racial hierarchy, and highlights continuities with debates around white gatekeeping in the Jewish community that are still unfolding today. Applying race as an explicit analytic thus not only reframes the work of the Alliance, but enables us to rethink Jewish history and historiography more globally.

The Effects of the Multi-Hospital Global Budget Payment on Medical Expenditure and Service Volume: The Evidence from Dangyang County, China.

Global budget payment is currently the prevailing payment strategy internationally. In China, the concept of multi-hospital global budget payment has been proposed with the aims of achieving cost control effects while also encouraging hospital collaboration and optimising allocation of healthcare resources. This study seeks to analyse the impact of multi-hospital global budget payment in China on healthcare expenditure and service volume. A retrospective comparative study was carried out in Dangyang County, China. The exposure cases were migrants who were not locally registered in the residence registration system. The study period encompassed January 1, 2017, to December 31, 2019. Including 3,246,164 outpatient medical records and 242,685 inpatient medical records. The key variables are medical expenditure and service volume indicators. Continuous variables were reported as mean and tested by t-test. We used interrupted time series analysis models to estimate the changes in the level and trend of each outcome measure after the policy. After the outpatient global budget payment reform, the monthly medical expenditure of the hospital alliance has transitioned from a discernible upward trajectory to a deceleration in the rate of growth. The outpatient volume in public and private high-level hospitals decreased at a rate of -419.26 person/month and -137.04 person/month, respectively. In terms of inpatient service volume, only private high-level hospitals reported a decrease, with a reduction rate of -15.38 individuals per month. This study presents new evidence demonstrating that the multi-hospital global budget payment can effectively control costs and promote resource reallocation when implemented jointly with hospital alliance policies. However, overly lenient budget caps risk counterproductive effects.

Russian strategic narratives, 2022–2023

Russia, in its competition with the liberal world for establishing the dominant discourse—alongside hard power military means—deploys soft power, leveraging the allure of illiberal values to forge foreign policy alliances, undermine the credibility of international institutions, and reshape the global order. Russian strategic narratives delineate the political objectives of the Russian government. In a contest for discursive authority with other global actors, Russia presents its vision of a new world order—a world partitioned among major powers—where Moscow holds the authority to determine the fate of peoples in the “Greater Eurasia” region, including Europe

A DYNAMIC ADDITIVE AND MULTIPLICATIVE EFFECTS NETWORK MODEL WITH APPLICATION TO THE UNITED NATIONS VOTING BEHAVIORS.

Motivated by a study of United Nations voting behaviors, we introduce a regression model for a series of networks that are correlated over time. Our model is a dynamic extension of the additive and multiplicative effects network model (AMEN) of Hoff (2021). In addition to incorporating a temporal structure, the model accommodates two types of missing data thus allows the size of the network to vary over time. We demonstrate via simulations the necessity of various components of the model. We apply the model to the United Nations General Assembly voting data from 1983 to 2014 (Voeten, 2013) to answer interesting research questions regarding international voting behaviors. In addition to finding important factors that could explain the voting behaviors, the model-estimated additive effects, multiplicative effects, and their movements reveal meaningful foreign policy positions and alliances of various countries.

The Trend of China-ROK Strategic Cooperation and China's Response under the Competition Pattern between China and the US

Since the Biden administration came to power, the United States has pursued the policy of alliance first, and the alliance between the US and South Korea has been further strengthened. Under the competition pattern between China and the United States, South Korea is facing increasing pressure to choose sides, and there are challenges in the strategic cooperation between China and South Korea. However, based on the close economic ties between China and South Korea, the advantages of the progressive camp in the National Assembly and the long-held pragmatic diplomatic tradition of South Korea, the impetus and possibility of maintaining the stable development of China-ROK strategic cooperation still exist. China should do its best to ease the asymmetric dilemma between the US-South Korea alliance and China-South Korea relations, promote the establishment of a security mechanism in Northeast Asia, and maintain regional security and stability.

Community voices on alcohol harm in Sierra Leone: Perceptions of prevention needs

ObjectiveThe research purpose is to determine alcohol prevention needs in Sierra Leone. MethodsWe analyzed a cross-sectional survey from fall 2020, distributed by the West African Alcohol Policy Alliance to their partners across nine West African countries. The survey included questions on perceptions of alcohol harm, research priorities, and capacity and reach of the organizations represented. Only participants from Sierra Leone were included (n = 33). ResultsWhen asked if they thought measures taken to prevent alcohol-related harm in their country have been adequate, 66% answered inadequate (n = 32). Asked if heavy drinking of commercial alcohol is a concern in their community, 96% said yes (n = 25), and 92% said heavy drinking of traditional brew or distilled spirits is a concern in their community (n = 24). Finally, 91% said that their organization would be interested in implementing an alcohol counter-marketing campaign (n = 23). ConclusionsBased on the perception of survey participants, efforts to prevent alcohol-related harm thus far are inadequate in Sierra Leone where heavy drinking is a critical concern. CBOs and NGOs already engaged in alcohol harm prevention are eager to support and adopt new strategies. InnovationThis is the first research to seek direct input from CBOS and NGOs about alcohol harm prevention in Sierra Leone.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

An Invisible Strategy with Visible Gains: Gray Zone Strategy of the Northeast Asian States and Challenges to South Korea

Gray zone strategy garners growing attention as China's indirect approach against the U.S., her great power competitor. Unlike the conventional wisdom, the gray zone mechanism is not new historically but rather has been widely at play in many areas in the international arena, particularly in Northeast Asia. South Korea has been under the gray zone offensive of China and North Korea. Typical examples are Beijing's THAAD retaliation and Pyongyang's incrementally advancing nuclear program under a gray discourse of denuclearization of the Korean Peninsula. The examination provides insight into international implications: gray zone strategy as a transitional remedy, its availability to the strong, the different impacts of regime types, and the need for international attention to Pyongyang's gray zone approach towards nuclearization. This analysis also sheds some light on policies for South Korea, including an alliance policy and multilateral efforts.