Results Of Reform Research Articles

Institution-level admissions initiatives in Chile: enhancing equity in higher education?

ABSTRACTDuring the last 10 years, a group of selective universities in Chile has started to implement admissions programs that consider the achievement of students in the context of the educational opportunities they have had, thus reducing reliance on the national college entrance exam. This study explores the program theories in a sample of these programs and their effects on access and academic outcomes. We use a mixed method approach: program theory is explored through the analysis of program documents and interviews, and the effects on access and outcomes are explored through descriptive and inferential statistics of institutional data. This study aims to contribute to the research exploring the evolution and outcomes of institutional admission reforms intended to tackle the problem of equity in higher education.

What Works and Why? Lessons from Public Management Reform in Malaysia

ABSTRACTThis article examines the Malaysian experience with public management reform to verify arguments about various reform models. Drawing on empirical data, it investigates reforms that have worked and those that have had limited impacts on public service improvements. It identifies critical success factors that determine reform outcomes and concludes that for reforms to succeed a combined top–down and bottom–up approach is crucial. It argues that while diagnostic and problem-oriented reforms have a better chance of being successful, the value of best-practice reforms should not be discounted. The cumulative impact of such reforms can be significant, as the Malaysian case demonstrates.

Desirable places: spatial representations and educational strategies in the inner city

This article examines how the outcome of neoliberal educational reforms has affected urban schooling in the inner city of Stockholm – making it into a centralized nexus or a ‘hot-spot’ for students and schools. The aim is to analyse how geographical place and space have become major distinctive criteria in inner-city students’ educational strategies, as well as a comparative advantage for upper-secondary schools in the fierce in-between school competition. The data consist of interviews with close to 120 participants, official statistics and marketing from 55 inner-city upper-secondary schools. Our findings suggest that the growing commodification and upward socio-spatial homogenization of the inner city both affect the way schools use spatial representations in their marketing and also the strategies deployed by students in their school choice.

Investment Expenditures of Local municipalities in Japan in the 2000s

In this paper, I analyzed the investment expenditures of local municipalities in Japan in the 2000s by examining the cases of different municipalities and obtained the following results. First, merged municipalities issued Special Merger Bonds and nonmerged/depopulated municipalities issued Depopulation Bonds most. Second, in nonmerged/nondepopulated municipalities began to focus more on works funded by grants and local bonds rather than on unsubsidized works funded by Road Bonds and other types of local bonds. That is, in the past, the total value of Road Bonds was the largest of all bond totals. However, Road Bonds were replaced by School Bonds issued to supplement School Block Grants established during the decentralization reform in the 2000s. Therefore, this phenomenon is one of the outcomes of the decentralization reform. In Japan, the decentralization can increase public works for schools in cities and some select towns and villages with high financial capability indices. This could widen the gap between rich and poor municipalities. The theory of cumulative causation by Gunnar Myrdal can be attributed to this phenomenon

Getting off the carousel: Exploring the wicked problem of curriculum reform.

IntroductionMaking substantial changes to the form and delivery of medical education is challenging. One reason for this may be misalignment between existing conceptualizations of curricula and curriculum reform in medical education, with the former perceived as ‘complex’ yet the latter as linear. Reframing curriculum reform as a process-driven, complex entity may enhance the possibility of change. To explore the utility of this approach, we carried out an exploratory case study of curriculum reform in a real-life context.MethodsWe used a qualitative case study approach. Data were collected from 17 interviews with senior faculty involved in curriculum reform in one medical school plus document analysis of approximately 50 documents and files, to provide background, context, and aid triangulation.ResultsData coding and analysis was initially inductive, using thematic analysis. After themes were identified, we applied the ‘wicked problem’ framework to highlight aspects of the data. This paper focuses on two main analytic themes. First, that multiple players hold different views and values in relation to curriculum reform, resulting in various influences on the process and outcomes of reform. Second, ‘solutions’ generate consequences which go beyond the anticipated advantages of curriculum reform.DiscussionThis is the first empirical study of curriculum reform in medical education which uses the wicked problem framework to conceptually illuminate the complex processes which occur in relation to reform. Those involved in reform must be reflective and attentive to the possibility that persistent and emerging challenges may be a result of wicked problems.

Exploring the Role of Ideology in Interdisciplinary Science Education Policy

Despite its popularity in education studies literature, interdisciplinary science education is mostly considered outside the multitude of social forces that drive education reform. This has contributed to a mythologizing of interdisciplinary science education and lead to assumptions about the necessity of its intervention into science education practice. This research constructs a critical analysis of interdisciplinary science education by exploring a philosophical understanding of the relations between scientific disciplines, investigating discourse about interdisciplinarity in science education policy literature, and provides socioeconomic context for this reform movement. In particular, Louis Althusser's theory of ideology as material force, his conception of the spontaneous philosophy of scientists, and his theses on the ideological nature of interdisciplinary science are foundational to this critique. Althusser's contributions allow for critical reflection on interdisciplinarity and the effects of promoting it throughout scientific enterprise. Viewing interdisciplinary science education through this critical lens allows for demarcating the ideological narratives of reformist discourse from the intended outcomes of reform. This investigation elucidates the intervention of interdisciplinarity as an ideological force governing the reproduction of scientific labor, with intended downstream socioeconomic effects, such as shifting science labor from the public sector to private industry to accommodate for austerity. The conclusions of this analysis advocate for historical materialist methodologies in science education research and critical education studies, while emphasizing the role of ideology in socioeconomic reproduction.

Court reform programmes: the Malaysian experience

In this paper Justice Azahar bin Mohamed (Federal Court Judge, Malaysia; Inns of Court Fellow, Institute of Advanced Legal Studies) gives a brief account of the experience in Malaysia of transforming the judicial landscape with the introduction of new measures to tackle a massive backlog of cases and unacceptable delay in the litigation process. The article focuses on the key initiatives aimed at strengthening judicial systems and procedures, including efforts to address court management systems, procedural rules, and jurisdictional limits of courts and implementation of alternative dispute resolution. Some of the accomplishments and the resulting outcomes of the reforms are highlighted, and the article concludes by setting some future directions which the court should take.

Liberalization of a retail electricity market: Consumer satisfaction and household switching behavior in Japan

Policy makers pursue open markets through deregulatory reform based on a belief that they increase economic efficiency and produce benefits for consumers mainly through price reductions. However, the superiority of competition over regulated monopolies is not established. In a liberalized market, consumers exercising their ability to choose a utility provider is a crucial way of shaping the outcomes of deregulatory reform. While achieving a high switching rate is not the ultimate goal of market reform, it is an important tool through which consumers gain from policy form. We use data from a Japanese household survey conducted before and after recent liberalization and find a positive impact of liberalization on consumer satisfaction by enabling consumers to choose an electricity provider. This result indicates that switching can be utility improving by increasing customer satisfaction and underlines the importance of switching behavior in effectively utilizing deregulatory reform. This study also examines a broad set of determinants of provider switching and discusses the policy implications of the empirical results.

Lessons From Transitional Reforms: What Are The Fundamentals For Successful Transformation?

After more than two decades of enduring global reforms, the current paper makes an attempt to investigate the fundamental prerequisites of a successful reform program. The study is particularly complicated by the ambiguity surrounding the very subject matter. While most scholars are united in the view that in order to facilitate a successful transitional process, transitional economies must execute fundamental grassroots reforms, there is no formally accepted universal blueprint of what is considered to be an acceptable transitional program. In an effort to broaden the scope of the investigation, the author probes into neoclassical economic thinking and examines ‘conventional reform indicators’ commonly associated with successful reforms. But the quest brings the author to the realization that mainstream neoclassical economic thinking by itself is not sufficient; it leaves behind unanswered fundamental questions which—for the sake of methodological and pragmatic necessity—demands resolution. Consequently, the author excavates beneath superficial philosophical thinking, and probes ‘mainstream theories’ for answers to valid problems confronting transitioning economies. The inquiry is not only beneficial for knowledge, but has implications for policy-making. The paper is sectioned into four parts: introduction is an appraisal of conventional thinking; section II examines reform pre-requisites and pragmatic questions; section III is an attempt to suggest answers to questions prompted in section II and rationalize unequal reform outcomes in reforming societies that execute identical reform program; the concluding section synchronously weaves together the different pieces and ideas by drawing attention on the uniqueness of contemporary reforms and lessons learned from past reforms.

Tracing a pathway to success: How competing interest groups influenced the 2013 EU Common Fisheries Policy reform

Adaptation of environmental policies to often unexpected crises is an important function of sustainable governance arrangements. However the relationship between environmental change and policy is complicated. Much research has focused on understanding institutional dynamics or the role of specific participants in the policy process. This paper draws attention to interest groups and the mechanism through which they influence policy change. Existing research offers conflicting evidence in regards to the different ways in which interest groups may affect change. This paper provides an in-depth study of the 2013 European Union Common Fisheries Policy reform − a policy change characterized by active interest group participation. It traces the activity of interest group coalitions to understand how they achieved influence under a changing policy context. The study involves interviews with interest group representatives, policy experts and decision-makers, document analysis of interest group statements and EU legislative documents. Findings identify the important role of coalition-building and informational lobbying for environmental interest group success in exploiting favorable sociopolitical conditions and influencing reform outcomes. An insight on interest group influence and its conditions contributes to our understanding of the complex dynamics of the environmental policy process as well as its implications for policy adaptation to environmental change.

Research of impacts on medical visit behaviors of patients due to the two reforms of the clinic-pharmacy-separation at a hospital in Beijing

Objective To study the impacts and the difference made by the pilot reform and comprehensive reform of clinic-pharmacy-separation on the medical visit behaviors of outpatients in Beijing. Methods Invoice information of outpatients′ fee payment during the December 2012 reform and April 2017 reform at the hospital was collected. Information of these patients at the same time as controls was collected to analyze patients′ fee categories, so as to study the effect on the behavior of these patients. Results The outpatient visits decreased by 5.29% as a result of the pilot reform. The ratio of medical insurance patients rose by 6.86%, and that of such patients seeking only prescriptions rose by 4.30%; number of outpatient visits decreased by 2.03% after the comprehensive reform, while the ratio of medical insurance outpatients dropped by 2.61%, and those seeking prescription only dropped by 2.54%. Conclusions The comprehensive reform of clinic-pharmacy-separation has influenced the outpatient′s medical visit behavior, evidencing a positive outcome of the healthcare reform. Key words: Clinic-pharmacy-separation; Outpatients; Medical visit behavior; Beijing

Analysing a Chinese Regional Integrated Healthcare Organisation Reform Failure using a Complex Adaptive System Approach.

Introduction:China’s organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS) provides a new perspective and methodology for analysing the health system and policy implementation.Methods:We observed the typical case of Qianjiang’s Integrated Health Organization Reform (IHO) for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS.Results:The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision.Discussion and Conclusions:The traditional organised health system is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a semi-organised system. Medical institutions and professionals operate in a middle ground between complete adherence to administrative orders from state-run health systems and completely adapting to the market. Thus, decision-making, implementation and analysis of health policies should also be updated according to this current standing. The simplest way to manage this new system is to abandon linear top-down orders and patiently wait for an explicit picture of IHO mechanisms to be revealed after complete and spontaneous negotiation between IHO allies is reached. In the meantime, bottom-up feedback from members should be paid attention to, and common benefits and fluid information flow should be prioritised in building a successful IHO.

Implementing the National Curriculum Reform In China: A Review of the Decade

In China, the eighth round of national curriculum reform (NCR) is the most serious, systematic, and ambitious attempt to transform the basic education curriculum system since 1949. Through a review of the contexts, processes and outcomes of the implementation of the NCR from 2001–2011, this paper provides a further discussion on three pairs of apparently conflicting aspects: policy borrowing or policy learning; revolution or evolution; success or failure. It enriches our understanding of the implementation of large-scale reform in a non-western context like China in the following ways: Firstly, the NCR is China’s reaction against as well as response to the requirements of the current era of globalization; secondly, the debates and setbacks during the implementation of the NCR are not necessarily destructive, and a more integrative view should be adopted by the NCR on the balance between tradition and innovation, between localized concerns and global perspectives; thirdly, it is not wise to make a rash judgment on the reform outcomes of the NCR, especially the invisible and profound cultural changes. All those who are concerned about the evaluation of the NCR may need to rethink and clarify their views and positions on the purpose of education.

Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants.

Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes. Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform. Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03). Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.

Looking inward or outward? Vietnam higher education at the superhighway of globalization: culture, values and changes

ABSTRACTGlobalization and internationalization forces have placed Vietnam higher education (VHE) under the pressure of change. Reforming VHE has therefore become imperative for institutions at this crossroad of change forces. However, reform efforts have been ad-hoc, fragmented and unstable. Reform outcomes have remained fairly limited and fall under scrutiny. Drawing on a case study of the Advanced Program, we argue that importing the curriculum from a Western country without thoughtful consideration of the local culture, history and dynamics would result in low cost efficiency and cost ineffectiveness, leading further to a huge waste of resources. We emphasize the importance of an inward-looking approach to higher education reforms because it brings the centuries-long Vietnamese cultural values into play. At the same time, policy borrowing must be accompanied with a culturally responsive curriculum and pedagogy, and it recognizes the role of Vietnamese teaching and learning culture. This inward-looking approach is complementary to an outward perspective, allowing for a comprehensive and solid understanding of the globalization forces and the global power structure within which VHE system is located.

New public management and collaboration in canterbury, New Zealand’s freshwater management

Reconciling often-conflicting economic and environmental values, uses, and interests for freshwater is a policy challenge worldwide. Examining the Canterbury region of New Zealand’s South Island between 1999 and 2010, this paper focuses on the outcome of neoliberal reforms intended to achieve the political-economic imperative of environmental protection alongside economic prosperity. Linking the literature of multiple clientelism with New Public Management, we use the concepts of ‘authority’ and ‘autonomy’ to evaluate the challenges faced by local government to implement its decisions to manage freshwater in this neoliberal context. The case study shows that local government struggled to attain authority and autonomy over freshwater under a New Public Management regime, which has resulted in the degradation of freshwater quality and quantity in the region. The paper concludes that the adoption of collaborative governance in response to the failures of New Public Management has the potential to entrench the problems it seeks to resolve.

Appraisal of efficiency and performance of public hospitals in Sanming

Objective To evaluate the performance and efficiency of public hospitals in Sanming city, for suggestions on bettering their medical resources deployment efficiency and operational efficiency. Methods Descriptive analysis was used to longitudinally describe the general performances of such hospitals, leveraging the operating data of 21 public hospitals of the city. Meanwhile, appropriate indexes were selected to construct data envelopment analysis models for analysis of hospital operational efficiency and variations. Results Longitudinal analysis showed the operation process as stable, the efficiency as improved, and the structure as optimized thanks to the reform. Horizontal analysis found three hospitals (14% of all) as efficient in general, and seven (33%) as efficient technically. Those hospitals found as inefficient technically suffer from overinvestment or output deficiency to varying extents. Three hospitals (14%) were found with scale efficiency, while those found without scale efficiency were regarded as diminishing returns on scale. Conclusions Reforms measures must be adhered to consolidate outcomes of the ongoing reform; Regional healthcare resources planning must be consolidated to improve the efficiency of resource allocation; Delicacy management must be made to enhance service delivery capabilities. Key words: Sanming; Public hospitals; Hospital performance indicators; Data envelopment analysis; Efficiency evaluation

Outcome appraisal of the payment reform of public hospitals in Sanming

Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city. Methods Interrupted time series analysis was used to compare changes of the average days of stay, per capita hospitalization expense, outpatient expense per visit, proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform. Results Comparisons before and after the reform found the average days of stay at the original momentum, poor control in curbing the proportion of medical expense and that of drugs during hospitalization, a dropping followed by rising trend in the outpatient expense per visit, and minimal drop of the abovementioned proportions. Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer, structural trend of hospitalization expense makeup, and rationality pending scrutiny. Key words: Sanming; Payment reform; Diagnosis related groups; Outcome evaluation; Interrupted time series analysis

DESEMPLEO EN AMÉRICA LATINA: ¿FLEXIBILIDAD LABORAL O ACUMULACIÓN DE CAPITAL?

Unemployment in Latin America fell substantially in 2000-2013, which, from the standpoint of conventional theory, would be the outcome of reforms designed to make the labor market more flexible. On the other hand, a post-keynesian perspective would maintain that a dropping unemployment rate is due to rising capital accumulation. This paper aims to determine which of these theoretical visions is supported by the empirical evidence. The panel data results suggest that capital accumulation is the variable that explains the majority of the behavior of unemployment. The policy recommendation based on this evidence is to keep investment growing via instruments that stimulate effective demand.

The digital government imperative: a context-aware perspective

ABSTRACTThe paper applies a ‘context-aware’ research approach to explore Italy’s digital government trajectory, using the information and communication technology -enabled programme that introduced the One-Stop Business Shop to exemplify its analytical potential. The interpretive lens captures the political, institutional and external forces at play to illustrate how the outcomes of public-sector reforms are shaped not by legislative strong-arming and ubiquitous technological enablement but by the environmental dynamics. To demonstrate the central role of contextual factors in achieving the desired change, the study conducts a qualitative exploratory analysis that opens doors left mostly closed by the deterministic view of the mainstream literature on digital reform.