Recent Policy Research Articles

The Size of Transactions, Types of Products, and the Choice Between Electronic Payments and Cash Usage

Fueled by recent policy advancements and technological progress, India’s digital payment system is on the verge of becoming a noteworthy success story. Concurrently, data also highlights the continued reliance on cash. While broad national-level data can provide insights into overall citizen preferences, we utilize a survey-based data-set to gain insight into how factors such as ’transaction size,’ ’nature of the product,’ ’consumer perception,’ ’trust’ in digital payments, and the costs associated with digital transactions influence consumer payment behavior. While demographic factors like age and income play a role in these choices, we discover compelling evidence that an individual’s choice of digital payment methods is strongly shaped by their perception of these options, transaction size, trust, associated costs, and the product category. Notably, we observe that as transaction size increases, the use of digital payment methods tends to decrease.

Proactive frailty in primary care: A primary care system fit for frailty.

Older adults with frailty are at increased risk of premature death, and numerous negative sequalae including falls, disability, and dementia alongside increased healthcare costs. Most healthcare interactions for older people with frailty take place in primary care, and there is increasing interface working between primary and secondary care to manage this patient group including virtual wards, frailty management programmes and Hospital @ Home. This commentary aims to place proactive frailty into recent policy perspective, alongside highlighting some of the current challenges around the implementation of proactive frailty programmes.

Changes in early HIV/AIDS mortality rates in people initiating antiretroviral treatment between 2013 and 2023: A 10-year multicenter survival study in Senegal

BackgroundHIV/AIDS-related early mortality has long been a significant challenge. Subsequent to recent policy changes and treatment advancements, we aimed to assess changes in early mortality rates in 2017–19 and 2020-23 compared to 2013–16. MethodsThis is a 10-year multicenter survival study in people living with human immunodeficiency virus having initiated ART between 2013 and 2023. We used frailty-based competing risk models to estimate adjusted early (6-month and one-year) mortality hazard ratios (HRs) in people living with HIV (PwHIV) having initiated ART in 2013–16 (comparator), 2017–19, and 2020–23. ResultsWe enrolled 4006 persons of whom 2281 (56.9 %) were female; median age was 40 years (IQR: 31–50); 635 (15.9 %) were at WHO clinical stage IV and 934 (23.3 %) had a CD4 count <200 cells/mm3. Median follow-up was 80.4 months (IQR: 48.6–106.7). All in all, 463 participants died (4.37 deaths per 100 person-years), including 296 at one year of follow-up (7.4 % [95 % CI: 6.6–8.2]). ART initiation in 2016–19 and 2020–23 was associated with 27 % (adjusted HR [aHR]: 0.73; 95 % CI: 0.55–0.98) and 63 % (aHR: 0.37; 95 % CI: 0.25–0.56) reductions in one-year mortality rates, respectively, compared to the 2013–16 period. ConclusionEarly mortality risk has significantly decreased over time in Senegal. However, the proportion of PwHIV with AIDS-defining conditions remains concerning. Continued efforts to ensure early diagnosis and prompt linkage to care are needed for more impact.

Out of focus but still relevant? Influenza-related resource utilization and vaccination coverage gaps in adults below 60 years of age with underlying conditions: an analysis of 2016–2024 real-world data in Germany

Background In 2003, the WHO aimed for a 75% or higher influenza vaccination rate among at-risk populations. However, this target was achieved in a few groups during selected seasons in some European countries, and never in Germany. Adults with underlying conditions (UCs) are a critical negleted group for influenza vaccination. This study aimed to identify data gaps in influenza burden and vaccination coverage among adults under 60 with UCs in Germany and bridge these gaps using real-world data. Material and methods We conducted systematic research and analyses using German administrative and claims databases from June 2016 to April 2024. We report on epidemiology, direct care costs, indirect costs from work incapacity, vaccination coverage rates, and describe data gaps. Results Influenza data for high-risk populations are limited. Comprehensive data on influenza epidemiology and vaccination coverage rates (VCR) is available, though with a delay in data availability. Before and after the pandemic, individuals aged 50-59 had the highest rates of influenza-related hospitalization and ICU admission compared to younger age groups. Across all age groups and seasons, individuals with UC experienced higher rates of medically attended influenza cases, hospitalizations, and healthcare costs, with those aged 35–59 being particularly vulnerable. Vaccine coverage was higher in adults aged 35–59 compared to those aged 18–24, and in females compared to males. Limitations Discrepancies of vaccination status, limited data availability, and variations among the extent of UCs. Conclusion In Germany, recent policy measures have mainly targeted those aged 60 and above. While this elderly population experiences the highest disease-related impact, influenza can also lead to substantial healthcare resource utilization (HCRU) and costs in younger populations with chronic UCs; Facilitating vaccination access for this group, such as through pharmacies, is essential. Definition of quantifiable vaccination targets and measures to increase vaccination rates based on these targets are required.

The role of stigma on the pregnancy experiences of women with disabilities in Kathmandu: a qualitative study

Stigma impacts women with disabilities during their pregnancy experiences, specifically through its components; societal beliefs, stereotypes, and attitudes. Through an interpretivist approach, this study addressed how stigma’s components impact the pregnancy experiences of women with disabilities in Kathmandu, especially considering recent policy changes on Nepali disability healthcare. Twelve semi-structured interviews [SSIs] with women with physical or visual disabilities were conducted, with a supplementary focus group discussion [FGD] between mothers without disabilities. Through a Thematic Analysis, themes from the SSIs and FGD were identified. Societal beliefs on disability’s genetic inheritance, stereotypes that the women lack independence and the ability to give birth, and healthcare providers’ negative attitudes impacted the women with disabilities’ pregnancy experiences by socially alienating them. However, positive family attitudes and the women’s own self-empowered beliefs may indicate improvements from policy changes and a subsequent reduction of stigma.

Hepatocellular carcinoma risk scores for non-viral liver disease: A systematic review and meta-analysis

BackgroundHepatocellular carcinoma (HCC) risk prediction models may provide a more personalised approach to surveillance for HCC among patients with cirrhosis. This systematic review aims to summarise the performance of HCC prediction models in patients with non-viral chronic liver disease. MethodThe study was prospectively registered with PROSPERO (ID: CRD42022370078) and reported in accordance with PRISMA guidelines. MEDLINE and EMBASE databases were searched using a validated search filter for prediction model studies. Two reviewers independently assessed studies for inclusion and risk of bias. Model performance (discrimination and calibration) were identified to assess the risk of HCC at specified time points. A random effects meta-analysis was done on a subset of studies that reported performance of the same model. Results7,854 studies were identified. After review, 14 studies with a total of 94,014 participants were included. 45% of patients had viral hepatitis, 27% alcohol related liver disease (ArLD) and 19% metabolic associated steatotic liver disease (MASLD). Follow-up ranged from 15.1 - 138 months. Only one model was developed using a competing risk approach. Age (7 models) and sex (6 models) were the most frequently included predictors. Model discrimination (AUROC or c-statistic) ranged from 0.61 - 0.947. Only the ‘aMAP’ score (age, male sex, albumin,bilirubin, and platelets) had sufficient external validation for quantitative analysis, with a pooled c-statistic of 0.81 (95% CI 0.80-0.83). Calibration was reported in only 9 of 14 studies. All studies were rated high risk of bias. ConclusionStudies describing risk prediction of HCC in non-viral chronic liver disease are poorly reported, have a high risk of bias and do not account for competing risk events. Patients with ArLD and MASLD are underrepresented in development and validation cohorts. These factors remain barriers to the clinical utility and uptake of HCC risk models in persons with the commonest liver diseases. Impact and implicationsThe recent EASL policy statement emphasises the potential of risk-based surveillance to reduce both HCC-related deaths and surveillance costs. This study addresses the gap in understanding the performance of current HCC risk models in patients with non-viral liver diseases, reflecting the epidemiological landscape of liver disease in Western countries.In our review of these models, we identified several key concerns regarding reporting standards and risk of bias and confirmed that patients with alcohol-related liver disease (ArLD) and metabolic-associated steatotic liver disease (MASLD) are underrepresented in model development and validation cohorts. Additionally, most models fail to account for the significant risk of competing events, leading to potential overestimation of true HCC risk.This study highlights these critical issues that may hinder the implementation of risk models in clinical practice and offers key recommendations for future model development studies.

Increasing corn cultivation exacerbated crop residue burning in Northeast China in 21st century

China's endeavors to mitigate recurrent crop residue burning (CRB) and improve air quality have yielded positive results owing to recent pollution prevention policies. Nonetheless, persistent challenges remain, particularly in the Northeast China (NEC), where low temperature complicates crop residue management. Here, we examined the effects of cropping pattern adjustment on variations of CRB patterns in NEC during 2001–2021, utilizing the Moderate-resolution Imaging Spectroradiometer (MODIS) burned area dataset, the Visible Infrared Imaging Radiometer Suite (VIIRS) active fire dataset, and the high-accuracy crop planting area maps. Our results revealed an overall upward trend of 805.96 km2/yr in NEC CRB from 2001 to 2021. The corn CRB area accounted for more than 50% of the total CRB area in each CRB-intensive year (2013–2021), and the increasing corn CRB generally aligns with the growing corn cultivation fields. A seasonal shift in CRB was found around 2017, with intensive CRB activities transitioning from both autumn and spring to primarily spring, particularly in the Songnen Plain and Sanjiang Plain. The changing trend of PM2.5 concentration aligned spatially with the shift. Moreover, the CRBs in spring of 2020 and 2021 were more severe than the major burning seasons in previous years, likely due to the disruptions during COVID-19 lockdowns. In certain years, the explanatory power of spring CRB on PM2.5 concentration was comparable to that of other natural factors, such as precipitation. This study underscores the critical need for sustained and region-specific strategies to tackle the challenges posed by CRBs.

De-risking Global Supply Chains: Looking Beyond Material Flows

executive summary: This essay examines supply chain de-risking driven by two forces: (1) the renewed concerns of the U.S. and its allies about supply chain resilience and (2) China's long-standing strategy to redefine the global order. main argument A defining feature of global supply chains is they are powered by material, information, financial, and human flows. By examining these multiple flows in the evolution of global supply chains, our analysis goes beyond the singular focus on material flows that is common in recent economic and foreign policy discourse. Another defining feature of global supply chains is the strategic interaction between different actors. Following this line of thinking, we argue that de-risking is not a unilateral option for the West and its developed economy partners but rather an interactive and fluid development taking place around the globe. This can be seen in the U.S.'s growing emphasis on improving supply chain resilience through reshoring, nearshoring, and friendshoring, as well as in China's diversification into markets such as Russia and the global South, with broader implications for major economies. Looking beyond material flows to information, financial, and human flows is important to monitor these indicators of the ongoing transitions in global supply chains. policy implications • Policymakers must recognize that de-risking is not a unilateral process but involves strategic interactions among multiple global actors. • It is imperative to consider the implications of information, financial, and human flows, in addition to material flows, to develop effective de-risking strategies. • Ensuring political stability and policy continuity is essential to effective de-risking, particularly in the context of changing administrations and economic policies. • In implementing de-risking, efforts should ensure coordination across the four types of flows while addressing the challenges of increased complexity and potential lack of visibility into operations. • The role of emerging economies in de-risking is critical, as they stand to benefit significantly but also play a key role in achieving diversified and resilient supply chains.

Economic optimization of sustainable soil management: a Dutch case study

Soil quality is pivotal for crop productivity and the environmental quality of agricultural ecosystems. Achieving sufficient yearly income and long-term farm continuity are key goals for farmers, making sustainable soil management an economic challenge. Existing bio-economic models often inadequately address soil quality. In this study, we apply the novel FARManalytics model, which integrates chemical, physical, and biological indicators of soil quality indicator, quantitative rules on how these indicators respond to farmers’ production management over time, and an economic calculation framework that accurately calculates the contribution of production management decisions towards farm income. This is the first study applying this model on existing arable farms. FARManalytics optimizes crop rotation design, cover crops, manure and fertilizer application and crop residue management. Nine Dutch arable farms were analyzed with a high variation in farm size, soil type, and cultivated crops. First, we assessed farm differences in soil quality and farm economics. Second, we optimized production management to maximize farm income while meeting soil quality targets using farm-specific scenarios. Third, we explored the impact of recent policy measures to preserve water quality and to increase the contribution of local protein production. The results show that the case farms already perform well regarding soil quality, with 75% of the soil quality indicators above critical levels. The main soil quality bottlenecks are subsoil compaction and soil organic matter input. We show that even in front-runner farms, bio-economic modeling with FARManalytics substantially improves economic performance while increasing soil quality. We found that farm income could be increased by up to €704 ha−1 year−1 while meeting soil quality targets. Additionally, we show that to anticipate on stricter water quality regulation and market shift for protein crops, FARManalytics is able to provide alternative production management strategies that ensure the highest farm income while preserving soil quality for a set of heterogenous farms.

반도체 장비 교육을 위한 PLC기반 PID제어 가상 시스템 개발 및 구현에 관한 연구

IIn line with the government’s recent semiconductor talent training policy, vocational high schools and universities are receiving substantial funding for facility and equipment construction. Building semiconductor cleanroom facilities and processing equipment is very costly, while the limited lab space makes providing semiconductor education difficult. Therefore, an alternative education method which solves these issues is needed. To make PID control learning of semiconductor equipment more accessible in terms of cost, space, and difficulty, this study implemented a virtual system in a virtual simulation space, and confirmed the educational effectiveness through a comparative analysis of the real situation and virtual simulation.

Teacher shortages: a social justice perspective on an Australian teacher education policy

ABSTRACT Australia and much of the Global North are facing a teacher shortage crisis. In this paper, we examine the most recent (2023) Australian education policy response to the crisis that ties this crisis to Initial Teacher Education (ITE): Strong Beginnings: Report of the Teacher Education Expert Panel (TEEP). Social justice imperatives related to economic, cultural, and political justice are used in this paper not only to explore the contents of this policy but also to think about the problem beyond borders. The policy focus, we argue, has shifted towards greater government regulation and intervention into ITE programs than ever before and that such moves work to undermine teacher professionalism. Whilst issues of student and teacher diversity are raised within some aspects of the policy, systemic social justice issues for education related to poverty, ethnicity, gender, teacher and student voice, and workplace justice are not adequately addressed. There is also little recognition within this policy that some schools are much harder to staff than others. In presenting this critical analysis, we offer ways forward for social justice imperatives to be realised within Australian ITE policy and the broader global teacher shortage crisis.

The Movement: Reproductive Health and Rights in 2024

Women’s sexual and reproductive health (SRH) encompasses several topics, including but not limited to sexual expression, pregnancy, childbirth, contraception, and diseases of the reproductive system. The use of legal authority and power, as well as political influence, have long been factors used to regulate women’s SRH. In the United States (U.S.), examples of state and national legislation have been undertaken to impact SRH and medical treatment and decision-making related to SRH. Several national and international organizations engage in sexual and reproductive health rights (SRHR) activities. The activities of these national and international organizations in SRH often include policy formulation, data collection, monitoring, reporting, and other functions. While definitions of sexual and reproductive health rights vary, there are commonalities and core issues that can be identified. These include issues related to the LGBTQ population, immigration, and reproductive health rights among minoritized groups, which are leading topics wrapped around SRHR and of debate in recent history. This article aims to discuss sexual and reproductive health in promoting population health and societal well-being, recent policy decisions impacting SRH, and the role nurses play in shaping research, practice, and policies. For this paper, sexual and reproductive health rights (SRHR) are defined as an extension of human rights relating to an individual’s autonomy, sexuality, sexual expression, reproduction, and access to information and resources on SRH. SRHR also includes freedom from violence, discrimination, and mistreatment. While a comprehensive review of these areas is beyond this article's scope, historical and recent examples are illustrated.

The rising cost of liver transplantation in the United States.

Liver transplantation (LT) is the only curative treatment for end-stage liver disease and significantly improves patient outcomes. However, LT is resource-intensive and costly, with expenditures rising dramatically in recent years. Factors contributing to this increase in cost include expanded transplant criteria, utilization of marginal organs, and broader organ distribution, resulting in significant logistical expenses. Advanced technologies like organ perfusion devices, while promising better outcomes, further inflate costs due to their high price and market monopolization. Moreover, living donor liver transplant (LDLT) and utilization of donation after cardiac death (DCD) organs introduce higher initial expenditures yet potential long-term savings. Despite rising costs, reimbursement has remained largely stagnant, putting financial strain on transplant programs, and threatening their sustainability. This review examines the multifaceted drivers of rising costs in LT, focusing on recent policy changes, the role of organ procurement organizations (OPOs) and the impact of new technologies. We also propose comprehensive solutions at national, OPO, and local levels, including optimizing resource allocation, leveraging regional collaborations, and advocating for revised reimbursement models to curb escalating costs. Addressing these challenges is critical to ensuring the continued viability of LT programs and maintaining patient access to this life-saving intervention.

Tax Policy Expectations and Investment

ABSTRACTThis paper examines how firms’ tax policy expectations (TPE) evolve around and relate to their investment responses to changes in tax policy. Using a text‐based approach to measuring TPE, we find that two recent tax policy–changing events—namely, the 2016 U.S. presidential election and the enactment of the Tax Cuts and Jobs Act (TCJA)—spawned considerable between‐ and within‐firm variation in TPE, with aggregate time‐series patterns in TPE occasionally challenging prevailing assumptions in previous research. Further, we observe that event‐induced TPE relate to investment both before and in response to the TCJA's passage in 2017, with offsetting associations between its first and second moments, and that these TPE moderate the TCJA's intended investment‐stimulating effect. Furthermore, we document a difference between domestic and multinational firms in their TPE‐investment response, with the former (latter) more likely to adjust the level (shift the country location) of their investment. Overall, our findings support the idea that TPE can impact investment behavior in the face of a tax policy change and suggest that our methodology can be used by future research to incorporate TPE into analyses of tax policy effects.

Udělování československého státního občanství „krajanům vracejícím se do vlasti“ podle ústavního zákona č. 74/1946 Sb.

The aim of this article is to highlight certain aspects of the application of Constitutional Act No. 74/1946 on the granting of citizenship to compatriots returning to their homeland, and to present some of the research brought to light from archival collections of the post-war Ministry of Labour and Social Welfare and of the Czechoslovak Foreign Institute. The article points out that remigration under article 1 of the above-quoted Constitutional Act was not merely a privileged naturalization as was remigration under article 2 – compatriots were legally entitled to citizenship. Attention is paid especially to the contemporary extensive interpretation, which we could capture through the maxim in favorem remigrationis. Hence, for example, the legal terms “liberation of Czechoslovak territory from enemy occupation” and “Czechoslovak resettlement action” used to be interpreted remarkably broadly in the administrative practice of the post-war republic. In addition, the study reflects on the concepts of nation that have been crucial in determining the state’s policy on compatriots and remigration, and it looks for parallels with the recent compatriot policy of the Government of the Czech Republic.

Authoritarian environmentalism 2.0: An incremental transition of environmental governance in China

The recent policy practice in China has shown nuanced differences from previous accounts of authoritarian environmentalism. The emerging discourse of green transformation shows dual tendencies for (re-)centralizing and decentralizing environmental institutions. Our understanding of authoritarian environmentalism in China requires an update. We review the recent policy practice and the scholarly literature to advance a modified framework of authoritarian environmentalism. Using the Central Environmental Inspection Teams and emissions trading schemes as examples, we highlight the coordinated practice of strengthening state control while strategically using mass mobilization and market mechanisms. We argue that non-state actors and bottom-up tools are being absorbed into the politics of (re-)centralization. The centralizing state accommodates a limited range of participatory and decentralizing elements in an attempt to modernize the governance system. Our modified framework recognizes the mutually reinforcing authoritarian and liberal elements, and sheds light on the broader trends of environmental governance in China.

Beyond administrative burden: Activation and administrative harm

AbstractWithin recent public policy and administration scholarship, there has been a growing focus on the concept of “administrative burden” to describe the learning, compliance and psychological costs incurred by citizens when trying to access services and exercise social and political rights. Specifically, in the context of activation and welfare‐to‐work programmes, scholars have highlighted the effects of administrative burdens on claimants' autonomy, dignity and well‐being. We bring critical social policy scholarship on administrative harm into conversation with Adam and Balfour's concept of “administrative evil” to highlight the underlying dynamics of masking, moral inversion and dehumanisation that facilitate street‐level workers to adopt dispositions of enforcement of administrative burdens. To illustrate the applicability of Adam and Balfour's work to understanding how experiences of administrative burden can be intensified by the practices and dispositions of street‐level workers, we draw on examples of from an ethnographic study of the delivery of welfare‐to‐work in Australia.

Club Convergence in Productivity among European Regions: Recent Evidence and Policy Implications

We use data on 155 NUTS regions, with the objective of i) generating TFP series over 1996-2018, and ii) testing for club-convergence. We also employ a logistic regression to identify the significant club-membership conditioning factors. We contribute to the literature on two main grounds. Firstly, we are the first to extract TFP series while applying a methodology that allows for heterogeneous production functions and accounts for cross-section dependence and nonstationarity. Secondly, we are the first to apply a TFP-club convergence analysis in the context of European regions over a large period of time that witnessed several shocks affecting the European integration. Our analysis reveals that: (i) most of the regions of the top TFP convergence clubs are located in the "old" EU-member states, with few regions situated in countries that joined the EU after 2004; (ii) several regions in the South are trailing with the risk of falling in a "productivity trap"; (iii) regions situated in new EU-member countries registered remarkable TFP growth rates; (iv) larger regional research and development resources, and higher employment in high-technology sectors are associated with a greater probability of being member of top-ranked TFP convergence clubs. Our findings suggest that the needs of the lagging regions should be prioritized in the agenda of the EU. In this respect, we suggest several recommendations.

Comparing methods for estimating causal treatment effects of administrative health data: A plasmode simulation study.

Estimating the causal effects of health policy interventions is crucial for policymaking but is challenging when using real-world administrative health care data due to a lack of methodological guidance. To help fill this gap, we conducted a plasmode simulation using such data from a recent policy initiative launched in a deprived urban area in Germany. Our aim was to evaluate and compare the following methods for estimating causal effects: propensity score matching, inverse probability of treatment weighting, and entropy balancing, all combined with difference-in-differences analysis, augmented inverse probability weighting, and targeted maximum likelihood estimation. Additionally, we estimated nuisance parameters using regression models and an ensemble learner called superlearner. We focused on treatment effects related to the number of physician visits, total health care cost, and hospitalization. While each approach has its strengths and weaknesses, our results demonstrate that the superlearner generally worked well for handling nuisance terms in large covariate sets when combined with doubly robust estimation methods to estimate the causal contrast of interest. In contrast, regression-based nuisance parameter estimation worked best in small covariate sets when combined with singly robust methods.

Reclaiming Initial Teacher Education in universities: Moving beyond a technicist model

Recent policy developments in England, particularly since 2021, have resulted in increased regulation and marketisation of Initial Teacher Training (ITT)/Initial Teacher Education (ITE). Although the origins of these developments go back much further than 2021, the current context in which ITE operates in England is, arguably, both challenging and unstable. Since 2010, the Government has increased the involvement of schools in ITE, creating an unstable climate for those who work in ITE in universities, through the School Direct initiative. School-Centred Initial teacher Training (SCITT) routes also precede this. The involvement of schools in ITE in England has extended to schools taking a leading role in the recruitment, selection and training of teachers and these developments have also, in some quarters, resulted in an anti-intellectual, anti-theoretical and anti-university discourse, which has been damaging to universities. This paper argues that current policy developments in ITE are reductionist and technicist and makes a case for the role of universities in ITE.