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This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in‐depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.

Objective To quantify the effect of Medicaid expansions on office‐based care among the newly eligible. Data Source 2008–2014 Medical Expenditure Panel Survey. Study Design The main sample is adults age 26–64 with incomes ≤138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act. For this population, difference‐in‐differences linear probability models compare utilization between expansion and nonexpansion states and between 2008–2013 and 2014. Extraction Methods Medicaid eligibility is simulated using data on family relationships, state of residence, and income. Principal Findings Relative to comparable adults in nonexpansion states, newly eligible adults in expansion states were 9.1 percentage points more likely to have any office‐based primary care physician visit in 2014, a 21.4% increase from 2013 (p‐value = .004); 6.9 percentage points more likely to have a specialist visit, a 25.2% increase from 2013 (p‐value = .036); and 5.1 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant, a 34.5% increase from 2013 (p‐value = .016). Conclusions State Medicaid expansions in 2014 were associated with greater likelihoods of visits with a variety of office‐based providers. The estimated effects are larger among newly eligible compared with previous estimates on broader populations of low‐income adults.

Objective To explore organizations’ experiences providing family planning during the first year of an expanded primary care program in Texas. Data Sources Between November 2014 and February 2015, in‐depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Study Design Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Data Extraction Interview transcripts were analyzed using a theme‐based approach. Themes were compared across the three types of organizations. Principal Findings Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients’ other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence‐based. Conclusions Many primary care organizations in Texas initially lacked the capacity to provide evidence‐based family planning services that women's health organizations already provided.

The paper examines the value‐generating strategies used in some of New Zealand's primary activities in a rapidly changing trading context in which the countries of East Asia increasingly figure. These strategies range from scaling up volume, with a consequent conspicuous impact on rural landscapes, to innovative value‐enhancing relationships linking producers, processors and consumers in processes which value landscapes for the contribution they make to provenance stories. Our argument is that higher‐value strategies are necessarily more intensely collaborative and involve a pursuit of engaged relationships, especially between onshore producers and manufacturers and consumers at a distance. We term this collaborative form of strategising as ‘the relationships economy’. We illustrate our argument using two case studies, dairying and merino. While there are great differences in scale between them, and dairying focuses significantly on volume‐generating capacity, there are players in dairying who are adopting higher‐value relationships‐based approaches similar to those developed in the merino industry. The common thread connecting the case studies is that of intentional enactment, which echoes earlier periods in New Zealand's trading history when considerable work was undertaken by industry participants to create new markets for primary products.

The 2010 Affordable Care Act extended dependent coverage for adult children up to age 26 in the USA. Since then, considerable studies have assessed its various impacts among young adults. However, little is known about whether there is any change in health care use when young adults age out of dependent coverage. This study examines health care consumption changes among young adults prior to their aging out process. I used data from a large insurance claim database and studied health care utilization of young adults under parents' coverage during a 2‐year period in a difference‐in‐difference framework. I found that young adults had relative reductions in health services use, except ER visits, compared with individuals who stayed under parents' coverage. This pattern was the same for both male and females. Individuals with regular medical needs had greater relative reductions compared with those without regular medical needs. The relative reductions in health care use during the aging out process may have an important impact on young adults' health, especially for those with regular medical needs. More efforts could be made to help them maintain regular medical utilization during the transition.

Objective We examine whether drugs’ excluded versus recommended status on pharmacy benefit manager exclusion lists corresponds to evidence from cost‐effectiveness analyses, lack of evidence, or rebates. Data Sources To find cost‐effectiveness data for drugs on 2016 exclusion lists of CVS Caremark and Express Scripts, we searched the Tufts Cost‐Effectiveness Analysis Registry and the peer‐reviewed literature. Study Design For each excluded and recommended drug, we compared the mean cost‐per‐QALY, and we calculated the difference between the numbers of excluded and recommended drugs for which we could find no cost‐effectiveness evidence. Data Collection As keywords in our searches, we used the brand and generic drug name and “cost‐effectiveness” and “cost‐per‐quality‐adjusted life‐year.” Of 240 retrieved studies, 110 were selected for analysis. Principal Findings The mean cost‐per‐QALY for excluded drugs was higher ($51,611) than the cost‐per‐QALY for recommended drugs ($49,474), but not statistically significant. We could find no cost‐effectiveness evidence in the Registry or peer‐reviewed literature for 23 of the excluded drugs, and no evidence for 5 of the recommended drugs. Conclusions Cost‐effectiveness does not correlate with a drug's excluded or recommended status. Lack of cost‐effectiveness evidence favors a drug's excluded status.

Objective To build and test a model that predicts community discharge probabilities for Medicaid‐eligible nursing home (NH) residents who remain in the nursing home at 90 days after admission and, thus, would be candidates for the Money Follows the Person (MFP) program. Data Source The Minimum Data Set, Medicaid Management Information Systems, and Minnesota Vital Statistics file. Data Cohort of 33, 590 nursing home stays that qualified for Medicaid by the 90th day of their stay from 383 Minnesota nursing homes from July 2011 to June 2013. Study Design Mixed effects logistic regression model to predict community discharge. Principal Findings The scoring system had a high level of accuracy in predicting community discharge for both the fitting and validation cohorts. Subpopulations with severe mental illness or intellectual disability were well represented across the entire score range. Conclusions Findings are being applied in the Minnesota's MFP initiative (Moving Home Minnesota) to target Medicaid‐eligible NH residents for transitioning to the community. This approach could be applied to MFP in other states.

Objective To examine the effects of the penetration of dual‐eligible special needs plans (D‐SNPs) on health care spending. Data Sources/Study Setting Secondary state‐level panel data from Medicare‐Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. Study Design A difference‐in‐difference strategy that adjusts for dual‐eligibles’ demographic and socioeconomic characteristics, state health resources, beneficiaries’ health risk factors, Medicare/Medicaid enrollment, and state‐ and year‐fixed effects. Data Collection/Extraction Methods Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee‐for‐service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Principal Findings Results indicate that D‐SNPs penetration was associated with reduced Medicare spending per dual‐eligible beneficiary. Specifically, a 1 percent increase in D‐SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D‐SNPs penetration and Medicaid or total spending. Conclusion Involving Medicaid services in D‐SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual‐eligible beneficiaries. Starting from 2013, D‐SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D‐SNPs on health care spending. More research is needed to examine the impact of D‐SNPs on dual‐eligible spending.

This paper presents a copula‐based method for identifying and estimating the coefficient of a binary endogenous regressor in a Poisson regression. The method offers advantages over existing approaches. Most importantly, it relies upon standard maximum likelihood approaches, and it does not require numerical integration. Further, as part of its implementation, the method provides a convenient test for the presence of endogeneity. The empirical application investigates the effect of insurance status (a binary measure) on doctor visits (a count measure).

This article examines the “chicken‐egg” two‐way relationships between online consumer reviews and sales, and assesses the dual influencer and indicator roles of online consumer reviews in relation to purchase behavior. Considering the time factor, we adopt the methodology of Granger causality test and track 3,390 products on Amazon.com over a 2‐month period. The results reveal that a causality loop exists between online consumer review volume and sales. Specifically, our findings indicate that the volume of negative consumer reviews drive consumers' purchasing decisions, but the volume of positive consumers reviews only marginally affects purchasing decisions. Also, consumers generate more positive reviews than negative reviews after sales. Our results highlight the importance of negative consumer reviews; negative reviews not only lead to sales, but sales, in turn, lead to higher volume of negative reviews. The findings suggest an alternative strategy for practitioners to address negative online consumer reviews and highlight the awareness effect of online consumer review postings that can later convert into purchase behaviors.

This representative study of German search engine users (N = 1,000) focuses on the ability of users to distinguish between organic results and advertisements on Google results pages. We combine questions about Google's business with task‐based studies in which users were asked to distinguish between ads and organic results in screenshots of results pages. We find that only a small percentage of users can reliably distinguish between ads and organic results, and that user knowledge of Google's business model is very limited. We conclude that ads are insufficiently labelled as such, and that many users may click on ads assuming that they are selecting organic results.

Objective The objective of this literature review was to summarise current research regarding how consumers seek health‐related information from social media. Primarily, we hope to reveal characteristics of existing studies investigating the health topics that consumers have discussed in social media, ascertaining the roles social media have played in consumers’ information‐seeking processes and discussing the potential benefits and concerns of accessing consumer health information in social media. Methods The Web of Science Core Collection database was searched for existing literature on consumer health information seeking in social media. The search returned 214 articles, of which 21 met the eligibility criteria following review of full‐text documents. Conclusion Between 2011 and 2016, twenty‐one studies published explored various topics related to consumer information seeking in social media. These ranged from online discussions on specific diseases (e.g. diabetes) to public health concerns (e.g. pesticide residues). Consumers’ information needs vary depending on the health issues of interest. Benefits of health seeking on social media, in addition to filling a need for health information, include the social and emotional support health consumers gain from peer‐to‐peer interactions. These benefits, however, are tempered by concerns of information quality and authority and lead to decreased consumer engagement.

Despite its high political interest, the impact of removing user charges for health care in low‐income settings remains a debatable issue. We try to clear up this contentious issue by estimating the short‐term effects of a policy change that occurred in 2006 in Zambia, when 54 of 72 districts removed fees. We use a pooled synthetic control method in order to estimate the causal impact of the policy on health care use, the provider chosen, and out‐of‐pocket medical expenses. We find no evidence that user fee removal increased health care utilisation, even among the poorest group. However, we find that the policy is likely to have led to a substitution away from the private sector for those using care and that it virtually eliminated medical expenditures, thereby providing financial protection to service users. We estimate that the policy was equivalent to a transfer of US$3.2 per health visit for the 50% richest but of only US$1.1 for the 50% poorest.

Purpose This study examined the time from breast cancer diagnosis to initiation of treatment among Alaska Native (AN) women. We evaluated the impact of age, cancer stage, and rural/urban residence at diagnosis. Methods We evaluated characteristics of women recorded in the Alaska Native Tumor Registry who received a first diagnosis of breast cancer between 2009 and 2013. Median time from diagnosis to treatment was assessed. Associations of demographic and clinical characteristics with timely initiation of treatment were evaluated using logistic regression and Cox proportional hazards models. Results Two hundred seventy‐eight (278) AN women were diagnosed with invasive breast cancer in years 2009‐2013. Mean age at diagnosis was 56.8 years (SD = 13.0). The median time from diagnosis to initiation of treatment was 23 days (P < .05) with most (94.6%, n = 263) meeting the ≤60‐day guideline target. Time to treatment was not associated with rural/urban residence, age, or stage at cancer diagnosis. Conclusion These findings indicate that most AN women diagnosed with breast cancer within the AN Tribal Health System receive timely treatment after diagnosis.

Background Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. Methods Semi‐structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So‐Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. Results The majority of pregnant women participants (80%) declared non‐adherence to instructions for hanging and maintaining insecticide‐treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio‐efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant women's limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re‐treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. Conclusion Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.

Introduction Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross‐country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. Methods We used OECD data, which include health system governance and financing‐related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). Results We find that governance and financing‐related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross‐country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single‐payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. Discussion These differences can partially be explained because multi‐payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.

Background Few studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2‐arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability. Objective To explore views and motivations towards a proposed 2‐arm stem cell trial and identify factors that may impede and enhance participation. Design This study adopts a naturalistic design to explore the complexity of this field, employing a participatory action‐research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40‐75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach. Discussion and Conclusion Stroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post‐trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2‐arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

This work extends the masspersonal communication model (MPCM; O'Sullivan & Carr, 2017) by introducing anticipated interaction as a way to understand variations within the masspersonal continuum. Drawing from Thompson's mediated communication framework (1995), we argue that anticipated interaction paves the way for establishing a communicative relationship between interactants. In social media, this relationship is rooted in a sender's expectations for audience response and the imagined responsive audience. Using experience sampling, we show that anticipated interaction varies across social media. Further, we outline the relational and situational factors associated with expecting response and the specificity of imagined responsive audience. These variations and their sources characterize masspersonal communication as a socially and technologically situated practice shaped by multiple intersecting influences.

This research focuses on the identification of social roles and an investigation of their influence in online context. Relying on a systemic approach for role conceptualization, we investigate member's activity, shared content and position in the network within a consumer to consumer social media‐based community (SMC) around a product. This investigation led to the identification of ten core roles, based on three key elements: object of interest (product, practice, and community), main contribution type (sharing information and seeking information), individual orientation (factual, emotional). We propose an explanation about how these roles, through their positioning, participate in the community dynamics and how they contribute to the creation and diffusion of cookery as a social practice, shaping the periphery around this practice.

Political information sharing in social media offers citizens opportunities to engage with news and express their political views, but how do different patterns of online political information exposure, including both incidental and selective exposure, affect sharing? Using two‐wave panel survey data collected in the United States, we examine the relationship between incidental and selective exposure and their consequent links to political information sharing, across different levels of strength of political party affiliation. Our results demonstrate that incidental exposure to counter‐attitudinal information drives stronger partisans to more actively seek out like‐minded political content, which subsequently encourages political information sharing on social media. The results highlight the need to consider both types of political information exposure when modeling citizens' political behavior online.

Purpose To examine the relationship between area population density and community pharmacy‐based Alzheimer's Disease (AD)‐related services: pharmacists’ medication knowledge and counseling, immunizations, and in‐stock cognitive enhancers in 3 predominantly rural regions of the United States. Methods A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists’ medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi2) by pharmacy location to evaluate the relationship between rurality and AD‐related pharmacy services. Chi‐squared and logistic regression analyses were performed using Stata 10.1. Findings Pharmacies in more rural areas (50.1‐100.0, 25.1‐50.0, and ≤25.0 persons/mi2) were about 50% less likely to offer immunizations (95% CI: 0.32‐0.91; 0.32‐0.76; 0.28‐0.80, respectively) compared to the least rural areas (>100.0 persons/mi2). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi2) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31‐0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41‐0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39‐0.82) in stock. Conclusions We found disparities in AD‐related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists’ knowledge and improve pharmacy services to reduce disparities.

A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.

A trend of the shortening duration of pregnancies carried to term has been observed in several countries and represents a growing public health concern. This paper describes the trend in the Czech Republic and shows its relation to the changing demographic structure of mothers and the organisation of maternity care. Data from the birth register are used and supplemented with information about the capacity of maternity care (number of beds at maternity clinics, number of obstetricians and midwives). Logistic regression is used to estimate the odds of 37 to 39 vs 40+ completed weeks of gestation. The results show that the average gestational age at term decreased by 2.1 days between 2000 and 2013. The odds of 37 to 39 weeks of gestational duration increased, mainly due to the reduction in the number of beds at maternity clinics (adjusted odds ratio of 1.51). The effects of the number of health care staff members were weaker. The number of midwives positively influenced gestational duration, while the number of obstetricians had a negative effect. Maternal demographic structure cannot explain the trend. A likely explanation is the increased use of planned early term caesarean sections.

Background Social network processes impact on the genesis and management of mental health problems. There is currently less understanding of the way people negotiate networked relationships in times of crisis compared to how they manage at other times. Objective This paper explores the patterns and nature of personal network involvement at times of crises and how these may differ from day‐to‐day networks of recovery and maintenance. Method Semi‐structured interviews with 25 participants with a diagnosis of long‐term mental health (MH) problems drawn from recovery settings in the south of England. Interviews centred on personal network mapping of members and resources providing support. The mapping interviews explored the work of network members and changes in times of crisis. Interviews were recorded, transcribed and analysed using a framework analysis. Results Three key themes were identified: the fluidity of network relationality between crisis and recovery; isolation as a means of crises management; leaning towards peer support. Personal network input retreated at times of crisis often as result of “ejection” from the network by participants who used self‐isolation as a personal management strategy in an attempt to deal with crises. Peer support is considered useful during a crisis, whilst the role of services was viewed with some ambiguity. Conclusions Social networks membership, and type and depth of involvement, is subject to change between times of crisis and everyday support. This has implications for managing mental health in terms of engaging with network support differently in times of crises versus recovery and everyday living.

In April 2005, Lucio Gutiérrez was removed from office in the context of a fast‐growing economy. With no economic hardship to fuel social outrage, the failure of Gutiérrez illustrates how political and institutional factors can be the most important forces determining presidential survival. In this article, we qualitatively analyse the path toward confrontation between Gutiérrez and the congressional opposition which led to his political demise. We find that Ecuador's weak democratic tradition working through more proximate causes – radicalism, normative preference for democratic institutions and a negative institutional equilibrium – coupled with other institutional and political variables accelerated Lucio Gutiérrez's fall from power.

Objectives To investigate the association between hospital safety culture and 30‐day risk‐adjusted mortality for Medicare patients with acute myocardial infarction (AMI) in a large, diverse hospital cohort. Subjects The final analytic cohort consisted of 19,357 Medicare AMI discharges (MedPAR data) linked to 257 AHRQ Hospital Survey on Patient Safety Culture surveys from 171 hospitals between 2008 and 2013. Study Design Observational, cross‐sectional study using hierarchical logistic models to estimate the association between hospital safety scores and 30‐day risk‐adjusted patient mortality. Odds ratios of 30‐day, all‐cause mortality, adjusting for patient covariates, hospital characteristics (size and teaching status), and several different types of safety culture scores (composite, average, and overall) were determined. Principal Findings No significant association was found between any measure of hospital safety culture and adjusted AMI mortality. Conclusions In a large cross‐sectional study from a diverse hospital cohort, AHRQ safety culture scores were not associated with AMI mortality. Our study adds to a growing body of investigations that have failed to conclusively demonstrate a safety culture–outcome association in health care, at least with widely used national survey instruments.

Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression‐induced medical costs may be primarily driven by the cost‐shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy‐induced obstacles for the access to mental health care resources.

The explosive growth of mobile apps makes it difficult for users to find their needed apps in a crowded market. An effective mechanism that provides high quality app recommendations becomes necessary. However, existing recommendation techniques tend to recommend similar items but fail to consider users’ functional requirements, making them not effective in the app domain. In this article, we propose a recommendation architecture that can generate app recommendations at the functionality level. We address the redundant recommendation problem in the app domain by highlighting users’ functional requirements, an element that has received scant attention from existing recommendation research. Another main feature of our work is extracting app functionalities from textural user reviews for recommendation. We also propose an effective approach for functionality extraction. Experiments conducted on a real‐world dataset show that our proposed AppRank method outperforms other commonly used recommendation methods. In particular, it doubles the recall value of the second best method under an extremely sparse setting, increases the overall ranking accuracy of the second best method by 14.27%, and retains a high diversity of 0.99.

For diversity and novelty evaluation in information retrieval, we expect that the novel documents are always ranked higher than the redundant ones and the relevant ones higher than the irrelevant ones. We also expect that the level of novelty and relevancy should be acknowledged. Accordingly, we expect that the evaluation algorithm would reward rankings that respect these expectations. Nevertheless, there are few research articles in the literature that study how to meet such expectations, even fewer in the field of biomedical information retrieval. In this article, we propose a new metric for novelty and relevancy evaluation in biomedical information retrieval based on an aspect‐level performance measure introduced by TREC Genomics Track with formal results to show that those expectations above can be respected under ideal conditions. The empirical evaluation indicates that the proposed metric, geNov, is greatly sensitive to the desired characteristics above, and the three parameters are highly tuneable for different evaluation preferences. By experimentally comparing with state‐of‐the‐art metrics for novelty and diversity, the proposed metric shows its advantages in recognizing the ranking quality in terms of novelty, redundancy, relevancy, and irrelevancy and in its discriminative power. Experiments reveal the proposed metric is faster to compute than state‐of‐the‐art metrics.

Aims The aim of the study is to verify the knowledge and practices of health professionals working in prenatal care (PNC) related with syphilis during pregnancy and to identify the main barriers to the implementation of protocols for the control of this disease. Methods A cross‐sectional study in Teresina, Brazil, from January to May 2015, was conducted with 366 physicians and nurses working in PNC, corresponding to 70% of eligible professionals. We evaluated 20 knowledge and practice criteria related to the diagnosis and treatment of syphilis during pregnancy with a 95% compliance standard. We performed descriptive analysis of the data and used χ2 statistical test to verify differences according to professional category. Results Only 2 criteria, “knowledge about mother to child transmission according to gestational age” and “counselling on infection,” reached 95% compliance. Knowledge of the epidemiological profile of congenital syphilis and the goal of elimination of congenital syphilis and knowledge about serological tests had scores below 50%, while practices related with posttest counselling, cure control, and treatment of partners reached 60%. We identified organisational barriers related to the late initiation of PNC, to the delayed return of syphilis test results, to the application of benzathine penicillin in primary care units and to the treatment of partners. Conclusions Strategies for early initiation of PNC, implementation of rapid tests for syphilis, ensuring treatment of pregnant women with penicillin, adequate partner treatment, and continued education of health professionals on clinical management and counselling in sexually transmitted diseases are necessary to eliminate congenital syphilis.

Background Patient engagement in research (PEIR) is promoted to improve the relevance and quality of health research, but has little conceptualization derived from empirical data. Objective To address this issue, we sought to develop an empirically based conceptual framework for meaningful PEIR founded on a patient perspective. Methods We conducted a qualitative secondary analysis of in‐depth interviews with 18 patient research partners from a research centre‐affiliated patient advisory board. Data analysis involved three phases: identifying the themes, developing a framework and confirming the framework. We coded and organized the data, and abstracted, illustrated, described and explored the emergent themes using thematic analysis. Directed content analysis was conducted to derive concepts from 18 publications related to PEIR to supplement, confirm or refute, and extend the emergent conceptual framework. The framework was reviewed by four patient research partners on our research team. Results Participants’ experiences of working with researchers were generally positive. Eight themes emerged: procedural requirements, convenience, contributions, support, team interaction, research environment, feel valued and benefits. These themes were interconnected and formed a conceptual framework to explain the phenomenon of meaningful PEIR from a patient perspective. This framework, the PEIR Framework, was endorsed by the patient research partners on our team. Conclusions The PEIR Framework provides guidance on aspects of PEIR to address for meaningful PEIR. It could be particularly useful when patient‐researcher partnerships are led by researchers with little experience of engaging patients in research.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1013-1034, September 2017.
Purpose The aim of this paper is to frame the stakeholder-driven system mapping approach in the context of climate change, building on stakeholder knowledge of system boundaries, key elements and interactions within a system and to introduce a decision support tool for managing and visualising this knowledge into insightful system maps with policy implications. Design/methodology/approach This methodological framework is based on the concepts of market maps. The process of eliciting and visualising expert knowledge is facilitated by means of a reference implementation in MATLAB, which allows for designing technological innovation systems models in either a structured or a visual format. Findings System mapping can contribute to evaluating systems for climate change by capturing knowledge of expert groups with regard to the dynamic interrelations between climate policy strategies and other system components, which may promote or hinder the desired transition to low carbon societies. Research limitations/implications This study explores how system mapping addresses gaps in analytical tools and complements the systems of innovation framework. Knowledge elicitation, however, must be facilitated and build upon a structured framework such as technological innovation systems. Practical implications This approach can provide policymakers with significant insight into the strengths and weaknesses of current policy frameworks based on tacit knowledge embedded in stakeholders. Social implications The developed methodological framework aims to include societal groups in the climate policy-making process by acknowledging stakeholders’ role in developing transition pathways. The system map codifies stakeholder input in a structured and transparent manner. Originality/value This is the first study that clearly defines the system mapping approach in the frame of climate policy and introduces the first dedicated software option for researchers and decision makers to use for implementing this methodology.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1035-1052, September 2017.
Purpose The purpose of this paper is to explore and characterize knowledge integration approaches for integrating external knowledge of suppliers into new product development projects. Design/methodology/approach This paper is based on a multiple, in-depth case study of six product development projects at three knowledge-intensive manufacturing firms. Findings Firms make purposeful choices to devise knowledge integration approaches when working in collaborative buyer – supplier projects. The knowledge characteristics of the supplier input guide the choice of either coupling knowledge sharing and combining across firms or decoupling knowledge sharing (across firms) and knowledge combining (within firms). Research limitations/implications This study relies on a limited number of case studies and considers only one supplier relationship in each project. Further studies could examine the challenge of knowledge integration in buyer – supplier relationships in different contexts, i.e. in relation to innovation complexity and uncertainty. Practical implications Managers need to make choices when designing knowledge integration approaches in collaborative product development projects. The use of coupled and decoupled approaches can help balance requirements in terms of joint problem-solving across firms, the efficiency of knowledge integration and the risks of knowledge leakage. Originality/value The conceptualization of knowledge integration as knowledge sharing and knowledge combining extends existing perspectives on knowledge integration as either a transfer of knowledge or as revealing the presence of pertinent knowledge without entirely transmitting it. The findings point to the complexity of knowledge integration as a process influenced by knowledge characteristics, perspectives on knowledge, openness of firm boundaries and elements of knowledge sharing and combining.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1053-1076, September 2017.
Purpose Although mobile devices are ubiquitous among employees, their awareness and readiness to use mobile technologies for competence development is still not widespread and therefore requires further exploration. The purpose of this study is to propose a conceptual model based on the unified theory of acceptance and use of technology (UTAUT) to explain the determinants that affect employees’ intention to use mobile devices and software for knowledge transfer during the process of knowledge management. Design/methodology/approach A conceptual model based on the UTAUT with new variables concerning relative usability (RU) and user autonomy (UA) and new connections between the determinants was developed as a result of a subject matter literature review. A structural equation modelling approach was used to validate the model on the basis of data collected via a survey collected from 371 employees from 21 sectors, both public and private. Findings The UTAUT model extended by new variables like RU and UA explains employee acceptance of mobile technologies for knowledge transfer reasonably well. New proposed variables highlighted that the usability of technology compared to other solutions and user autonomy in the selection and the use of applications have the strongest impact on the employees’ intention to use mobile devices and software for knowledge transfer. Research limitations/implications This model explains the 55 per cent behavioral intention of employees to use mobile technologies for knowledge transfer. Even though it is quite high in terms of acceptance theories, some new variables should be explored. Furthermore, study does not verify whether m-learning acceptance for knowledge transfer is sector-specific. Practical implications Mobile technologies used for knowledge transfer by employees should allow for high UA through their ability to select solutions that they find convenient, use of preferred platforms, personalize applications and utilize devices and software in various environments. They should not be simplified and should have the same functionality and efficiency of use as alternative solutions like web and desktop applications, even if additional effort to learn them would be required. Mobile technologies that take into account UA and RU support the process of employees capturing, distributing and effectively using knowledge. Originality/value The elaborated model provides a valuable solution with practical implications for increasing mobile technologies acceptance for knowledge transfer. The study results contribute both to knowledge management and technology acceptance research fields by introducing two new determinants for the acceptance of technologies in knowledge transfer, such as UA and RU with several additional connections between existing UTAUT variables.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1077-1097, September 2017.
Purpose This study aims to investigate how psychological motivations influence the knowledge-sharing intention of employees and how these effects are moderated by traditional Chinese culture. Design/methodology/approach A questionnaire survey was conducted in China to test the research model. The target samples comprised MBA students who have enough practical experience, as well as considerable academic experience. Findings The results suggest that anticipated reciprocal relationships, anticipated extrinsic rewards and sense of self-worth exert different effects on knowledge-sharing intention. In addition, traditional Chinese culture plays different roles in the relationships among these three psychological motivations and knowledge-sharing intention. Specifically, guanxi orientation positively moderates the effect of anticipated reciprocal relationships and negatively moderates the effect of sense of self-worth. Face gaining negatively moderates the effect of anticipated reciprocal relationships and positively moderates the effect of sense of self-worth. Face saving negatively moderates the effect of anticipated reciprocal relationships and sense of self-worth. Originality/value A few studies in extant knowledge management (KM) literature provided insights into how traditional Chinese culture could directly affect knowledge sharing. The authors depart from these studies by integrating these characteristic indigenous concepts (i.e. face and guanxi orientation) into this study. The authors offer an indigenous cultural view of how these indigenous concepts truly influence an individual’s psychological states and inclination in KM literature. Through this approach, the results confirm that these cultural factors do play an important role during the formation of knowledge-sharing intention and reveals several important research findings.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1098-1119, September 2017.
Purpose The aim of this study is to empirically test the link between employee ambidexterity and two supportive organizational cultures, namely, a perceived culture of empowerment and a knowledge-sharing culture. Furthermore, the paper addresses the mechanisms through which these supportive organizational cultures work to enable employees to engage in ambidextrous behaviour. Specifically, the role of intrinsic motivation is investigated. Design/methodology/approach Data were obtained from 136 managers employed in the five main Belgian service sectors. Findings The findings indicate that a perceived culture of empowerment is positively related to intrinsic motivation, which in turn facilitates employee ambidexterity. Also, a moderating effect of extrinsic motivation on employee ambidextrous behaviour is found. At the same time, a perceived knowledge-sharing culture is having no effect on ambidexterity or intrinsic motivation. Research limitations/implications Insights into the roles of individuals in achieving ambidexterity help to advance the theoretical understanding of how a supportive organizational context may enhance employee ambidexterity. Originality/value Despite the growing body of research on antecedents of ambidexterity, there is still lack of thorough understanding of how a supportive organizational context may enhance employee ambidexterity and the roles of individuals in achieving ambidexterity. This is one of the first studies that investigate these factors in relation to individual level ambidexterity (as opposed to organization level ambidexterity).

Journal of Knowledge Management, Volume 21, Issue 5, Page 1120-1141, September 2017.
Purpose This paper was aimed at investigating the impact of knowledge management (KM) procedures on enriching human resources in Water and Waste Water Company in East Azerbaijan, Iran. Design/methodology/approach The samples used in this study included the employees of Water and Waste Water Company in Tabriz, East Azerbaijan, Iran. A questionnaire was used for collecting data from the employees of the abovementioned company. Its reliability and validity were first examined and checked. Then, Smart partial least squares 2.0 was used for analyzing the structural model. Findings The results acknowledged the validity of the introduced model for enriching human resources. The findings indicated that five variables, namely, kind of knowledge, top managers, information technology, culture and organization of knowledge, have significant impact on enriching human resources. Research limitations/implications It is undoubtable that research studies might have specific limitations which should be pointed out and addressed in future studies. The followings are the major limitations of the study: because the present study was carried out in Water and Wastewater Company in Tabriz, East Azerbaijan, hence, generalizing the findings of this study to other professional contexts and organizations should be made with caution. In fact, the present study need to be replicated in other context to find whether the same or different results are obtained. In other words, different cultural, contextual and professional conditions might result differently from the ones reported here. Inasmuch as the present study was a cross-sectional study and the data were collected via questionnaire, a longitudinal study with a longer observation and investigation might shed more light on the efficacy of KMS in organizations. The present study focused on a specific dependent variable (human resource empowerment) which was explained by different dimensions of an independent variable, i.e. KM. However, the impact and efficacy of KMS can be investigated on other organizational variables and parameters. In this study, due to certain logistic and real-life limitations such as the limited time of the staff members of the target organization, we had to use only one data-collection instrument. Nevertheless, future studies can use data triangulation so as to better capture professional contexts of the study. Furthermore, another limitation of the study is related to the individual variables of the employees which remained untouched. That is, whether employees’ personal, emotional and cognitive variables can modify the impact of KM on human resource empowerment was not investigated in the present study. Practical implications Organizational managers are recommended to provide the background for employees to share their experiences. Organizations should invest on designing and developing patterns and strategic perspectives in human resource empowerment as a key factor toward becoming knowledge-based organizations. Originality/value This paper is one of the few applied studies which acknowledged the relationship between knowledge management initiatives and empowering human resources. It addresses the gap between knowledge management and human resource empowerment.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1142-1162, September 2017.
Purpose Although most of the literature supports the existence of a substitutive relationship between exploration and exploitation, some authors suggest that this relationship is complementary (ambidexterity), and others argue that there is no relationship. This paper aims to introduce organizational innovation into the analysis and discusses which of these three relationships prevails. Design/methodology/approach Analyses were performed using data from Spanish Technological Innovation Panel for the period 2008-2013. It should be emphasized that the use of panel data is essential in the analysis of the interaction of exploration and exploitation, as exploration only makes sense in the long run. Econometric strategy uses a two-stage selection model, estimated using the Wooldridge’s (1995) consistent estimator for panel data with sample selection. To perform the test, the hypothesis uses the approach of complementarity. Findings The results show that the relationships exploration-organizational innovation and exploitation-organizational innovation are complementary, provided that the analysis is performed on companies that simultaneously carry out exploration and exploitation activities, respectively. This indicates that the achievement of ambidexterity is strongly conditioned by the simultaneous realization of organizational innovations. Practical implications Managers and policymakers should be aware that the simultaneous implementation of exploration and exploitation yields better results when the corresponding organizational innovations are also implemented. Originality/value This paper extends the empirical investigation of the relationship between exploration and exploitation, seen in conjunction with organizational innovation, and using the complementarity approach as a research tool.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1163-1182, September 2017.
Purpose In downturns, social enterprises (SEs) arise as a resilience business model. The authors focus on knowledge absorptive capacity (KAC) as a key dynamic capability to create shared value (SHV). The purpose of this study is to analyze whether it exists a cause-effect relationship between KAC and SHV creation in SEs. Design/methodology/approach The research model relates KAC and SHV creation. SHV creation involves two components: economic value (EV) and social value (SV). The authors argue that KAC has a positive effect on EV and SV creation, considering SV as a mediator variable. The model is tested by means of PLS-SEM. Findings The results reveal the existence of a positive and significant relationship between KAC and SHV creation, as well as the mediating role of SV creation. Research limitations/implications The sample comprises 127 SEs from the Euro-Mediterranean region (euro-region comprising areas from France and Spain), it would be interesting to include other euro-regions in future research. Practical implications The authors confirm KAC as an important antecedent of SHV creation and also that SEs create EV by means of SV, pointing to the existence of direct and indirect effects. This way, confirming the existence of a mediating effect. Originality/value It points the importance of KAC in SEs, something that has not been addressed before by the literature. It also goes beyond performance by considering SHV creation as a measure of SEs’ outcomes, as well as the definition of the variable SHV including not only social related issues but also environmental (green) issues.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1183-1201, September 2017.
Purpose The purpose of this paper is to discuss how the management of collective intellectual capital (CIC) occurs in a seaport through the actions of the network coordinator. Design/methodology/approach A case study was conducted in a seaport, focusing on the actions taken by a network coordinator – a port authority – to develop the seaport’s CIC. The seaport is conceptualised as a meta-organisation, composed by interdependent actors which may possess different interests and different levels of power. Findings Evidence suggests that the mobilisation of different dimensions of power, in both coercive and non-coercive ways, is needed to promote a higher level of collaboration. Indeed, by mobilising non-coercive dimensions of power, the network coordinator can foster a sense of community within the meta-organisation, grounded in a trust-based collective culture that can potentiate collaboration, and thus allow the attainment of a more “sustainable” type of CIC. Research limitations/implications Despite the validity of the interpretations provided by the case study, generalisation of this study should only be conducted in a theoretically framed manner. Practical implications The findings can provide network coordinators with a better understanding of the consequences of using different dimensions of power to leverage its intangible assets and enhance the meta-organisation’s performance. Originality/value The paper focus on the IC management of a specific type of meso-level unit, which possess some particular characteristics of its own: a seaport. Also, the paper aims to fill a gap in literature regarding the management of different dimensions of power and its effects over IC creation.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1202-1217, September 2017.
Purpose The purpose of this paper is to empirically examine the moderating effect of competitive advantage on the resource value and rareness combination and firm performance. Design/methodology/approach The authors adopted a quantitative research method to achieve the aims of this study. The data collected came from a sample of footwear firms and the hypotheses assessed by multivariate analysis. Findings The findings provide insights into previously inconsistent findings regarding the exploitation of resources and capabilities and contribute to resolving these issues by considering the conditions under which the resource value and rareness combination contributes to firm performance levels and the effects of competitive advantage on this relationship. Interestingly, the authors find that it cannot be inferred that the rarer the resources and capabilities combination, the greater the probability of attaining competitive advantage. Research limitations/implications As limitations, the authors would highlight the fact that the results are specific to one particular industrial sector, and thus not susceptible to the drawing of generalisations as well as the fact that the study does not make recourse to triangulating its methodology (for example, through interviews), which would generate more precise, detailed and objective information. The findings have important managerial implications and the authors close by presenting future research directions. Originality/value This study offers an explanation for previous mixed findings on the relationship between the resource value and rareness combination and firm performance and makes a contribution regarding how such combinations are of great relevance to the organisation and business strategy to turn in better performance levels.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1218-1239, September 2017.
Purpose The purpose of this paper is to identify the factors influencing the growth of healthcare virtual communities of practice (VCoPs) through a seven-year longitudinal study conducted using metrics from social-network and semantic analysis. By studying online communication along the three dimensions of social interactions (connectivity, interactivity and language use), the authors aim to provide VCoP managers with valuable insights to improve the success of their communities. Design/methodology/approach Communications over a period of seven years (April 2008 to April 2015) and between 14,000 members of 16 different healthcare VCoPs coexisting on the same web platform were analysed. Multilevel regression models were used to reveal the main determinants of community growth over time. Independent variables were derived from social network and semantic analysis measures. Findings Results show that structural and content-based variables predict the growth of the community. Progressively, more people will join a community if its structure is more centralised, leaders are more dynamic (they rotate more) and the language used in the posts is less complex. Research limitations/implications The available data set included one Web platform and a limited number of control variables. To consolidate the findings of the present study, the experiment should be replicated on other healthcare VCoPs. Originality/value The study provides useful recommendations for setting up and nurturing the growth of professional communities, considering, at the same time, the interaction patterns among the community members, the dynamic evolution of these interactions and the use of language. New analytical tools are presented, together with the use of innovative interaction metrics, that can significantly influence community growth, such as rotating leadership.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1240-1253, September 2017.
Purpose The purpose of this paper is to investigate the impacts of absorptive capacity, learning motivation and acquired knowledge on knowledge transfer from business schools to business organizations, as it has been realized that in-service training business students can serve as a channel as well as a source in this type of knowledge transfer. The study also examines the mixed moderating role of job autonomy in the relationship between acquired knowledge and knowledge transfer. Design/methodology/approach A sample of 344 in-service training business students in Vietnam was surveyed to collect data. Confirmatory factor analysis was used to validate the measures, and structural equation modeling was used to test the hypotheses. Findings The findings reveal that absorptive capacity positively affects acquired knowledge but it does not have an effect on knowledge transfer. Learning motivation, however, has positive effects on both acquired knowledge and knowledge transfer. The findings also indicate that acquired knowledge is a determinant of knowledge transfer. Finally, job autonomy plays the role of a mixed moderator in the relationship between acquired knowledge and knowledge transfer. Practical implications This study signals the participating parties –business schools, business organizations and in-service training business students –that absorptive capacity, learning motivation, acquired knowledge and job autonomy are critical to the transfer of knowledge from business schools to business organizations. Originality/value This study contributes to the literature on university-to-industry knowledge transfer by providing empirical evidence for key determinants of knowledge transfer from business schools to business organizations through a new channel of knowledge transfer – in-service training business students.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1254-1271, September 2017.
Purpose The purpose of this paper is to construct and investigate relationships between knowledge-sharing factors, attitude and the intention to share of UK academics, as research on knowledge sharing in higher education is extremely sparse. Design/methodology/approach A research model and hypotheses were constructed from individual and organisational factors that were identified to affect knowledge sharing. Questionnaire data were obtained from 367 academics concerning their attitude and intention towards knowledge sharing. This was then used in a two-stage structural equation modelling approach where the measurement model was used for confirmatory factor analysis. The structural model was used to measure and test the hypothesised relationships. Findings Findings indicate that, in general, individual beliefs amongst academics were more influential on their knowledge-sharing attitudes than organisational culture. Furthermore, leadership was the most influential factor within the overall organisational culture whereas autonomy demonstrated the weakest relationship. Belief in the possibility of rewards through associations was found to be a highly significant individual factor. The relationship between attitude and intention was relatively weak although still statistically significant. Originality/value The research demonstrates that management should ensure that departmental leaders promote knowledge sharing and that valued rewards are linked to sharing within the department.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1272-1291, September 2017.
Purpose The purpose of this paper is to analyze the issue of knowledge transfer in the context of international asymmetric alliances. The objective is mainly to identify the barriers that can impede the knowledge transfer between asymmetric partners and to analyze the solutions adopted to overcome these barriers. Design/methodology/approach The authors use a qualitative study involving six cases of asymmetric alliances between Tunisian small-and-medium enterprises (SMEs) and European multinational corporations (MNCs). Findings The results of this research highlight a set of obstacles related to the context of asymmetric alliance itself and the nature of knowledge transferred by partners. The study emphasizes the importance of translation using artefacts by both partners and proximity with its geographical, organizational and technological dimensions to overcome these obstacles. Research limitations/implications The investigation of knowledge transfer in asymmetric alliances was based on the role played by only three proximity dimensions (geographical, organizational and technological), while other factors, such as institutional, social and cultural issues, were not considered. Indeed, future research may take these variables into account in studying solutions to overcome knowledge-transfer barriers in asymmetric alliances. Practical implications The paper calls the attention of asymmetric alliance managers to the importance of translation to perform work processes, facilitate knowledge transfer and overcome linguistic barriers. Managers should use virtual artefacts to reduce the constraints resulting from their geographical remoteness and to strengthen cooperation. Further, reinforcing geographical, organizational and technological proximity between partners involved in an international alliance is essential to facilitate knowledge transfer, essentially of tacit knowledge, and to accelerate innovation. Originality/value This study emphasizes the importance of the simultaneous role of artefacts, translation and proximity in overcoming obstacles related to the asymmetric alliance itself and the nature of knowledge transferred by partners. The results shed light on the issue of knowledge generation in asymmetric alliances.

Little is known about the response of physicians to changes in compensation: Do increases in compensation increase or decrease labour supply? In this paper, we estimate wage elasticities for physicians. We apply both a structural discrete choice approach and a reduced‐form approach to examine how these different approaches affect wage elasticities at the intensive margin. Using uniquely rich data collected from a large sample of general practitioners (GPs) and specialists in Australia, we estimate 3 alternative utility specifications (quadratic, translog, and box‐cox utility functions) in the structural approach, as well as a reduced‐form specification, separately for men and women. Australian data is particularly suited for this analysis due to a lack of regulation of physicians' fees leading to variation in earnings. All models predict small negative wage elasticities for male and female GPs and specialists passing several sensitivity checks. For this high‐income and long‐working‐hours population, the translog and box‐cox utility functions outperform the quadratic utility function. Simulating the effects of 5% and 10% wage increases at the intensive margin slightly reduces the full‐time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs.

Evidence about cost‐effectiveness is increasingly being used to inform decisions about the funding of new technologies that are usually implemented as guidelines from centralized decision‐making bodies. However, there is also an increasing recognition for the role of patients in determining their preferred treatment option. This paper presents a method to estimate the value of implementing a choice‐based decision process using the cost‐effectiveness analysis toolbox. This value is estimated for 3 alternative scenarios. First, it compares centralized decisions, based on population average cost‐effectiveness, against a decision process based on patient choice. Second, it compares centralized decision based on patients' subgroups versus an individual choice‐based decision process. Third, it compares a centralized process based on average cost‐effectiveness against a choice‐based process where patients choose according to a different measure of outcome to that used by the centralized decision maker. The methods are applied to a case study for the management of acute coronary syndrome. It is concluded that implementing a choice‐based process of treatment allocation may be an option in collectively funded health systems. However, its value will depend on the specific health problem and the social values considered relevant to the health system.

Many high utilizers of the emergency department (ED) have public insurance, especially through Medicaid. We evaluated how participation in Bridges to Care (B2C)—an ED-initiated, multidisciplinary, community-based program—affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible high ED utilizers. During the six months after the B2C intervention was completed, participants had significantly fewer ED visits (a reduction of 27.9 percent) and significantly more primary care visits (an increase of 114.0 percent), compared to patients in the control group. In a subanalysis of patients with mental health comorbidities, we found that recipients of B2C services had significantly fewer ED visits (a reduction of 29.7 percent) and hospitalizations (30.0 percent), and significantly more primary care visits (an increase of 123.2 percent), again compared to patients in the control group. The B2C program reduced acute care use and increased the number of primary care visits among high ED utilizers, including those with mental health comorbidities.

Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes. This finding was driven by the location choices of independent freestanding emergency centers and not by those of hospital-affiliated satellite emergency centers.

Many frequent emergency department (ED) users do not sustain high use over time, which makes it difficult to create targeted interventions to address their health needs. We performed a retrospective analysis of nonelderly adult frequent ED users in California to measure the persistence of frequent ED use in the period 2005–15, describe characteristics of persistent and nonpersistent frequent users, and identify predictors of persistent frequent use. Of the frequent ED users in 2005, 30.5 percent remained frequent users in 2006. A small but nontrivial population (16.5 percent, 5.7 percent, and 1.9 percent) exhibited persistent frequent use for three, six, and eleven consecutive years, respectively. The strongest predictor of persistent frequent ED use was the intensity of ED use in the baseline study year. The rate at which frequent users stopped using the ED frequently decreased over time, leaving a core group of chronic persistent users. These persistent frequent users differ from nonpersistent frequent users, who engaged in temporary intense use of the ED. Identifying and differentiating persistent frequent users is important, as they may be candidates for distinct interventions.