Elizabeth Maitland | University of Liverpool (original) (raw)

Papers by Elizabeth Maitland

Journal of International Business and Economy, Dec 1, 2004

Regions and countries compete for MNEs. Surprisingly, we know little about policy effectiveness a... more Regions and countries compete for MNEs. Surprisingly, we know little about policy effectiveness and the relative importance of policy factors and non-policy factors in managerial location decisions. Drawing on internalisation-resource, trade and location theory, this paper develops a model of policy and non-policy location variables, testing the model against 137 Japanese managers??decisions to invest in Australia and the ASEAN5 (Thailand, Singapore, Malaysia, Indonesia and the Philippines). Japanese managers treated Australia and ASEAN5 as different regions, but treated the ASEAN5 as the same region. A range of non-policy variables were ranked higher than policy variables as factors attracting Japanese MNEs to Australia or the ASEAN5, while policy variables were most important in shifting investment between ASEAN5 countries. In a study of incentive effectiveness, managers ranked the same incentive variables for Australia lower than for the ASEAN5. We also discovered that the transfer of parent competencies to subsidiaries in Australia was ranked significantly lower in importance than competencies transferred to ASEAN5 countries. Implications for policy-makers and economic development are drawn.

Evidence-based Complementary and Alternative Medicine, Oct 29, 2021

Background. Traditional Chinese medicine (TCM) has long been widely adopted by the Chinese people... more Background. Traditional Chinese medicine (TCM) has long been widely adopted by the Chinese people and has been covered by China's basic medical insurance schemes to treat ischemic stroke. Previous research has mainly highlighted the therapy effect of TCM on ischemic stroke patients. Some studies have demonstrated that employing TCM can reduce the medical burden on other diseases. But no research has explored whether using TCM could reduce inpatient medical cost for ischemic stroke in mainland China. e purpose of this study is to investigate the impact of the use of TCM on the total inpatient cost of ischemic stroke and to explore whether TCM has played the role of being complementary to, or an alternative for, conventional medicine to treat ischemic stroke. Methods. We conducted a national cross-sectional analysis based on a 5% random sample from claims data of China Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) schemes in 2015. Mann-Whitney test was used to compare unadjusted total inpatient cost, conventional medication cost, and nonpharmacy cost estimates. Ordinary least square regression analysis was performed to compare demographics-adjusted total inpatient cost and to examine the association between TCM cost and conventional medication cost. Results. A total of 47321 urban inpatients diagnosed with ischemic stroke were identified in our study, with 92.6% (43843) of the patients using TCM in their inpatient treatment. Total inpatient cost for TCM users was significantly higher than TCM nonusers (USD 1217 versus USD 1036, P < 0.001). Conventional medication cost was significantly lower for TCM users (USD 335 versus USD 436, P < 0.001). e average cost of TCM per patient among TCM users was USD 289. Among TCM users, conventional medication costs were found to be positively associated with TCM cost after adjusting for confounding factors (Coef. � 0.144, P < 0.001). Conclusion. Although the use of TCM reduced the cost of conventional medicine compared with TCM nonusers, TCM imposed an extra financial component on the total inpatient cost on TCM users. Our study suggests that TCM mainly played a complementary role to conventional medicine in ischemic stroke treatment in mainland China.

Digital health, 2023

Objective Online medical consultation (OMC) is increasingly used in China, but there have been fe... more Objective Online medical consultation (OMC) is increasingly used in China, but there have been few in-depth studies of consultation arrangements and fee structures of online doctors in China. This research assessed the consultation arrangements and fee structure of OMC in China by undertaking a case study of obesity doctors from four representative OMC platforms. Methods Detailed information, including fees, waiting time and doctor information, was collected from four obesity OMC platforms and analyzed using descriptive statistical analysis. Results The obesity OMC platforms in China shared similarities in the use of big data and artificial intelligence (AI) but differed across service access, specific consultation arrangements and fees. Big data search and AI response technologies were used by most platforms to match users with doctors and reduce doctors’ pressure. The descriptive statistical analysis showed that the higher the rank of the online doctor, the higher the online fee and the longer the wait time. Through a comparison with offline hospitals, we found online doctors’ fees exceeded offline hospital doctors’ fees by up to 90%. Conclusions OMC platforms can gain competitive advantages over offline medical institutions through the following measures: make fuller use of big data and AI technologies to provide users with longer duration, lower cost and more efficient consultation services; provide better user experience than offline medical institutions; use big data and fee advantages to screen doctors to match users’ consultation needs instead of screening by the rank of doctors only; and cooperate with commercial insurance providers to provide innovative health care packages.

Research Square (Research Square), Apr 20, 2023

Background Continuing Medical Education (CME) is an important part of the training process for he... more Background Continuing Medical Education (CME) is an important part of the training process for health workers worldwide. In China, training in Traditional Chinese Medicine (TCM) not only improves the expertise of medical workers, but also supports the Chinese Government's policy of promoting TCM as an equal treatment to western medicine. CME, including learning Traditional Chinese Medicine Technologies (TCMTs), perform poorly and research into the motivation of health workers to engage in CME is urgently required. Using a discrete choice experiment, this study assessed the CME learning preferences of primary health workers, using TCMT as a case study of CME programs.

Tropical Medicine & International Health, Feb 19, 2023

ObjectivesKnowledge of the predictors of nursing quality and safety remains a gap in global prima... more ObjectivesKnowledge of the predictors of nursing quality and safety remains a gap in global primary care research. This study examines organisational‐level and nurse‐level predictors of nurse‐reported quality of care from a management perspective.MethodsWe recruited 175 primary care nurses in 38 community health centres (CHCs) varying by size and ownership in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the Systems Engineering Initiative for Patient Safety model, the organisation‐level predictors comprised organisational structure, organisational culture, psychological safety and organisational support, while the nurse‐level predictors included organisational commitment and organisational citizenship behaviour. Nurse‐reported quality of care was measured by two questions: “How do you rate the quality of care that you provide?” and “Do you often receive complaints from patients or their family members at work?” Multilevel linear regression models were used to examine the predictors of nurse‐reported quality of care.ResultsAmong the four organisation‐level predictors, organisational structure, psychological safety and organisational support were positive predictors of nurse‐reported quality of care. Nurses working in CHCs with highly hierarchical organisational structures (Coef. = 0.196, p = 0.000), a high level of organisational support (Coef. = 0.158, p = 0.017) and a high level of psychological safety (Coef. = 0.159, p = 0.035) were more likely to report high quality of care or less likely to receive medical complaints. In terms of nurse‐level predictors, nurses willing to increase their knowledge through continuous education were more likely to report good quality of care (Coef. = 0.107, p = 0.049) and less likely to receive medical complaints from patients (Coef. = 0.165, p = 0.041).ConclusionsPotential management levers to improve quality of nursing care include formalised organisational structures, strong organisational support and a psychologically safe environment as well as the provision of training to facilitate continuous education. Implementing these recommendations is likely to enhance the nursing quality in primary care.

© 1998 Dr. Elizabeth MaitlandProperty rights regimes crucially affect the structure of economic a... more © 1998 Dr. Elizabeth MaitlandProperty rights regimes crucially affect the structure of economic activity, by defining the 'rules of the game'. Each country's 'rules of the game', or its institutional structure, is the outcome of a path dependent historical process. Given the institutional environment, MNEs expand internationally by writing a complex web of contracts with JV partners, wholly-owned subsidiaries, foreign licensees and the state. The first contribution of the thesis is the specification of a model of firm-state contracting based in New Institutional Economics. This expands and modifies traditional approaches to MNEs that take as given the property right regimes. Based on the concept of sovereignty, the thesis shows that the state is the key player in the definition, allocation and enforcement of the property rights regime. The state also contracts explicitly or implicitly with MNEs. These contradictory roles are explored theoretically. It is argued that the state is not a unitary actor but a series of political organisations comprising individuals subject to cognitive limitations and degrees of choice as to their behaviour. Manipulations of the investment environment occur not only through formal regulations and policy statements but also through corruption of office for private gain. State behaviour is motivated by unique sets of rules and players in each location. The thesis then studies how Australian firms met this contractual challenge in the transitional economies of India, Indonesia and Vietnam. Each country experienced fundamental shifts in their institutional environment with the re-opening of their economies to foreign investment. Each country was marked by a property rights regime that was unstable, changing and ill-defined. The hallmark of the study is the reliance on firm-specific data to analyse how Australian MNEs contracted in these newly opened economies. The data reveal that Australian MNEs competitive advantages lay predominantly in the expertise of their human capital and the co-specialisation of this tacit knowledge with codified organisational processes and tangible product technology. Given the institutional regimes in Indonesia and Vietnam, Australian firms wrote intermediate contractual arrangements governed by the notions of relational contract or formed JV agreements with firms possessing knowledge of the complexities of local commercial and political processes. In India, Australian firms under-estimated the institutional complexities. Despite negligible host country experience, Australian firms eschewed joint ventures, acquisitions and non equity alliances with local companies able to decipher the Indian institutional environment. Correspondingly, the firms experienced difficulties with the environment confronting them. In contrast to the successful performance of Australian firms in Indonesia and Vietnam, the firms in India expressed dissatisfaction with the performance of their activities. The types of multinational experience possessed by Australian differed across the three country samples. From their Asian networks of subsidiaries, Australian firms in Indonesia captured learning and information advantages that aided their entry and performance in Indonesia. In Vietnam, firms similarly possessed concentrated subsidiary networks in Asia, which were influential in the assessments of risk factors and the design of contractual arrangements. In India, prior multinational experience afforded few advantages in interpreting the complexity of the institutional environment. This study emphasises the importance of understanding the institutional regimes within which international business is conducted. It argues that these institutional regimes emerged as a path dependent historical process. Facing complex and opaque institutional environments, Australian firms designed contracts to capture returns in enlarging and promising economies. History and sovereignty were the defining variables in the expansion of Australian MNEs in India, Indonesia and Vietnam

Frontiers in Public Health, Sep 6, 2022

Conclusions: All attributes had a significant impact on participants' preference for Huimin Insur... more Conclusions: All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.

Routledge eBooks, Sep 25, 2003

Value in Health, Jun 1, 2023

Edward Elgar Publishing eBooks, May 25, 2001

Journal of Medical Internet Research, Jul 6, 2021

Background: All aging societies face the challenge of allocating limited resources for the highes... more Background: All aging societies face the challenge of allocating limited resources for the highest value of use. The sharing economy provides one method to address the imbalance between the demand and supply of health services to the older adult population. With a substantial aging population, China's practices in the sharing aging industry may set examples for other "getting old before getting rich" countries. Objective: There is a gap in both the data and research on China's aging industry sharing economy. This paper addresses these data and research lacunae by constructing a framework for the application of a sharing model in China's aging industry, by assessing the current state of the aging industry sharing economy, by setting out the challenges to the sharing aging health care and service economy, and by making recommendations for the development of the aging industry sharing economy. Methods: This paper constructs a sharing economy framework in the aging industry covering four aspects (people, facilities, capital, and information) to test the current state and future prospects of China's aging industry sharing economy. Results: In people sharing, we analyzed the sharing of emotional companionship, doctors, nurses, nursing attendants, and domestic helpers. We discussed facility sharing models from the point of land and housing, medical devices, and other items such as pensioner meals and shared medicine bins. We acknowledge that crowdfunding platforms have developed fast in China, but many older adult users faced problems in their operation. Information sharing is a developing field, which can optimize users' experiences and should help older adults filter out misinformation, but China currently does not have adequate sharing information platforms for older adults. Conclusions: We identified four major challenges in China's aging industry sharing economy: poor adaptability to technology for older adults, mediocre quality of shared services, one-size-fits-all and the concept of the useless elderly, and shortage of qualified practitioners. We make recommendations for specific measures by governments, communities, and enterprises to improve the sharing economy in the aging industry.

BMC Health Services Research, Sep 22, 2022

Background: China's social medical insurance system faces challenges in financing, product covera... more Background: China's social medical insurance system faces challenges in financing, product coverage, patient health responsibility sharing and data security, which commercial health insurance companies can help address. Confronting accelerated population aging, the rapid increase of patients with chronic diseases and the maternal and child healthcare needs created by the three-child policy, the Chinese government has encouraged the development of commercial health insurance. But China's commercial health insurance companies face financial sustainability problems, limited product ranges and high operating costs. At the same time, the informatization level of China's healthcare industry, and the value of healthcare big data, is increasing. We analyze and describe the potential application of healthcare big data in the life cycle of China's commercial health insurance system and provide specific action plans for Chinese commercial health insurance companies; identify the challenges to commercial health insurers; and make recommendations for the application of big health data by commercial health insurers. Our recommendations inform healthcare policy makers on the development of commercial health insurance and the improvement of the healthcare financing system. We not only verify the value of healthcare big data, but also identify specific ways that healthcare big data plays in the development of commercial health insurance. Based on the research results, we recommend new policies for government and new uses of healthcare big data for commercial health insurance institutions. The benign development of commercial health insurance will improve the level of health services in China. Methods: By interviewing health insurance managers (including actuaries, product managers, business executives, information technology medical workers, and commercial health insurance personnel) and by accessing research papers, industry reports, news reports and public information disclosure documents about commercial health insurance, we describe the impact of healthcare big data on the life cycle of commercial health insurance products and processes. Results: We identify the issues and challenges of commercial health insurers in the use of healthcare big data, and advance specific strategies to expand the use of healthcare big data. In the life cycle of commercial health insurance products, healthcare big data can improve premium income, control medical costs and increase operational efficiency. First, healthcare big data can increase premiums, products and services by attenuating moral hazard and adverse selection problems, where high quality clients over-pay and high-risk clients underpay for health insurance. Second, healthcare big data can reduce medical expenses compensation pay-outs by promoting the establishment

Frontiers in Nutrition, Dec 10, 2021

Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese ol... more Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of "at-risk" patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031-1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491-2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498-2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores < 3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6-23.6), Liu et al.

BMC complementary medicine and therapies, Jan 9, 2023

Background Traditional Chinese Medicine (TCM) has long been a widely recognized medical approach ... more Background Traditional Chinese Medicine (TCM) has long been a widely recognized medical approach and has been covered by China's basic medical insurance schemes to treat lung cancer. But there was a lack of nationwide research to illustrate the impact of the use of TCM on lung cancer patients' economic burden in mainland China. Therefore, we conduct a nationwide study to reveal whether the use of TCM could increase or decrease the medical expenditure of lung cancer inpatients in mainland China. Methods This is a 7-year cross-sectional study from 2010 to 2016. The data is a random sample of 5% from lung cancer claims data records of Chinese Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI). Mann-Whitney test was used to compare inpatient cost data with positive skewness. Ordinary least squares regression analysis was performed to compare the total TCM users' hospitalization cost with TCM nonusers' , to examine whether TCM use is the key factor inducing relatively high medical expenditure. Result A total of 47,393 lung cancer inpatients were included in this study, with 38,697 (81.7%) of them at least using one kind of TCM approach. The per inpatient medical cost of TCM users was RMB18,798 (USD2,830), which was 65.2% significantly higher than that of TCM nonusers (P < 0.001). The medication cost, conventional medication cost, and nonpharmacy cost of TCM users were all higher than TCM nonusers, illustrating the higher medical cost of TCM users was not induced by TCM only. With confounding factors fixed, there was a positive correlation between TCM cost and conventional medication cost, nonpharmacy cost (Coef. = 0.283 and 0.211, all P < 0.001), indicting synchronous increase of TCM costs and conventional medication cost for TCM users. Conclusion The use of TCM could not offset the utilization of conventional medicine, demonstrating TCM mainly played a complementary role but not an alternative role in the inpatient treatment of lung cancer. A joint Clinical Guideline that could balance the use of TCM and Conventional medicine should be developed for the purpose of reducing economic burden for lung cancer inpatients.

The Singapore Economic Review, Apr 1, 2001

Transitional Vietnam exhibits key characteristics that economists argue are conducive to corrupt ... more Transitional Vietnam exhibits key characteristics that economists argue are conducive to corrupt practices and, by knock-on effects, to slower economic growth. The process of liberalisation has shifted the status quo in Vietnam, permitting entry by a wider pool of bribe-takers and bribe-givers. Standard economic definitions of corruption focus on the abuse of public office for private gain, whereby corrupt practices are modelled as distortions in the distribution of government provided goods and services. This paper modifies existing models, specifying corruption as a distortion to the definition, allocation and/or enforcement of property rights. The model incorporates an explicit role for the incentive set that shapes behaviour by government officials, private individuals and firms. Abuse of public office is modelled as a distortion to property rights, including the re-assignment of private rights as the result of lobbying or rent-seeking activities. Local norms may sanction corruption against certain groups. The MNE is one case in point; others include different ethnic, religious and socioeconomic groups. As outsiders in an environment historically hostile to "outsiders", MNEs represent "easy" corruption targets.

Research Square (Research Square), Mar 6, 2023

In China, rural residents experience poorer health conditions and a higher disease burden compare... more In China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we focus on an income shock, in the form of China's New Rural Pension Scheme (NRPS), on outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents. METHODS Providing a monthly pension of around RMB88(USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data. RESULTS Without signi cant changes in health status and medication needs, 60-plus-year-old NRPS recipients signi cantly increased the probability of discretionary drug purchases by 33 percentage points. NRPS had no signi cant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests con rmed that FRDD was a robust estimation method and our result is robust. CONCLUSION NRPS was an exogenous income shock that signi cantly increased the probability of discretionary over-thecounter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-thecounter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.

BMC Health Services Research, Jan 26, 2023

Background As the main cause of cancer death, lung cancer imposes seriously health and economic b... more Background As the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010-2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper aims to investigate the characteristics and cost of hospitalized lung cancer patient, to examine the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and to explore the medical insurance payment method that can be conducive to controlling the cost of lung cancer.

Social Science Research Network, 2007

Electronic copy of this paper is available at: http://ssrn.com/abstract=965342 ... Yesterday&#x27... more Electronic copy of this paper is available at: http://ssrn.com/abstract=965342 ... Yesterday's Friends, Tomorrow's Foes? Offshoring, Rents and Institutional Settings ... Elizabeth Maitland School of Organisation and Management University of New South Wales Sydney NSW ...

Frontiers in Public Health, Apr 27, 2023

Objective: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to ... more Objective: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China's hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing's 2020-2021 pandemic relative to the 2017-2019 pre-COVID-19 benchmark period. Methods: Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing's HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. Results: In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017-2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. Conclusion: The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment