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  • Item type: Publicação , Access status: Acesso aberto ,
    Fostering proactive work behavior in rural doctors: A multilevel, multidimensional trust approach
    (2026-07-16) Ll Li; Ramalho, Nelson Campos; Wang Dong, .
    The accessibility and quality of China's primary healthcare system depend on rural doctors effectiveness, which is challenged in environments characterized by limited resources, complex policies, and diverse demands. Proactive work behavior (PWB) may offer a solution as put no burden on the system and allow to bridge systemic gaps. Yet, there is a lack of research about how to foster this behavior in rural doctors in China. Drawing on Social Exchange Theory and the Social-ecological systems theory, this study proposes a conceptual model that departs from trust, positing its positive effect on rural doctors' PWB through the mediation of compensation satisfaction. Based on a first qualitative study, 53 participants were interviewed to provide an account of the key dimensions in play, which highlighted a tiered trust framework encompassing a macro-level institutional trust, meso-level interpersonal trust, and micro-level self-trust. Departing from this, a second quantitative study tested a 2-1-1 multi-level model with three trust dimensions conceived to operate at the collective level, while compensation satisfaction and PWB are at the individual level. Using time-lag data from 505 rural doctors across 62 townships, findings showed that compensation satisfaction, especially salary, positively predicts PWB. Institutional and interpersonal trust predict PWB and compensation satisfaction more strongly than self-trust. Finally, compensation satisfaction partially mediates the trust-PWB relationship, revealing two pathways: an evaluative-exchange route (salary-mediated) and a safety-enablement route (direct trust effects). Embedded in the context of Guangdong's BaiQianWan Project, this study offers insights and an actionable evidence base for primary healthcare governance and human resource policies to reinforce the primary healthcare system in China via rural doctors' PWB.
  • Item type: Publicação , Access status: Acesso aberto ,
    The impact of uneven allocation of health resources on residents in different regions: An empirical study of Guangdong province
    (2026-07-13) Li Yugang; Rosa, Álvaro
    A equitable distribution of medical resources serves as a critical lever for promoting population health and sustainable development, and this issue has turned into a fundamental consensus among decision-makers and researchers. However, structural barriers - including regional economic disparities, fiscal decentralization systems, and the concentration of talent in urban centers - continue to impede the equitable allocation of high-quality medical resources, presenting significant challenges to achieving equity in the access to health. This study employed a mixed-methods approach, integrating expert consultation, questionnaire surveys, longitudinal panel data (2011-2020), Theil index decomposition, and in-depth interviews to assess the current state of medical resource allocation and examine the impact of distributional inequities on regional health disparities and overall population health outcomes. The results revealed that the Pearl River Delta region received significantly higher investment in medical resources and exhibited greater resource concentration compared to the eastern, western, and northern regions of Guangdong Province. Residents in remote areas demonstrated significantly higher prevalence in chronic diseases and exhibited consequently higher mortality rates. These adverse health effects of resource disparities were further exacerbated by population aging and low medical insurance coverage rates. This study recommends targeted public policy measures - such as fiscal transfers, community-level infrastructure investments, and talent incentive programs - to foster more equitable and resilient health systems.
  • Item type: Publicação , Access status: Acesso aberto ,
    Effective service recovery strategies in hospital services: An empirical analysis of two Chinese hospitals: Based on patient perspective
    (2026-07-07) Liu Jin; Bento, Paulo; Weidong Xia
    This research investigates the impact of hospital service recovery strategies on patients' subsequent behavioral intentions following service failures. It creates a theoretical model of "service failure scenario - service recovery strategy - perceived fairness - patients' subsequent behavioral intentions", gathers data from 555 complaining patients at two tertiary hospitals in Guangzhou, through questionnaires, and uses structural equation modeling to test the hypotheses. The results show that service failure scenarios have a strongly negative impact on service recovery strategies, indicating that increased failure severity and perceived controllability of the attribution reduce patients' perceived effectiveness of recovery strategies. Awareness of service recovery policies has a significant positive effect on recovery strategies. In turn, recovery strategies significantly positively influence perceived fairness, which partially mediates the relationship between recovery strategies and patients' subsequent behavioral intentions. The model accounts for 72.1% of the variance in patients' behavioral intentions, supporting the proposed process of "service failure - recovery strategy - fairness perception - behavioral intention." Theoretically, this study systematically confirms the links between service failure traits, recovery strategies, perceived fairness, and patient intentions within healthcare, expanding the application of social exchange and fairness theories. Practically, it provides hospitals with a management framework of "policy transparency - precise strategies - enhanced fairness perception", demonstrating that medical organizations can improve patient experiences by publicizing complaint procedures, tailoring recovery measures to specific types of failures, and optimizing interaction processes. This has important implications for strengthening doctor-patient relationships and enhancing healthcare service quality.