Este estudio analiza la relación entre los mecanismos de financiación sanitaria y la desigualdad del ingreso en un panel internacional de 135 países durante el período 2000–2020. Desde un enfoque macroeconómico comparado, se examina el papel del gasto total en salud como porcentaje del PIB y la proporción de pagos de bolsillo dentro del gasto sanitario, controlando por variables macroeconómicas y sociales como PIB per cápita, desempleo, inflación, educación y resultados sanitarios. Metodológicamente, se estimó un modelo de efectos fijos para capturar asociaciones contemporáneas intra-país y, como ejercicio de robustez, una especificación dinámica mediante el estimador GMM en primeras diferencias (Arellano–Bond), con el fin de incorporar la persistencia temporal de la desigualdad. Los resultados del modelo estático indican que un mayor gasto sanitario se asocia con reducciones moderadas en la desigualdad, mientras que una mayor dependencia de pagos de bolsillo se relaciona con incrementos en el coeficiente de Gini, consistente con su carácter regresivo. Sin embargo, al incorporar dinámica temporal, estos efectos pierden significancia estadística, mientras que la desigualdad muestra una marcada persistencia estructural. Asimismo, el desempleo y la mortalidad infantil emergen como determinantes relevantes de la desigualdad. En conjunto, la evidencia sugiere que la financiación sanitaria influye en la configuración distributiva, pero sus efectos no operan de manera inmediata ni independiente de trayectorias históricas consolidadas. Las reformas sanitarias deben entenderse como parte de estrategias redistributivas de largo plazo integradas con políticas laborales y fiscales.
Indonesia has made substantial progress toward universal health coverage (UHC) through the National Health Insurance (JKN) programme, yet evidence on financing, equity, efficiency, and governance remains fragmented. Previous reviews have largely examined individual aspects of JKN or health financing, limiting understanding of broader health system challenges. This systematic review synthesizes evidence from 27 studies using an integrated framework encompassing financing, equity, efficiency, and governance. The findings show that while JKN has expanded coverage and reduced some financial barriers, major challenges persist, including catastrophic health expenditure, regional disparities in access, inefficient provider payment systems, and governance fragmentation under decentralization. Preventive interventions consistently demonstrate favourable cost-effectiveness and long-term economic benefits. Immediate policy priorities include strengthening strategic purchasing and provider payment reforms, while long-term reforms should focus on hybrid financing, fiscal equalization, and preventive health investment. Indonesia’s experience offers lessons for other emerging economies pursuing sustainable and equitable UHC.
This study analyses the Spanish National Health System (2000–2026), examining reforms’ impact on universal health coverage (UHC) and financial protection under decentralization and fiscal constraints. To address this objective, a convergent mixed methods design combined Walt and Gilson’s health policy triangle with longitudinal analysis of health expenditures and the WHO UHC service coverage index. The findings indicate that the austerity measures (2012) shifted financial risk to households, increasing private and out-of-pocket spending without significantly reversing aggregate UHC scores. In contrast, rights-restoration (2018) and post-pandemic policies (2020–2026) renewed public investment and improved financial protection mechanisms. Overall, Spain shows resilient universalism, with institutional and social buffers preserving universality despite economic shocks.
The integration of digital services is increasingly relevant for healthcare sustainability, although user acceptance remains uneven. This study examines the influence of internet related lifestyles on the use of medical teleconsultation. Based on a survey of 1,412 Spanish teleconsultation users, an exploratory factor analysis identified multiple dimensions of e lifestyles, including interests, social use, perceived importance, barriers, novelty, and different types of needs. Subsequently, a latent class analysis revealed eight distinct user profiles, considering socio demographic characteristics and available resources. The findings indicate that users can be grouped into pro Internet, neutral and anti Internet profiles, each displaying different behavioural patterns in teleconsultation adoption and use. These results highlight that, in contexts with high internet penetration, teleconsultation usage is closely associated with users’ digital lifestyles rather than solely with socio demographic factors. Overall, the study provides a more nuanced understanding of behavioural heterogeneity in digital health adoption.
This study examines the evolving wealth gradient in non-communicable diseases (NCDs) and their financial consequences in the context of India’s ongoing demographic and epidemiological transition. We construct a panel dataset of individuals aged 50 years and above using Wave 2 and Wave 3 of the WHO Study on Global Ageing and Adult Health (SAGE) to analyse shifts in NCD burden and multimorbidity across wealth quintiles and their association with outpatient out-of-pocket (OOP) expenditure and catastrophic health expenditure (CHE). Our findings reveal that NCD burden and multimorbidity have become increasingly concentrated among poorer households in Wave 3 compared to Wave 2. However, increases in outpatient OOP spending and the risk of CHE remain disproportionately concentrated among poorer groups. Although the epidemiological transition is increasing NCD prevalence across socioeconomic groups, the financial burden remains uneven, highlighting the need to strengthen financial protection for ageing and vulnerable populations.
The research employs eight waves of the Spanish National Health Survey—1987 to 2011—to investigate whether self-reported weight perception (SWP) and weight control decisions are affected by the population weight norm. We find that the percentage of overweight or obese have changed from 37.82% to 50.68% in the survey period. Surprisingly, SWP, weight loss medication intake and dieting have not increased as expected. Similarly, people in the most overweight regions do not seem to perceive their weight or behave differently than those in the territories with the lowest body mass index (BMI) values. We argue that this pattern could be explained by a mechanism of adaptation to the norm. We find evidence that weight perception and behaviour are affected negatively by BMI norm—measured as average BMI in a region-year-sex group—after controlling for individual BMI. We argue that these results could be relevant for designing health policies and could provide an economic argument for public interventions based on the effect of social norms on decisions.
This study examines how different forms of digital social pressure relate to young consumers' purchase intentions toward local skincare products in Indonesia. Drawing on the Stimulus–Organism–Response (S–O–R) framework and Consumer Ethnocentrism Theory (CET), the study conceptualizes digital social pressure as arising from two distinct sources: social media influencers (SMI) and user-generated content–based social comparison (UGC-SCOM). It further examines fear of missing out (FoMO) as an affective mechanism and consumer ethnocentrism (CONET) as a value-based orientation associated with purchase intention. Data from a survey of young, digitally active consumers in Indonesia were analyzed using partial least squares structural equation modeling (PLS-SEM). The results show that both SMI and UGC-SCOM are positively associated with purchase intention, both directly and indirectly via FoMO. SMI is more strongly associated with FoMO, whereas UGC-SCOM shows a slightly stronger direct association with purchase intention. The indirect associations via FoMO were significant for both relationships, consistent with a partial mediating mechanism. CONET shows a positive direct association with purchase intention but does not significantly moderate the relationship between FoMO and purchase intention. Overall, the findings indicate that different forms of digital social pressure are associated with purchase intention through parallel evaluative and affective processes rather than through a fully integrated mechanism.
This exploratory study investigates how clinical unit managers' use of Performance Measurement Systems (PMS) relates to patient waiting times (WT) within Spanish public hospitals. The research examines whether managers who value PMS tools achieve better performance outcomes. The study analysed survey data from 67 clinical units across public hospitals in Galicia, Spain. To explore the relationship between PMS use and performance, the researchers utilised contingency tables and exact bivariate tests specifically designed for small samples. The results indicate a positive association between the use of specific managerial PMS tools and reduced waiting times. However, due to the limited sample size, these findings are considered exploratory rather than causal. Improving healthcare performance requires more than just implementing formal systems; it necessitates fostering managers' recognition of these tools' strategic value. Ultimately, the active engagement of clinical leaders is crucial for translating PMS into tangible service improvements. Strengthening managerial training and promoting a clearer understanding of PMS may help clinical unit managers use these tools more effectively. Policymakers and hospital administrators should support initiatives that enhance managers’ engagement with performance measurement, while recognizing the need for further research using larger samples and more robust empirical designs.
This study analyzes maritime transport productivity in trade between China and Latin America and the Caribbean, considering technological differences among countries. The DEA-Malmquist model is applied within a metafrontier framework to estimate productivity scores, complemented by a Prais-Winsten model to identify the factors explaining productivity variations. The results reveal that southern countries face less favorable technological conditions compared to those in the north and central regions, although both groups exhibit a gradual convergence toward the metafrontier of efficiency. Research and development capacity, industrial activity, and private sector participation have a positive effect on productivity, while structural changes show adverse impacts. The study concludes that enhancing port competitiveness through technological innovation, workforce training, and increased R&D investment is essential to strengthen Latin America's integration into global value chains and expand its participation in international trade.
This article offers a critical reflection on the impact of ethical leadership and servant leadership on individual creativity in organizational contexts between 2020 and 2025. Drawing on a systematic and argumentative review of recent literature, it examines the convergences, divergences, and differentiated effects of these prosocial leadership styles on the psychosocial conditions that facilitate or hinder the generation of novel ideas. Although both styles share an ethical and relational foundation, theirmechanisms of influence differ and may either foster or limit creativity depending on their moral intensity, normative orientation, and degree of emotional containment. The analysis also reveals paradoxical dynamics and shadow areas that challenge idealized views of prosocial leadership as an automatic driver of innovation. As a conceptual contribution, the study introduces the emerging model of prosocial-creative leadership, an interpretive proposal that integrates ethical principles, relational sensitivity, and psychological conditions conducive to creativity. The article concludes with theoretical and practical implications aimed at promoting organizational environments in which ethics and creativity mutually reinforce each other in a contextualized manner.
Household appliances are among the most frequently purchased products and contribute significantly to household energy consumption. As everyday devices used for routine domestic activities, many appliances require substantial amounts of electricity, making energy-efficient alternatives increasingly important for promoting sustainable consumption and reducing residential energy use. This study examines the determinants influencing householders’ purchase intentions toward energy-efficient home appliances. The research is grounded in the Theory of Planned Behavior (TPB), exploring the relationships among attitude, subjective norms, perceived behavioral control, and purchase intention, while also incorporating additional psychological factors such as self-expressive benefits and environmental knowledge. Furthermore, the study investigates the mediating role of environmental knowledge in shaping consumer purchase intentions. Data were collected from 398 respondents using a non-probability purposive sampling technique, and the analysis was conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings indicate that attitude, subjective norms, and perceived behavioral control have a positive and statistically significant influence on purchase intention toward energy-efficient appliances. Self-expressive benefits significantly influence consumers’ attitudes and indirectly affect purchase intention through attitude. However, environmental knowledge does not moderate the relationships between attitude and purchase intention or between perceived behavioral control and purchase intention. In addition, the Artificial Neural Network (ANN) analysis reveals that attitude is the most influential predictor of purchase intention, followed by subjective norms and self-expressive benefits, while environmental knowledge plays a comparatively weaker role, suggesting that economic and behavioral considerations remain stronger drivers of consumers’ purchasing decisions than environmental awareness alone.
Este estudio analiza la productividad del transporte marítimo en el comercio entre China y América Latina y el Caribe, considerando las diferencias tecnológicas entre países. Se aplica el modelo DEA-Malmquist dentro de un marco de metafrontera para estimar los puntajes de productividad, complementado con un modelo Prais-Winsten que identifica los factores que explican sus variaciones. Los resultados evidencian que los países del Sur enfrentan condiciones tecnológicas menos favorables que los del Norte y Centro, aunque ambos muestran un proceso de convergencia hacia la metafrontera de eficiencia. Además, la capacidad en investigación y desarrollo, la actividad industrial y la participación del sector privado influyen positivamente en la productividad, mientras que los cambios estructurales generan efectos adversos. Se concluye que fortalecer la competitividad portuaria mediante innovación tecnológica, formación laboral e inversión en I+D es clave para integrar a América Latina en las cadenas globales de valor.
This study examines the determinants of young Indonesian consumers’ intention to switch (ITS) from fast fashion to more sustainable alternatives. Integrating the theory of reasoned action (TRA) with status quo bias (SQB), it explores how social media influence and perceived product durability shape pro-environmental attitudes, and how perceived inertia moderates the attitude–intention relationship. A quantitative survey of 306 Gen Z and millennial consumers was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings reveal that social media exposure and perceptions of durability significantly strengthen pro-environmental attitudes, enhancing ITS. However, perceived inertia acts as a psychological constraint, weakening the effect of positive attitudes. By bridging motivational and constraint-based perspectives, this study extends TRA by including SQB, offering nuanced insights into the persistent attitude–intention gap in sustainable consumption and the behavioral dynamics of digitally engaged youth in emerging markets.
This study examines the long-term consequences of early school leaving and years of education on adult cognitive skills in Spain. Using an instrumental variable approach that leverages historical policy reforms—introducing minimum compulsory dropout school-leaving ages of 14 and later 16—we isolate the influence of dropout and education on literacy and numeracy skills. The analysis of data from the Programme for the International Assessment of Adult Competencies (PIAAC) 2012 and 2023 reveals that, when accounting for bias due to endogeneity, early school leavers may suffer significant declines in cognitive performance, with literacy scores dropping 1.72 standard deviations (SDs) and numeracy scores falling by 1.64 SDs. Furthermore, 1 year of additional education (above the average) appears to significantly raise cognitive performance by 0.26 SDs in literacy and 0.21 SDs in numeracy. However, we remain cautious with the interpretations, as secular trends may be present in our instrument. Associations reinforce that the accumulation of formal education is essential for skill development, emphasising the need for policies aimed at reducing (increasing) dropout rates (years of education) of the population, while considering the heterogeneity across socio-economic groups.
Este artículo reflexiona críticamente sobre el impacto del liderazgo ético y del liderazgo de servicio en la creatividad individual en contextos organizacionales entre 2020 y 2025. Con base en una revisión sistemática y argumentativa de literatura reciente, se examinan las convergencias, divergencias y efectos diferenciados de estos estilos de liderazgo prosocial sobre las condiciones psicosociales que impulsan o frenan la generación de ideas novedosas. Aunque ambos comparten una raíz ética y relacional, sus mecanismos de influencia difieren, pudiendo facilitar o limitar la creatividad según su intensidad moral, orientación normativa o grado de contención emocional. Se identifican además efectos paradójicos y zonas de sombra que cuestionan la visión idealizada del liderazgo prosocial como motor automático de innovación. El estudio concluye con implicaciones teóricas y prácticas que invitan a repensar el liderazgo en clave creativa, relacional y crítica, promoviendo entornos donde ética y creatividad se potencien mutuamente.
Humanization in the delivery of palliative care is a crucial issue that must be addressed by all stakeholders involved in the process. This study evaluates the social return on investment (SROI) of the ProArt program, which aims at humanizing palliative care through art activities. ProArt was implemented in the palliative care unit of Santa Clotilde Hospital in Santander, Northern Spain. To conduct this evaluation, qualitative methods focused on patients and focus groups were used to identify the stakeholders (patients, relatives, healthcare professionals, and volunteers) and their expectations. A retrospective evaluation using the SROI methodology was performed. Our results show a positive impact on all stakeholders. Patients reported improvements in their clinical condition, social relationships, decision-making power, and emotional well-being. Relatives improved their time management. Healthcare professionals reported a better work environment and a reduction in burnout. Volunteers enhanced their artistic skills and job satisfaction. Finally, the SROI analysis yielded a result of €8.32 for every €1 invested in the program.
The study examined the influence of knowledge management practices on various operational performance constructs, including product and service quality, cost management, and delivery speed, among SMEs in Nigeria. A descriptive research design was employed to collect data from a stratified sample of 393 SME respondents across various sectors via structured questionnaires. Data analysis was done using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results reveal that knowledge application (β = 0.175, t = 2.531, p < 0.05) and knowledge sharing (β = 0.221, t = 3.169, p < 0.05) have a positive and significant influence on product and service quality. Knowledge capturing (β = 0.110), storing (β = 0.125), and creation (β = -0.031) were all insignificant. For cost management, knowledge capturing was the only significant one (β = 0.163, t = 2.012, p < 0.05). In contrast, knowledge application (β = 0.190), sharing (β = 0.169), and storing (β = 0.154) were all found to have a positive and significant impact on delivery speed. The results emphasise the strategic need for knowledge application, sharing, and storage to enhance the operational performance of SMEs. This study also encourages further investigation into other factors that affect the cost efficiency of SMEs in emerging economies.
Consumer awareness of environmental issues has steadily increased, with environmental values significantly shaping purchase intentions. Essential to environmental sustainability are ecological packaging and ecological products. This study examines the impact of green product knowledge and green packaging on environmental beliefs, health consciousness, perceived behavioural control and consumer purchase intention, focusing on Visakhapatnam (India). A quantitative survey was conducted using purposive sampling, targeting individuals who are familiar with green products. Data from 306 respondents were analysed using the Statistical Package for the Social Sciences (SPSS) and AMOS. Structural equation modelling (SEM) was used to validate the conceptual framework. The results indicate that green product knowledge, environmental beliefs, health consciousness, and perceived behavioural control have an impact on green purchase intention, whereas green packaging does not. These findings emphasise the importance of psychological and informative factors for shaping environmentally friendly consumer behaviour. This study contributes to the existing literature on sustainable consumer behaviour, especially related to green fast-moving consumer goods (FMCG). It provides practical insight to marketers, decision-makers, and environmentalists who aim to promote environmentally friendly FMCG products. Additionally, focusing on significant psychological and behavioural factors allows for designing strategies that help the environment and improve public health.
In Mexico, the services sector plays a prominent role in productive activity due to the effects of manufacturing production oriented toward foreign trade. The growth of services has little impact on economic growth due to its low interaction with other sectors and the lack of industry maturity. However, a concerning aspect is the increase in manufacturing production, which heavily depends on the use of imported inputs. The research applies the Input-Output model methodology and Growth Analysis using the Input-Output Tables from 2000 and 2018 published by the OECD to examine the effect of production and the use of factors in the services sector on economic growth. The study concludes that, in the short term, the growth of services is driven by the industry's impact. In contrast, in the long term, services follow a growth path heavily reliant on imported intermediate inputs, similar to industry.
The current regulatory and practical situation of rural land use planning in Galicia is complex. However, for the first time, a regulatory instrument has been designed specifically for this purpose: the Catalogue of Agricultural and Forestry Land. This article aims to analyse the possibilities offered by this instrument for rural land use planning, as well as the consequences of its implementation. To this end, a methodology based on comparing the spatial pattern of current agroforestry land uses with those derived from the catalogue through quantitative indicators and spatial metrics has been applied, considering the efficiency of agricultural and forestry activities and the land environmental sustainability. This analysis is applied to the case study of the catalogue approved for the agroforestry park of Remu & iacute;& ntilde;o (A Arnoia), as it covers the largest area of those currently available. The results show that the land use planning proposed by the catalogue provides a notable decrease in rural land use fragmentation, an increase in viable agricultural and forestry land units, a reduction in fire risk, and an increase in ecological value. current agroforestry land uses with those derived from the catalogue through quantitative indicators and spatial metrics has been applied, considering the efficiency of agricultural and forestry activities and the land environmental sustainability. This analysis is applied to the case study of the catalogue approved for the agroforestry park of Remu & iacute;& ntilde;o (A Arnoia), as it covers the largest area of those currently available. The results show that the land use planning proposed by the catalogue provides a notable decrease in rural land use fragmentation, an increase in viable agricultural and forestry land units, a reduction in fire risk, and an increase in ecological value.
