Background: This study aimed to examine relations between social support, job stress, and public service motivation (PSM), also assessed how social support and job stress affect PSM in China based on the job demands-resources (JD-R) theory. Methods: The survey investigated a sample of 973 healthcare workers employed in public hospitals in Beijing, Xiamen, and Guangzhou in 2017 (including doctors, nurses, medical technicians, and administrators). Correlation analysis and Structural equation modeling (SEM) were used. Results: Challenge stress and hindrance stress were directly negatively associated with PSM. Supervisor support was significantly positively associated with PSM, and the path from coworker support to PSM was significant. Supervisor support was significantly negatively associated with hindrance stress, and coworker support was significantly negatively associated with challenge stress. Hindrance stress and challenge stress significantly mediated the relations between supervisor support and PSM, and between coworker support and PSM respectively. PSM might be raised by increasing supervisor support and coworker support and by limiting hindrance stress and challenge stress. Conclusion: Our study suggests that administrators of public hospitals should be mindful of the intense job stress of healthcare workers and undertake interventions targeting challenge stress and hindrance stress. Also, public hospital administrators should encourage and assist supervisors in their leadership functions. Besides, administrators of public hospitals should emphasize coworker support and good employee relationships.

With the rapid increase of aging workforces, companies worldwide are concerned with improving the health and working status of older workers. Sense of control is an important psychological variable in sociology but has attracted less attention in studies of occupational health and management. This study examined the association of sense of control with presenteeism among aging workers in the United States. Data from the Health and Retirement Survey were analyzed, specifically, 2308 observations in 2012. Structural equation modeling was used to assess work environment, sense of control (measured in relation to personal mastery and perceived constraints), and associations with presenteeism. The moderating effect of subjective social status on the association between sense of control and presenteeism was examined with a moderated mediation model. In the final structural equation modeling model, work environment was directly inversely associated with presenteeism, and work environment was significantly inversely associated with perceived constraints. There was a direct positive association between work environment and personal mastery, a direct positive association between perceived constraints and presenteeism, and a significant inverse association between personal mastery and presenteeism. The significant indirect effects between work environment and presenteeism were significantly mediated by sense of control. Subjective social status inversely moderated the relation between presenteeism and perceived mastery, a dimension of sense of control. To increase the performance of aging workers in the United States, managers should create a work environment that facilitates access to job resources, as this might improve personal sense of control, particularly among those with high subjective social status.

This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers.

Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.

Background: This study examined relations between social support, job stress, and public service motivation, also assessed how social support and job stress affect public service motivation based on the job demands-resources (JD-R) theory. Methods: The survey investigated a sample of 973 healthcare workers employed in public hospitals in Beijing, Xiamen, and Guangzhou in 2017. Through random sampling according to employee number, age and job title, we selected 5% to 10% of healthcare workers in each target hospital. Finally, we got 973 valid participants, and the response rate was 93.8%. We used correlation analysis, structural equation modeling, Sobel test, and subgroup analysis to test by investigating a sample of 973 healthcare workers from 3 Chinese public hospitals. Results: Challenge stress and hindrance stress were directly inversely associated with public service motivation. Supervisor support was significantly positively associated with public service motivation, and the path from coworker support to public service motivation was significant. Supervisor support was significantly negatively associated with hindrance stress, and coworker support was significantly inversely associated with challenge stress. Hindrance stress and challenge stress significantly mediated the relations between supervisor support and public service motivation, and between coworker support and public service motivation respectively. Conclusions: Public service motivation might be raised by increasing supervisor support and coworker support and by limiting hindrance stress and challenge stress among healthcare workers in China.