Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

贫困大学生心理健康及社会支持状况的研究

探讨和研究贫困大学生心理健康与社会支持状况及两者之间的关系，可以为有效地进行心理危机干预提供参考依据。我们以河海大学495名贫困大学生为实验组，476名非贫困大学生为对照组，采用90项症状自评量表（SCL-90）和社会支持评定量表（SSRS）进行团体施测，结果发现贫困大学生的心理健康和社会支持状况均低于非贫困大学生，尤其是在人际敏感、抑郁和精神病性三方面差异达到非常显著的水平；在贫困大学生中，女生的心理健康水平低于男生，文科学生低于理工科学生，来自城市的贫困大学生低于来自乡村的贫困大学生；贫困大学生的心理健康水平和社会支持状况存在显著相关。提高个体感受到的主观支持及其对社会支持的利用度，将有利于贫困大学生心理健康水平的提高。     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

城市公共空间与大众健康--19世纪英国城市公园发展的启示

在城市发展和改造过程中,英国近代城市先后着手进行城市公共空间———公园建设,从而掀起了一场造园运动。这场运动既是英国城市发展的必然结果,同时也是解决城市环境问题、提高大众健康水平的需要。而公园等公共空间的建设,为居民提供了一个锻炼与休闲的空间,有利于提高居民的健康水平。健康的人居环境,为各阶层民众提供了聚会的场所,体现了社会成员和谐相处的精神,成为英国资本主义成熟的重要表现之一。     

大学生自我表露的比较研究

目的:考察主动到心理咨询中心求助的大学生自我表露和孤独状况并与普通大学生的资料进行比较;考察来访者对咨询员的自我表露与其他目标人的表露之差异。结果发现:求询大学生与普通大学生的自我表露相比显著地低;求询大学生对咨询员的表露比其他目标人的表露显著地高;求询大学生的孤独感明显地高于普通大学生;心理咨询在大学生发展过程中起着重要的作用。     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

福州市社区空巢老年人健康状况调查

目的了解空巢老年人的健康现状及其影响因素,为老龄工作提供科学依据。方法2002年4~5月进行入户调查,采用分层整群抽取福州市鼓楼、台江、仓山三个区60岁及以上的社区老年人,共得到有效样本1767例,其中空巢老人696名。空巢老人躯体健康、生活自理能力(ADL)、经济状况、精神健康、社会健康5个维度的健康状况及其影响因素的调查是本次研究的主要内容。结果福州市社区空巢老年人占老年人总体比例的39%,其中男性多于女性;由logistic检验得出空巢老年人健康状况受年龄、性别、原职业、是否赞成非家庭养老方式、锻炼程度等因素的影响。结论倡导空巢老年人形成良好的生活饮食习惯与自我保健意识,加强对空巢老年人慢性病的防治,丰富老年人的精神生活、社会生活,提高对空巢老年人经济支持,完善社区为老服务,从而改善空巢老年人的健康状况。     

生态运动与绿色主义福利思想：生态健康科学与新型公共卫生框架

人与自然、社会与自然关系既是经典的理论议题,又是紧迫重大的现实政策问题.本文从生态运动入手,系统介绍作为生态运动理论基础的绿色福利主义,并以生态健康科学为基本理论视角,简要探讨新型现代公共卫生政策框架及其革命性的现实、理论与政策涵义.     

心理健康教育模式在课堂教学中的建构

在实证的基础上论述了心理健康教育模式在课堂教学中的建构 ,以期增进学生的心理健康