医疗保险的特性与管理——基于美国医改案例的分析

美国的医疗保险体系以商业医疗保险制度为主,研究奥巴马医疗改革方案的内容和变革走向,有助于认识医疗保险的特征和管理方法,并从中获取新的有益的启示。本文通过对美国医疗改革法案的分析认为,医疗保险是准公共产品,不能完全依靠市场机制来解决;医疗保险是重要的公共管理事务;医疗保险制度的建立重在公平性;医疗保险的管理必须强化政府责任,强化对保险机构和医疗服务机构的监管。     

Fostering secure attachment in low- and middle-income countries: Suggestions for evidence-based interventions

Children struggling with the effects of trauma in low- and middle-income countries (LMIC) face a substantial mental health resource gap that limits their opportunities for positive psychosocial development. Multidisciplinary interventions working to close this gap may benefit from incorporating an empirically supported treatment (EST) into their approach that targets a universal mechanism implicated in resilience, like attachment. ESTs should be selected based on their level of empirical support and cultural adaptability, and then modified on the basis of qualitative evaluations conducted with the local population and stakeholders. This paper will provide an overview of attachment as a mechanism of resilience, a critical analysis of existing attachment-based ESTs, and recommendations for overcoming EST implementation barriers in LMIC.     

The role of social and cognitive factors in individual gambling: An empirical study on college students

Most of the studies on the determinants of individual gambling behaviour rely on cognitive theories. In our study, we argue that, besides cognitive factors, several social factors might play an important role as well. We analyse data from an ad hoc webmail survey conducted on about 2000 undergraduate students enrolled in a large public university in the Northern Italy in the academic year 2012–13. Using a variety of statistical techniques (standard regression models, boosted regression trees and structural equations models), we show that social variables affect both participation in gambling in the past year and latent gambling propensity. In particular, controlling for several proxies for individual cognitive ability and understanding of probability, gambling propensity is positively affected by the degree of gambling in the social surrounding (parents, peers, neighbourhood) and the acceptability of gambling activities to the individual. Moreover, in our sample of college students the role of social factors appears to be larger than that of cognitive factors, and this is consistent across different types of models and specifications.     

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing,Decision Making,and Liking in an Eye‐Tracking Study

Researchers recommend the use of pictographs in medical risk communication to improve people's risk comprehension and decision making. However, it is not yet clear whether the iconicity used in pictographs to convey risk information influences individuals’ information processing and comprehension. In an eye‐tracking experiment with participants from the general population (N = 188), we examined whether specific types of pictograph icons influence the processing strategy viewers use to extract numerical information. In addition, we examined the effect of iconicity and numeracy on probability estimation, recall, and icon liking. This experiment used a 2 (iconicity: blocks vs. restroom icons) × 2 (scenario: medical vs. nonmedical) between‐subject design. Numeracy had a significant effect on information processing strategy, but we found no effect of iconicity or scenario. Results indicated that both icon types enabled high and low numerates to use their default way of processing and extracting the gist of the message from the pictorial risk communication format: high numerates counted icons, whereas low numerates used large‐area processing. There was no effect of iconicity in the probability estimation. However, people who saw restroom icons had a higher probability of correctly recalling the exact risk level. Iconicity had no effect on icon liking. Although the effects are small, our findings suggest that person‐like restroom icons in pictographs seem to have some advantages for risk communication. Specifically, in nonpersonalized prevention brochures, person‐like restroom icons may maintain reader motivation for processing the risk information.     

Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers’ cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.     

Using agency data for evidence-based programming: a university-agency collaboration

Agencies providing residential treatment are encouraged, or even mandated, to collect outcomes data and to implement evidence based practices, yet little guidance has been provided on how to do so using agency administrative data that are collected on an ongoing basis. We examined data on Child and Adolescent Functional Assessment Scale (CAFAS) scores for 1608 admissions to a residential treatment center from 2002 through 2008. CAFAS scores were measured every 90 days, providing multiple CAFAS scores for each individual. Results demonstrated that on average residents improved in functioning over time. Sensitive to the evolving needs of residents who had been entering the program, the treatment center made significant program changes in 2006 to attempt to better serve residents through a broad array of specialized programming. Compared to the overall results, the analysis suggested that residents who entered the program since October 2006 appeared to have made larger improvements in their CAFAS scores. Results were derived by employing multilevel models appropriate for estimating growth trajectories with repeated measures data. Conversations with agency staff suggested that using administrative data, and advanced statistical models, were extremely helpful for organizational decision making and evidence-based programming.     

Differential customer racial attitudes toward scandal and patriotism: The Mitchell Report,the Olympics,race, and baseball memorabilia

This paper investigates differential customer racial reaction to negative and positive publicity related to professional athletes. In terms of negative publicity, it analyzes the effect of mention in the Mitchell Report on the price of baseball cards. In regards to positive publicity, it considers the impact of having been identified as a member of the United States Olympic or national team. After controlling for player productivity with performance statistics, the effects of being mentioned in the Mitchell Report are isolated within regression analysis to draw conclusions concerning customer racial attitudes toward the steroids scandal. Similar analysis is conducted to see the impact of being seen as a baseball representative of the United States. Regression results are consistent with the conclusion that negative publicity devalues the cards of nonWhite players but not of White players. Positive publicity, however, increases the value of a player's card regardless of ethnicity.     

Identifying potential cycling market segments in Dar-es-Salaam, Tanzania

Most travel behaviour studies that seek to promote cycling define market segments based on socio-demographics, travel mode use or attitudes. They do not address the stages of change process in travel behaviour, whereas this information can be instrumental in influencing travel behaviour change. This paper adopts the stages of change model to identify potential cycling market segments and to analyse and profile each of the market segments based on socio-economic factors, current travel behaviour, attitudes, perceptions and motivations. A survey was conducted among 620 individual regular commuters in the city of Dar-es-Salaam. On the basis of cycling behaviour attitudinal-variable statements, as developed from the stages of change model, the survey data were classified in six different segments: pre-contemplation, contemplation, prepared for action, action, maintenance and relapse. The study revealed that the different segments have different needs and are motivated by different factors suggesting that they need to be treated in different ways. These market segments can have important implications for designing cycling policies and promotional strategies that best serve the needs of each segment. The results indicate that urban policies and marketing strategies which aim to promote bicycle use may first target the contemplation, prepared for action and action segments that are most motivated to change and willing to cycle.     

医疗改革对我国卫生行业绩效的影响——基于三阶段DEA模型的实证分析

我国医疗卫生体制改革始于20世纪80年代,改革所带来的医疗政策变化对卫生行业的医疗供给效率产生显著的影响.利用三阶段DEA方法可对1985 - 2009年我国卫生行业医疗供给效率进行测度,并分析其变化的政策影响因素.结果表明,医疗供给效率经历了1985 -1992年的改善、1993 - 2002年的低位徘徊和2003 - 2009年的持续改善三个阶段,效率变化过程体现了明显的政策效应.政策剥离的分析更能反映卫生行业实际经营状况的医疗供给效率,证实了医疗卫生领域存在市场失灵问题.我国政府应通过逐年加大财政卫生支出等措施,引导、扶持广大社会成员实现自我健康关怀,在促进公平性与改善医疗供给效率的同时,不断提高全民健康水平.     

对我国医学人文教育模式的探讨

医学模式的转变,使得医学人文精神在医疗服务中的重要性不断提高,医学人文教育也因此受到人们越来越多的关注。文章在分析国内外医学人文教育的基础上就我国建立可持续的医学人文教育模式、提高医学人文教育效果进行了探讨,并提出了相应的政策和机制保障。