参加医疗保险对农村居民健康的影响——基于CHARLS 2015数据的实证分析

基于CHARLS 2015数据,采用倾向得分匹配法实证分析参加医疗保险对农村居民健康的影响。研究发现:参加医疗保险对农村居民的日常活动能力和自评健康影响不显著,参加医疗保险对农村居民认知能力具有显著的正向影响。据此提出,应进一步提升社会医疗保险保障水平、扩大社会医疗保险保障范围、促进商业医疗保险有序发展、推进"三医"高效协同联动等,以充分发挥医疗保险的健康保障功能,从而进一步提升参加医疗保险对农村居民健康的正向影响。     

The importance of cross‐disciplinary scientific engagement in the development of quantitative procedures for aggregate safety assessments

Recent guidance on safety monitoring during drug development, issued by regulatory authorities in the United States and European Union, indicate a shift in focus towards aggregate safety monitoring and scientific evaluation of integrated safety data. The call for program‐level reviews of accumulating safety data, including from ongoing studies, provides an opportunity to leverage the scientific expertise and medical judgment of safety management teams with (a) a multidisciplinary approach, (b) quantitative frameworks to measure level of evidence, and (c) assessments that are product‐specific and driven by medical judgment. A multidisciplinary team, regularly reviewing aggregate safety data throughout the development program, is vital not only for early signal detection but also for generating a better understanding of the accumulating data and context needed for decreasing false alarms.     

Surgical Identity Play: The Anatomy Lab Revisited

The anatomy lab has been studied by sociologists interested in professional socialization since the 1950s. This is because the act of dissecting a cadaver is thought to be foundational for both the student's medical knowledge and the development of the student's professional identity. In this paper, I revisit the anatomy lab both historically and ethnographically. Drawing on theoretical insights from the laboratory ethnography tradition within science and technology studies, I show that students use material artifacts in the lab to support their “surgical identity play.” This activity is structured by the laboratory's performative architecture even while it is unsupervised by anatomy faculty. While many analyses of professional socialization focus on how students learn to interact with patients during their training, I show that the anatomy lab experience is an important form of professional socialization because here students learn to employ surgical instruments, language, and dress, and begin to relate to each other as colleagues.     

重大公共卫生事件中应如何作为:来自医学人类学哈佛学派的启示

聚焦人类学者在针对重大公共卫生事件的跨学科研究中应该有何作为这一议题,通过借鉴来自医学人类学哈佛学派的民族志洞见和研究经验,为当下2019新型冠状病毒疫情危机中所进行的田野观察和分析,以期获得灵感和启示,并探索有可行性和操作性的研究策略和方法。     

中国基本医疗保险的实际参保率及其分布特征:基于多源数据的分析

全民覆盖是基本医疗保险降低国民医疗费用负担的前提条件。中国基本医疗保险是否实现了全民覆盖仍存在争议。本文利用多源调查数据,分析了我国基本医疗保险实际参保率及其分布特征。不同来源的数据基本证实,2015-2016年,中国仍有超过10%的国民没有参加任何一项基本医疗保险制度。其中,城镇居民、非农户口和没有户口的居民、东北地区、年轻人、儿童、未就业人群、低收入人群、在校学生以及流动人口基本医疗保险实际参保率更低。城乡居民实行自愿参保,因管理部门分割、信息系统不统一导致的重复参保以及因财政补贴制度导致的户籍地参保等制度设计,是导致基本医疗保险未能实现全民覆盖的根源。要实现基本医疗保险全民覆盖,解决国民医疗后顾之忧,未来我国基本医疗保险应实行强制参保、以家庭为单元参保、常住地参保,建立全国统一的基本医疗保险信息系统,并鼓励发展补充性医疗保障制度。     

“通知—删除”规则在电子商务专利侵权中的适用——兼论《民法典》第1195条

随着电子商务的蓬勃发展，“通知—删除”规则在有效制止电子商务专利侵权中具有重要作用。我国在21世纪初引进“通知—删除”规则，逐步构建了适用于电子商务领域专利侵权的“通知—删除”规则。《民法典》正式施行以来，“通知—删除”规则在适用于电子商务专利侵权中暴露出诸多问题：存在规则滥用隐患，权利人与商家利益失衡，通知与反通知的审核标准难以一致，因错误通知造成商家损失难以恢复，等等。解决好这些问题，需从专利侵权的特殊性出发，贴合《民法典》第1195条的规定，遵循“通知—删除”规则的立法目的进行解释适用；应重视和探索电子商务平台的自治能力，推动“通知—删除”规则在电子商务专利侵权中的解释适用。     

互联网医疗服务法律监管研究

随着互联网技术的进步以及医疗改革的深入,互联网医疗服务成为新生业态.然而,我国互联网医疗服务法律监管体系还不够完善,缺乏统一规范的监管体系,多头监管、个人隐私隐患大、纠纷处理解决机制不健全等现实困境尚未解决,不利于互联网医疗服务行业的发展和人民群众身心健康.为解决上述问题,通过梳理发达国家的成功经验,如美国的移动医疗应用程序监管和个人隐私保护、欧盟的互联医疗数据管理、英国的行业协会监管等,结合我国现有国情,建议从完善立法体系、建设隐私保护机制、构建行业监管、明晰医疗服务主体责任等方面健全互联网医疗法律监管制度,以期推动互联网医疗服务行业发展,保障医患双方的合法权益.     

多渠道医疗门诊挂号的时间策略研究

现阶段多种门诊挂号方式并存时，根据患者特性制定不同的等待时间策略尤为重要。本文考虑门诊挂号的三种渠道：直接排队挂号渠道、电话预约挂号渠道与O2O预约挂号渠道。在价格外生前提下，综合考虑患者的渠道偏好程度、时间敏感性与提前支付敏感性，基于效用理论构建患者的渠道选择模型。根据该模型推导得出不同市场条件下医院的需求，医院再据此制定患者的等待时间策略以达到利润最大化的目的。研究发现：当医院仅开通单一挂号渠道时，若患者的时间敏感度越大、渠道偏好程度越小，等待时间均越小；开通某两种挂号渠道时，还需考虑患者对两种渠道的偏好比例，偏好某种渠道的患者比例增加，选择该渠道的患者等待时间增加，选择另一渠道的患者等待时间减小；同时开通三种渠道时，最偏好某渠道的患者比例越大，选择该渠道的患者的等待时间也越大；在所有情况下，患者对提前支付的敏感度均不影响最优等待时间的制定。     

Mentorship experiences during registrar training: reflections of Black African specialists in the Western Cape

In order to meet the significant staffing challenges to health care provision in South Africa, the need to support the training and retention of Black medical specialists has been identified. This small qualitative study aimed to explore experiences of mentorship among a group of Black medical specialists in hopes of understanding the value and potential challenges that these relationships raise. Ten Black medical specialists were interviewed about their experiences of being mentored during their registrar training. The interview data was analysed using discourse analysis, and the results comprise of three main themes, namely: Difficulty accessing mentorship, a lack of Black and/or female role models and finally, experiences of feeling excluded from soft networks. The experiences explored in this study indicate the need for open dialogue within the mentorship dyad regarding certain taken-for-granted assumptions surrounding race, so as to aid the provision of more effective and satisfying mentorship outcomes.     

Designing Graphs that Promote Both Risk Understanding and Behavior Change

Graphs show promise for improving communications about different types of risks, including health risks, financial risks, and climate risks. However, graph designs that are effective at meeting one important risk communication goal (promoting risk‐avoidant behaviors) can at the same time compromise another key goal (improving risk understanding). We developed and tested simple bar graphs aimed at accomplishing these two goals simultaneously. We manipulated two design features in graphs, namely, whether graphs depicted the number of people affected by a risk and those at risk of harm (“foreground+background”) versus only those affected (“foreground‐only”), and the presence versus absence of simple numerical labels above bars. Foreground‐only displays were associated with larger risk perceptions and risk‐avoidant behavior (i.e., willingness to take a drug for heart attack prevention) than foreground+background displays, regardless of the presence of labels. Foreground‐only graphs also hindered risk understanding when labels were not present. However, the presence of labels significantly improved understanding, eliminating the detrimental effect of foreground‐only displays. Labels also led to more positive user evaluations of the graphs, but did not affect risk‐avoidant behavior. Using process modeling we identified mediators (risk perceptions, understanding, user evaluations) that explained the effect of display type on risk‐avoidant behavior. Our findings contribute new evidence to the graph design literature: unlike what was previously feared, we demonstrate that it is possible to design foreground‐only graphs that promote intentions for behavior change without a detrimental effect on risk understanding. Implications for the design of graphical risk communications and decision support are discussed.