How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

The relationship between lifetime health trajectories and socioeconomic attainment in middle age

A large literature demonstrates the direct and indirect influence of health on socioeconomic attainment, and reveals the ways in which health and socioeconomic background simultaneously and dynamically affect opportunities for attainment and mobility. Despite an increasing understanding of the effects of health on social processes, research to date remains limited in its conceptualization and measurement of the temporal dimensions of health, especially in the presence of socioeconomic circumstances that covary with health over time. Guided by life course theory, we use data from the British National Child Development Study, an ongoing panel study of a cohort born in 1958, to examine the association between lifetime health trajectories and socioeconomic attainment in middle age. We apply finite mixture modeling to identify distinct trajectories of health that simultaneously account for timing, duration and stability. Moreover, we employ propensity score weighting models to account for the presence of time-varying socioeconomic factors in estimating the impact of health trajectories. We find that, when poor health is limited to the childhood years, the disadvantage in socioeconomic attainment relative to being continuously healthy is either insignificant or largely explained by time-varying socioeconomic confounders. The socioeconomic impact of continuously deteriorating health over the life course is more persistent, however. Our results suggest that accounting for the timing, duration and stability of poor health throughout both childhood and adulthood is important for understanding how health works to produce social stratification. In addition, the findings highlight the importance of distinguishing between confounding and mediating effects of time-varying socioeconomic circumstances.     

制约学校体育实施健康教育的诸因素分析

本文主要对影响学校体育实施健康教育的因素进行了分类研究 ,为学校体育实施健康教育提供科学的参考依据。     

Does parents’ valuation of children’s health mimic their valuation of own health?

A single latent variable model of health status and therapeutic health care utilization is estimated for parents and own children of 6,557 US households. The equation system that identifies latent health status simultaneously determines a number of indicators of general health, including presence of morbidity symptoms, mobility limitations, medication needs, and utilization of therapeutic health care services. The main goal of the paper was to obtain an unbiased estimate of parents’ marginal substitution rate between own and child health. Results indicate that parents’ valuation of their children’s health exceeds their valuation of own health by almost twofold on average.

论和谐社会的道德价值导向

道德价值取向的多元化是当代社会的重要特征,构建和谐社会必须坚持正确的道德价值导向,在多元道德价值取向之间实现合理整合,追求道德价值的和谐一致。社会主义荣辱观是构建和谐社会的基本道德规范,也是构建和谐社会的价值取向,必须不断地建设和谐的道德价值观,促进社会的和谐发展。     

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.     

Development of the Mental Illness and Disorder Understanding Scale

Abstract: Although administrative bodies such as community health centers have implemented various awareness campaigns to promote community understanding of mental health and to reduce the stigma associated with mental illness and disorder, there have been few reports that have quantitatively analyzed the effects of these campaigns in Japan. Therefore, this study was conducted for the purpose of developing the evaluative “Mental Illness and Disorder Understanding Scale (MIDUS)” for awareness campaigns and assessing its reliability and validity. A survey was conducted on 1 004 community residents using a self‐administered questionnaire. An assessment of the reliability and validity of the scale was then conducted. The Cronbach a coefficient of the MIDUS was 0.78, thus indicating adequate reliability. Factor analysis of the MIDUS revealed three factors: “Treatability of illness”, “Efficacy of medication” and “Social recognition of illness”. In addition, a significant correlation was observed between the MIDUS and existing scales, and fixed criterion‐based validity was demonstrated. The MIDUS utilizes items worded in the form of affirmative expressions so as to avoid promoting new bias. It was confirmed to be both reliable and valid, thereby suggesting its usefulness as an evaluative scale of awareness campaigns.     

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。     

文化符码与心理符码的合－－鲁迅作品中的看客形象小议

看客是鲁迅作品中的重要形象,它一方面作为一种文化符码出现在作品中,代表着鲁迅对中国封建文化的认识,体现着封建文化的吃人本质;另一方面,它又表现着鲁迅内心世界的恐惧心理,成为创作主体的心理符码.鲁迅对看客形象的塑造,是按照抽象这一艺术原则进行的,他限制看客的活动空间,把看客抽象成无生命的结晶质.这些艺术表现均源于鲁迅摆脱内心恐惧的需要.