Nicotine Addiction: Implications for Public Health Policy

Although the morbidity and mortality caused by cigarette smoking occur in adulthood, the initiation of tobacco use and the development of nicotine addiction typically occur during adolescence. The purpose of this paper is to examine the determinants of nicotine addiction, focusing on the development of addiction in youth, and to explore implications for public health policy. An understanding of the pharmacological and nonpharmacological factors that determine the course of nicotine addiction is critical in developing rational policies regarding tobacco products. The Food and Drug Administration's rule to regulate cigarettes and smokeless tobacco products is discussed. The fact that smokers typically make the transition from casual use to nicotine addiction during adolescence argues for developing and implementing effective prevention efforts and smoking cessation treatment programs that are youth-oriented.     

Access, Choice and Travel: Implications for Health Policy

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be the ‘local’ provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients’ access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio‐economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients’ willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.     

National Health Insurance: An Alternate Medical Viewpoint

Increasing medical technology, expertise and community expectations of health care are leading to an alarming escalation of health costs throughout the world. Many health planners are expressing doubts as to whether quality of health care can be maintained in the present circumstances. It is maintained that the Australian Government's proposal of National Health Insurance is an interim measure, intended to grant hospital and medical expenditure assistance to the entire community, at minimum cost. There is little evidence that the scheme threatens the medical market place, as it is seen at the moment, and a plea is made for productive and constructive discussion of the scheme by the medical profession.     

The State Children's Health Insurance Program: Participation and Substitution

We examine the effects of SCHIP enactment by focusing on two policy concerns: take-up and crowd-out. The literature has examined how income eligibility expansions affect the type of children's insurance coverage. However, states jointly implemented various policy instruments. The results in previous works do not control for this variety. We analyze how changes in several SCHIP factors affected decisions regarding health insurance coverage. Our analysis indicates that the estimates in the literature may have combined the effects of various policy factors. In distinguishing individual policy factors, our results provide useful information for designing effective public health insurance programs.     

农村商业健康保险的定位及发展模式

商业健康保险是农村医疗保障体系的有机组成部分。它在满足农村居民个性化的风险保障需求以及提供专业化的经办管理服务方面能发挥积极作用。在农村医疗保障体系中,公共医疗保险居基础性地位,商业健康保险则居补充性地位,两者应协调发展,共同构建我国农村多层次医疗保障体系。现阶段,我国农村商业健康保险发展模式包括补充型发展模式、替代型发展模式以及第三方管理模式三种类型,其未来发展模式包括医保合作模式、第三方管理模式,以及最终打造成以健康保障为中心、集医疗服务提供与经办管理服务为一体的农村商业健康保险产业链发展模式。     

A Review of Adult Attachment Measures: Implications for Theory and Research

There has been increasing interest in adult attachment from both theoretical and empirical perspectives. Because the test of a theory is based on our ability to assess theoretical constructs, the review is organized around assessment techniques. Delineating the content, focus, assumptions, and correlates of different attachment measures highlights central issues and problems in conducting research in adult attachment. In this review, we present theoretical issues related to adult attachment, in particular, individual differences, working models, and the role of attachment in adult life. A summary of the measures commonly used in the study of adult attachment follows. The literature review is organized by measure, examining topics such as relations between childhood experiences and adult attachment status, and adult attachment and adult personality and functioning, parenting and partnership behavior. Studies which explore relations between measures are discussed before concluding with thoughts about future directions.     

Rwanda's Health System and Sickness Insurance Schemes

After the war and the 1994 genocide, Rwanda drew up a national health policy with a view to realigning its health system. The reform, which was designed to remedy the deficiencies of the previous system, focused on community involvement in managing and financing health services. Achieving this objective was never going to be easy, but thanks to a growing number of initiatives 37.8 per cent of the Rwandan population now have some degree of sickness insurance cover. However, the system in general, and more particularly the mutual associations organized around the community, needs to be strengthened.     

Fitness and Fatness in Relation to Health: Implications for a Paradigm Shift

Health care professionals most often approach health promotion for large persons in the context that health improvement can be attained only through weight loss. Unequivocal acceptance of the notion that thinness equals health and fitness has been the only health intervention strategy available for many large men and women. The apparent ineffectiveness of traditional diet and exercise programming to reduce body weight has caused many health care providers, obesity researchers, and lay persons to challenge the further use of diet and exercise for the sole purpose of reducing body weight in the large person. A brief survey of the most popular dieting techniques used over the past 40 years shows that most techniques cycle in and out of popularity, and that many of these techniques are hazardous to health. Data from the scientific community indicate that diet and exercise programs for weight loss are ineffective in producing reduced weight maintenance after a period of 3 to 5 years. On the other hand, there are data indicating that overweight men and women can become healthy without losing significant amounts of weight. Furthermore, epidemiological studies indicate that fitness, not fatness, is related to disease and mortality. Any intervention strategy for the obese should be one that promotes the development of a healthy lifestyle. The outcome parameters used to evaluate the success of such an intervention should be specific to disease risk and symptomatologies and not limited to medically ambiguous variables like body weight or body composition.     

Mental Health Problems Among Single Mothers: Implications for Work and Welfare Reform

Welfare reform's emphasis on work and self-sufficiency assumes that poor single mothers are similar in their status and functioning to the rest of the population. However, we find that their status is quite distinct. Logistic regression results reveal that the likelihood of working is 25% lower for those with a psychiatric disorder. Mental health problems may prevent women from undertaking the tasks necessary to find employment, or women with these problems may lack the self-confidence needed to take on new challenges. Our findings suggest that mental health problems among single mothers deserve greater attention as a barrier to self-sufficiency and highlight the need for more effective intervention and treatment efforts to improve economic and social outcomes.     

Carers' Perspectives on the Internet: Implications for Social and Health Care Service Provision

To date, little is known about carers’ experience of usingonline services and informa­tion. Data are reported fromthe Carers Online national postal survey of 3,014 adult carersand from an assisted access study involving 60 other adultswho had been given training and cost-free Internet access athome. Half of the survey respondents reported having used theInternet on at least one occasion for a range of purposes relatedto both caring and other aspects of their lives. Major barriersto use identified by both users and non-users included lackof access to equipment and the Internet, difficulties with equipmentand systems, cost, limitations on time, and lack of interestand skill. Fourteen per cent of the whole sample said that nothingwould encourage them to use the Internet. All of the assistedaccess group used the Internet for a similarly wide range ofpurposes. Key benefits identified included convenience, flexibility,speed and range of information available, while problems withequipment and systems and time constraints were major barriersto effective Internet use. Findings suggest that while directInternet access has some benefits for some carers, it shouldcurrently be only one of a range of ways of meeting their informationneeds.     

Regulated Competition in Social Health Insurance: A Three-Country Comparison

The objectives guiding healthcare reforms in Germany, Switzerland and the Netherlands were to increase efficiency and consumer satisfaction in the provision of healthcare services. This paper reviews the incentives for and instruments of competition for consumers, sickness funds and healthcare providers in these three countries which are necessary to fulfil these objectives. Incentives for risk selection of sickness funds are high in Germany and Switzerland while they are low in the Netherlands. Incentives for consumer choice are also highest in Germany and Switzerland. In all three countries sickness funds have only a few instruments of competition. The effects of competition have been disappointing so far. The objectives of competitive healthcare reforms can be achieved only if incentives for and instruments of competition consistently support competitive behaviour on the part of market actors.     

Promoting Inequity: The Jamison Report Proposals on Health Insurance

The Report of the Commission of Inquiry into the Efficiency and Administration of Hospitals (the Jamison Report) contained a series of recommendations relating to health insurance. This paper reviews those recommendations and the existing health insurance arrangements, and argues that the Jamison proposals will lead to greater inequity rather than greater equity.     

When Social Health Insurance Goes Wrong: Lessons from Argentina and Mexico

Social health insurance (SHI) has gained popularity in recent years as a health‐care funding mechanism for developing countries in Latin America and beyond. This is reflected in a number of high‐profile conferences sponsored by international agencies, and a profusion of externally funded reform projects. This article assesses the potential of SHI to provide a sound model of health‐care financing, drawing on the experiences of Argentina and Mexico. It uses four criteria to assess the performance of SHI: coverage, equity, effectiveness and sustainability. The article begins by outlining key principles of SHI and comparing it to other models of health‐care financing. It then gives a comparative overview of four SHI programmes in Argentina and Mexico, before analysing their performance in greater detail. The article finishes by extracting lessons from this comparative analysis, both for the countries studied and for global debates on SHI.     

A Short-term Longitudinal Study of Children's Playground Games in Primary School: Implications for Adjustment to School and Social Adjustment in the USA and the UK

In this study we described development of boys’ and girls’ games on the school playground at recess as they progressed across the first year of primary school in London (UK) and Minneapolis (USA) in order to document age‐related trends in games during this period and to examine the predictive role of games in children's adjustment to school and more general social adjustment. Consistent with expectations, games accounted for a significant portion of children’s, but especially boys’, behavior during recess. American children played games more frequently, especially simple games, relative to English children. Consistent with expectation, the complexity of games increased, especially for boys, across the school year for children in both countries. We also examined the extent to which facility with games forecasted adjustment to school and social adjustment. Games predicted both, but only in the USA sample. Results are discussed in terms of games being an important developmental task for children of this age. Implications for future research and educational policy are discussed.     

Patterns of Social Support in the Middle Childhood to Early Adolescent Transition: Implications for Adjustment

Children's social networks often include close family members, extended family members, and friends, but little is known about interindividual differences in the patterning of support from these sources. In this study, we used person‐oriented analyses to differentiate patterns of support for children undergoing the transition to adolescence. Social network and adjustment data were collected for an ethnically diverse sample of 691 fourth‐ and sixth‐grade children, with a two‐year follow‐up. Cluster analyses identified one pattern of support from both close family members and friends, a second pattern of support from both close and extended family members, and a third pattern of support primarily from close family members alone. Participants receiving support from close family in combination with either extended family or friends were better adjusted than were those without multiple support resources. The results suggest that a meaningful typology of children's social networks can be developed.     

Issues in Complementary Health Insurance in Belgium

This article attempts to assess the increasing role of complementary social insurance in healthcare in Belgium. As different players attempt to fill in the lacunae of the statutory social security scheme, the demarcation of their sphere of action and of their mutual relationship is becoming problematic. It is therefore interesting to see the evolution of solidarity and selectivity. The analysis of both categories and products in complementary health insurance indicates the limitations and the bottlenecks in coming years for the social security scheme on the one hand and complementary social insurance on the other.     

Development of Social Health Insurance in Mongolia: Successes, Challenges and Lessons

This paper examines the process of developing social health insurance in Mongolia, and its successes, challenges and lessons. The government of Mongolia introduced social health insurance in 1994, which is compulsory for all public and private sector employees and low-income and vulnerable population groups. The scheme also provided voluntary insurance for unemployed people of working age. About 95 per cent of the population was covered by health insurance within the first two years thanks to a high level of government subsidy for vulnerable population groups. The insurance benefit initially covered nearly all inpatient services except the treatment of some specified chronic and infectious diseases, which were directly funded by the government. The scheme not only had many successes but also faced challenges in maintaining universal coverage. The new financing arrangement has provided little financial incentive for healthcare providers to contain health expenditure, contributing to rapid health cost inflation. In addition to reforming the payment system for providers, there has been an increasing need to expand benefits into ambulatory care. The development of compulsory health insurance in Mongolia shows that a prepaid health insurance mechanism based on risk sharing and fund pooling is feasible in low-income countries given political commitment and government financial support for vulnerable population groups.