Health Care Service Needs and Correlates of Quality of Life: A Case Study of Elderly Chinese Immigrants in Canada

This study explored the health care service needs and the major correlates of quality of life among 127 community-dwelling elderly Chinese immigrants in a western Canadian city. Participants were interviewed in their homes by trained, bilingual interviewers employing a structured questionnaire that covered a wide range of topics including health care service needs, living arrangements, health status, social network, life satisfaction, and socio-demographic information. Results demonstrated that ethnic nursing homes, senior centres that provide programs and services, and homemaker services were respondents’ major service needs. Multiple ordinary least-squares regression analysis revealed that respondents who emigrated from Mainland China and those who exhibited greater psychological well-being, reported being physically more mobile, perceived fewer service needs, and expressed satisfaction with the quality of their neighbourhood demonstrated higher levels of life satisfaction.     

关于北京市宣武区社区居家养老模式初探

2005年以来,北京市宣武区在辖区牛街街道和大栅栏街道试点推行了居家养老工作。在开展居家养老试点工作中,始终从老年人的实际需求出发,坚持“抓好软件、优化硬件、老人受益”的原则,以高龄困难老年人为重点服务对象,面向全体老年人,使广大老年人居家就可以享受到“就近、快捷、优质”的服务。通过“政府扶持,加强领导;依托社区,构建居家养老服务平台;社会参与,全方位推进居家养老服务工作”的运作格局,取得了“投资少、见效快、老人得实惠”的良好效果。本文对宣武区居家养老试点工作进行了全面系统的总结,使之具有较强的理论性和可操作性,对于今后开展居家养老工作具有一定的借鉴作用。     

服务型政府在促进就业中的战略研究

自从20世纪90年代中后期以来,建设服务型政府,已经成为西方乃至世界各国行政改革的一个重要取向。为公民提供就业服务作为政府提供的公共服务的一种,在建设服务型政府中无疑是一项极为重要的指标。本文将促进就业作为建设服务型政府的突破口和着力点,通过分析我国的就业现状及政府应承担的责任,探讨了服务型政府在促进就业方面的战略选择。     

西北民族地区县级政府公共服务财政保障能力的困境与对策——以甘肃省临夏回族自治州为例

公共服务供给水平的差异很大程度上是由地方政府公共服务财政保障能力不同所致。民族地区县级政府公共服务财政保障能力,直接制约和影响民族地区公共服务供给水平。本文基于甘肃省临夏回族自治州8县（市）数据资料,对西北民族地区县级政府公共服务财政保障能力面临的困境进行了研究。研究发现,西北民族地区县级政府财政收入水平总体低下且存在很大差异,导致公共服务财政保障能力严重不足与失衡状况并存,使得政府公共服务能力陷入举步维艰的两难困境。最后,从完善地方财政体系角度,就提升民族地区县级政府公共服务财政保障能力提出了若干对策建议。     

城市社区居家养老服务模式探索——以南京市鼓楼区政府向“心贴心老年服务中心”购买服务为例

随着我国人口老龄化速度的加快和"四二一"家庭的不断增多,老年人的养老问题已成为各级政府和社会关注的焦点。以南京市鼓楼区为例,分析了在老龄化背景下,传统家庭养老模式功能的弱化和机构养老存在的现实问题已经不能满足目前老年人的养老需求;从社区居家养老概念出发,比较了社区居家养老服务模式的优势,重点对南京市鼓楼区政府向"心贴心老年服务中心"购买居家养老服务模式进行探索,最后提出了加快社区居家养老服务发展的几点政策建议。     

社会救助视角下农村家庭养老服务津贴政策构想

为救助困难家庭的老人、提升老人的养老质量,政府已为部分困难老人购买社会养老服务。然而受制于各地经济社会发展水平,在广大的农村地区、甚至部分城镇地区,社会化服务发展水平较低、服务人员和队伍不足,绝大多数家庭尚未享受到政府购买服务,困难老人仍然依靠传统的家庭养老服务。基于与政府购买社会养老服务政策相匹配的理念,文章通过梳理国内外家庭养老服务相关实践发现对提供服务的家庭予以部分经济补贴是可行之路,实际调研中也发现当下农村地区困难老人面临的养老责任扯皮推诿、服务水平低等问题多为经济不足诱发。针对农村地区为老人提供家庭养老服务的困难家庭,本文从目标、原则、管理体制等几个方面为其构建农村家庭养老服务津贴政策。     

促进我国流动人口基本公共卫生服务均等化的筹资机制研究

从筹资的角度分析制约我国地方政府向流动人口均等化供给基本公共卫生服务的原因,总结国外流动人口基本公共卫生服务筹资的经验,提出筹资机制改革建议。研究结果表明：我国现行的以常住人口为基数核定和安排基本公共卫生服务筹资责任的政策安排,给地方政府回避流动人口基本公共卫生服务的供给责任提供了制度空间,导致了流动人口公共卫生服务筹资“两头落空”的现象,影响了服务供给的均等化水平。我国须进一步强化中央政府的投入责任,保证流动人口基本公共卫生服务筹资的总体充足性,同时完善转移支付制度,增加对人口流入地的基本公共卫生服务经费补助金额,从而填补短期流动人口筹资政策的空白。     

Coping with adolescent fertility

In the Philippines, despite the conservative values of the population, factors brought about by increasing modernization encurage the youth to practice sex, although actual sexual behavior lags behinds attitudes. This is particlarly the case in Metropolitan Manila, the country's most urbanized region. In 1982, 4 of 10 live births were to women aged 15-24. There also are reports that births out of wedlock have increased in the past few years, with the biggest number of such births registered by women in the younger age groups. The magnitude of the problem causes concern among the policymakers, throughout the world, the Philippines included. The government and the private sector in the philippines have started to recognize the need to protect adolescents, particularly girls, from unplanned parenthood. Adolescent fertility programs in the Philippines and neighboring countries are relatively new and policymakers are working to strengthen them. Recently, the Commission on population (Popcom) organized the Youth and Premarriage Task Forces to address the specific needs and concerns of the youth. In line with this objective, private and government agencies have developed programs and projects for specific youth sectors which influence or may be influenced by adolescent secxuality norms. There are projects designed to suit the specific needs of in school youth, out of school youth, working youth, pregnnant unmarried women, and adolescent counselors. Some of these programs and projects are described. Similar to other projects, the adolescent fertility projects in the Philippines experience their share of problems and constrants, including shortage of trainers, lack of reliable data, inadequate supply of resource materials, and the need to strengthen government policy. In view of all this, a need exists to attract more people to train service providers who will attend to adolescents' information needs, ranging from common concerns like dating to more serious concerns like pregnancy. In a recent survey many service providers indicated that the were wary of providing contraceptive information and services to adolescents for 2 reasons: they believe these might promote sexual promiscuity among the married; and the fear they might be sued by irate parents. Coupled with the problem of lack of reliable data is the fact that few materials on sexually related materials have been developed in the philippines. Such local materials are needed for the benefit of both the youth and the service providers and counselors.     

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors.     

Reproductive health care in India: a new paradigm

India has adopted a new approach to family planning that locates these services within the reproductive health care context. This means that family planning and reproductive health services will be offered as an integrated package. To implement this approach, the government will follow a framework for reproductive health designed by Saroj Pachauri, director of the Population Council's office in New Delhi, to guide the government's new Reproductive and Child Health Project. This initiative marks a significant paradigm shift in India; away from a population-control approach, implemented through a top-down, bureaucratic, target-driven program, towards a gender-sensitive high-quality services responsive to the health needs of clients, especially the women. Considering the geographical variations in reproductive health, the framework contains two service packages: an essential and comprehensive version, each consisting of broad categories of service and matrix of interventions. To support the transition underway, the Council has launched an advocacy project to educate health care providers and policymakers about reproductive health issues and help them translate the framework into effective programs. In order to successfully implement this initiative, partnerships with the nongovernmental sector, especially at the community level are essential.     

Financing rural health services in Kenya

The paper analyzes household expenditure on medical care and the willingness to contribute towards service improvements at government health facilities. The analysis is based on survey data from two rural districts in Kenya situated approximately four hundred miles apart. The main finding is that medical care expenditure rises as household income increases, but the probability of willingness to pay fees for service improvement at government clinics declines with income. Income is an important determinant of the willingness to participate in a hypothetical government insurance scheme, with the probability of participation falling as income rises. These results should be interpreted with caution because of the potential for incorrect reporting of the willingness to pay for services that have an element of a social good. The policy implications of the results are briefly discussed.     

政府购买卫生计生基本公共服务研究

由于人口众多、需求多样并存在财政的刚性约束,通过政府购买方式推进基本卫生计生公共服务是时势所需。以是否政府核心职能、服务质量度量难易、服务可描述性、监督难易、竞争程度、居民需求、政府财力七个因素为指标,通过专家小组讨论法,对各项卫生计生基本公共服务的可购买性及可控性、可外包性做出了评定,并讨论了购买承接方选择、购买模式、央地分工、“十三五”路线图等问题。还针对近年来各地在购买卫生计生基本公共服务中遇到的资质要求不一、绩效评估不科学、公众不信任、无谓服务突出等问题,提出了相应的对策措施。     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' perceptions of available support networks and patterns of disclosure in order to raise awareness of their struggle against HIV and homophobia and to assist in empowering the low-income HIV-positive WSW community.     

Fertility,growth and the financing of public education and health

This paper considers the implications of the financing of government services to children when fertility decisions are endogenously determined. In particular, it is shown that when the services are financed by taxation, the equilibrium outcome is biased away from the socially preferred result. The bias results in higher fertility rates and lower economic growth rates than the efficient social optimum. This arises because each household internalizes the benefits, but not the costs of the tax-financed services. We consider alternative methods of financing the public provision of services and find that a combination of taxation and vouchers can eliminate the bias in the equilibrium outcome.We are grateful for comments from Alessandro Cigno and two anonymous referees.     

Are there sensible ways to analyze and use subjective indicators of urban service quality?

The application of subjective social indicators to evaluating local governmental services poses problems of interpretation and analysis. For several reasons, higher levels of subjective performance do not necessarily imply that in any other sense service performance is higher. Therefore, it may be erroneous to interpret an indicator such as expressed citizen satisfaction with a service as a measure of the quality of service government actually provides. Comparisons of average satisfaction levels can be especially misleading, as several simple simulation examples illustrate. This paper discusses some of the techniques and assumptions necessary for dealing with these problems, and offers some recommendations for using subjective indicators in local policy analysis.     

Expanding contraceptive choice: findings from Zambia

The Population Council's Expanding Contraceptive Choice program works to increase the contraceptive options available to women and men in developing countries. To achieve this goal, the Council is pursuing a new approach, one which begins with an assessment of contraceptive needs from which recommendations for upgrading contraceptive services are based. This new approach was tested in four countries including Zambia in which Stage I--contraceptive needs assessment--was completed. Results of the assessment indicated that despite the efforts of the national family planning program, 33% of Zambian women who do not want to get pregnant do not practice contraception. Only 9% of women use a modern contraceptive method. These results suggest that there is a need for introducing new contraceptive technologies and for expanding utilization of existing methods in the country. Also, stage I assessment yielded other positive outcomes which are enumerated in this paper. In response to this report, the Zambian government decided to proceed with stage II research on the viability of introducing new and underutilized contraceptive methods into the national family planning program.     

推进公共服务均等化途径研究

党的十七大明确提出,"围绕推进基本公共服务均等化,完善公共财政体系。"建设服务型政府,完善公共服务体系,强化社会管理和公共服务。"从而为全面落实科学发展观,加强改善民生,推进公共服务均等化,建设公共服务网络体系指明了方向。从全面落实科学发展观战略视角,对加强改善民生、推进公共服务均等化实现途径的现状、挑战、机遇和路径进行初步的研究,以进一步提高贯彻落实科学发展观和党的路线方针政策的自觉性和坚定性,增强实现党的根本宗旨的责任感和使命感。     

高度老龄化地区养老服务探索及发展策略研究--以天津市为例

人口老龄化加剧、社会经济发展转型与政府职能转变成为大力推动养老服务发展的客观要求。天津市已成为我国高度老龄化地区之一,在政府主导下初步形成了以社区居家养老和机构养老为主干的养老服务体系。但养老服务建设缺乏详细规划且管理机制尚未健全、养老服务事业的经费投入难以满足现实需求、区域间的养老服务资源非均等性明显、民办养老机构发展困难、专业养老护理人员缺乏等问题逐渐显现。未来时期应完善制度顶层设计和明确政府养老服务财政责任、促进养老服务管理标准化和加强行业监管、构建公办与民办养老机构差异化发展格局、促进养老服务人员的多元化与专业化、探索建立老年护理保险制度,从而推动养老服务健康发展。     

Identifying the Needs of LGBTQ Immigrants and Refugees in Southern Arizona

This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona, and it is the first study of its kind in the United States. Utilizing interview data collected with migrants, allies, and service providers in Tucson, Arizona, this article presents findings on the quality of service provision provided to this very underserved community pertaining to health care, housing, and legal services. The assessment shows that no services are provided specifically for LGBTQ migrants, and most LGBTQ migrants turn to family and friends when they have needs. The most significant result of this study pertains to the lack of cultural competence and an overall deficiency in terms of cultural awareness when it comes to the specific needs of LGBTQ migrants.