过度医疗与转诊制:一个排队论下的博弈模型

建立了一个转诊系统中排队和博弈的集成模型, 患者可能有轻微或严重型疾病, 而医生可能将轻微型疾病诊断为严重型疾病, 进行过度治疗.本文探究政府如何通过配置医院规模和调节医疗服务价格影响医患博弈, 使患者倾向于社区首诊、医生选择说实话.研究表明, 社区医院与三甲医院通过规模进行竞争, 社区医院规模越大或三甲医院规模越小, 诱导需求越能得到抑制.轻微型疾病治疗方案的价格较低时, 诱导需求以正概率存在;高于某阈值时, 诱导需求消失.提高严重型和轻微型疾病治疗方案的价差, 能够抑制诱导需求, 但不能完全消除, 也不能改善患者福利;和三甲医院相比, 社区医院在改善患者福利上效果更明显.     

分级诊疗服务系统中协调医疗转诊的政府补贴机制研究

本文研究协调医疗转诊制度运作的政府补贴机制设计问题。通过构建分级诊疗服务系统中政府、三级医院、社区医院及患者之间的一个四阶段博弈理论排队模型,本文给出各方参与主体的均衡决策和均衡绩效;评估有限财政补贴预算情形下影响补贴社区医院与补贴下转患者两种协调机制引导患者自愿下转进而促使医疗服务运营效能与社会福利提升及等待时间降低效率的影响机理。研究发现:对较低、中高、高等的运营利润关切度,或较高的社区能力成本,或足够少的预算,补贴社区更有助于患者下转的运行、患者效益与社会福利的提高以及等待时间的降低;对于较中低的运营利润关切度,或足够低的社区能力成本,或较中等的预算,补贴下转患者反而更优;对于较中等的运营利润关切度与社区能力成本,而预算较多时,补贴社区医院尽管对患者下转率及其效益提高、等待时间降低更有效,但对社会福利的提升的效率反而更低。     

政府补贴、管理层激励与技术创新能力——基于企业生命周期视角

以2010—2019年我国A股上市高新技术企业面板数据为例,运用熵值法测算企业技术创新能力,从生命周期视角研究政府补贴、管理层持股对企业技术创新能力的影响。实证分析结果表明：总体上看,政府补贴、管理层持股显著促进企业技术创新能力;管理层持股正向调节政府创新补贴与企业技术创新能力的关系,显著增强了政府补贴资金的创新支持效应。从企业生命周期阶段看,政府补贴的作用集中体现在成长期和成熟期企业,对衰退期企业的影响不显著;管理层持股的作用集中体现在成长期和衰退期企业,管理层持股的调节作用在成熟期和衰退期企业正向调节作用显著。研究结论对政府精确定位创新补助目标和补助时机,引导企业探索管理层持股计划、改善创新决策机制具有启示意义。政策建议是：坚定施行政府补贴政策,降低企业的研发成本;制定政府补贴政策时应充分考虑企业的生命周期阶段,避免“一刀切”的补贴;最大化发挥政府补贴政策的创新效应。     

医疗体制改革中政府管制途径和方式的研究

政府对医疗服务市场干预的主要目的是解决市场化导致的低收入者看不起病的问题,通常采用的方法是为他们提供免费医疗或给予一定的医疗补贴。而我国的医改中采用的是政府管制的方式是价格管制,这促使医院提供过多的医疗服务以及把服务的重点放在药品和检查上,在增加了医疗费用的同时也降低了医疗服务市场的效率。同时低价政策不但没有解决低收入群体看不起病的问题,反而增重了他们的医疗负担,进一步增加了医疗服务的社会不公平性。     

绿色耐用产品的节能补贴合同设计

通过建立“政府-企业-消费者”三阶段的博弈模型来研究节能补贴政策对绿色产品设计的作用机理,并给出了政府在两个目标(最大化单位产品节能指数或最大化总节能指数)下节能补贴合同的最优设计.此外,论文还分析了企业利润和消费者剩余总量在两种合同下的差异,结果表明:当补贴预算较低时,两种目标下的最优合同是一致的,此时企业和消费者并没有从节能补贴政策中获利;在最大化总节能指数的目标下,当补贴预算较高时,企业和消费者皆从节能补贴政策中获利.     

基于患者选择行为的医疗服务供应链定价与协调机制研究北大核心CSSCI

针对我国当前患者等待时间过长、医疗服务价格混乱现象,基于患者选择行为,建立由患者、医疗机构和政府组成的医疗服务供应链模型,分析不同等待时间和患者偏好下的医疗机构最优定价和协调机制。研究表明:相比于医疗机构分散决策,医疗机构合作的转诊制度可以减少患者等待时间,提高就诊量,但患者效用有所下降;而政府主导下的医疗联合体集中决策,采用"收益共享+成本分担"契约,可在提高患者效用的同时,实现医疗服务供应链协调。     

推进“健康重庆”建设的成功举措——市九人民医院创办社区卫生服务体系纪实

正十年前,作为重庆北部区域性中心医院的重庆市第九人民医院,在政府的支持、配合下,依托三甲医院雄厚的医疗、服务体系介入社区卫生服务,创建西部首家由三甲医院兴办的社区卫生服务体系——北碚区天生     

医疗健康大数据驱动的知识发现与知识服务方法

知识服务是提升我国医疗健康服务机构管理决策水平和提高资源利用效率的重要手段,在促进医疗健康资源整合和实现分级诊疗过程中具有不可替代的重要作用,关乎14亿人民健康福祉。由于我国现阶段优质医疗资源总量不足、分布不平衡,导致医疗健康管理和服务水平难以满足不断增长的高质量医疗健康服务需求。针对该突出矛盾,本文在界定了基于“资源观”的新时代医疗健康大数据概念的基础上,提出了医疗健康大数据驱动的知识服务方法论,包括医疗健康案例知识的组织与动态更新方法,医疗健康推理知识的生成与发现方法,以及考虑综合效用和多样性的医疗知识服务推荐方法,并将所提方法论应用于某三甲医院医疗集团的案例实践,结果表明医疗健康大数据驱动的知识服务方法提高了优质医疗资源的利用效率、基层医院的接诊能力、医疗机构的管理决策有效性,提升了患者的满意度,有力促进了智慧医疗和分级诊疗政策落地。     

基于信号博弈模型的公立医院利益补偿机制

针对医疗服务市场的特点,讨论了医药分业后政府补贴公立医院的利益补偿机制,以优化资源配置为目标建立医院与政府的信号博弈模型并进行均衡分析,发现市场的均衡效率随作假的伪装成本和期望风险成本减少而降低;实现市场完全成功的分离均衡的关键条件为保持较高伪装成本和期望风险成本;相应的政策应集中于建立医疗服务行业规范和提升医疗监察效率.     

物理-社会耦合系统下震后多方协同救援的微分博弈模型

地震灾害救援系统是一个涉及道路通行能力和多方参与的物理-社会复杂耦合系统。其中,物理系统中道路受损是影响救灾物资运输的重要因素之一,社会系统中政府和社会力量的协同治理成效决定了救灾效果。为提高物资运输效率和灾区救灾量,本文考虑道路通行能力构建政府和社会组织协同运输非合作救援模式、协同合作救援模式以及政府补贴模式的微分博弈模型,计算了三种模式下多方努力水平、补贴比例、救灾量和系统均衡收益。研究发现,在一定条件下,政府补贴作为一种激励机制,可提高社会组织救灾努力水平、实现双方救灾效益的帕累托改进。社会系统中三种救灾模式具有不同的耦合效果。其中,协同合作救援最优策略及整体最优收益均严格优于非合作和政府补贴两种模式。     

Introduction to Special Section on Sensitivity Analysis and Summary of NCSU/USDA Workshop on Sensitivity Analysis

This guest editorial is a summary of the NCSU/USDA Workshop on Sensitivity Analysis held June 11–12, 2001 at North Carolina State University and sponsored by the U.S. Department of Agriculture's Office of Risk Assessment and Cost Benefit Analysis. The objective of the workshop was to learn across disciplines in identifying, evaluating, and recommending sensitivity analysis methods and practices for application to food‐safety process risk models. The workshop included presentations regarding the Hazard Assessment and Critical Control Points (HACCP) framework used in food‐safety risk assessment, a survey of sensitivity analysis methods, invited white papers on sensitivity analysis, and invited case studies regarding risk assessment of microbial pathogens in food. Based on the sharing of interdisciplinary information represented by the presentations, the workshop participants, divided into breakout sessions, responded to three trigger questions: What are the key criteria for sensitivity analysis methods applied to food‐safety risk assessment? What sensitivity analysis methods are most promising for application to food safety and risk assessment? and What are the key needs for implementation and demonstration of such methods? The workshop produced agreement regarding key criteria for sensitivity analysis methods and the need to use two or more methods to try to obtain robust insights. Recommendations were made regarding a guideline document to assist practitioners in selecting, applying, interpreting, and reporting the results of sensitivity analysis.     

Distinguishing traumatic, vicarious and routine operational stressor exposure and attendant adverse consequences in a sample of police officers

Problems in studying occupational stress within the police service are identified and the paucity of work on operational duties as potential stressors are discussed. The present study reports the results of a factor analysis of operational stressors (N = 601 serving British police officers) that revealed three factors: exposure to death and disaster; violence and injury; sexual crime. These were demonstrated to be reliable scales and were included in logistic regression models together with a range of demographic and psychological variables. Models were applied to men and women separately, which showed there to be different predictors of the likelihood of suffering distress (measured by the General Health Questionnaire, GHQ) in terms of the officer's gender and operational role. Overall the model for women officers was better at predicting psychological distress than that for men. These findings are related to aspects of the police occupational culture. Further discussion is offered that conceptualizes police operational stressors as traumatic, routine and vicarious. Finally, some implications are drawn for the provision of stress intervention in the light of this differentiation.     

Criteria for selecting a production control philosophy

Logistic objectives constitute a compromise between having short leadtimes and a low volume of work in progress on the one hand and a high resource loading and due date obligation on the other. Miscellaneous production planning approaches offered today provide different combinations of logistic objectives for satisfying a manufacturing strategy. To combine the strength of the various approaches into a unified system, a new approach based on a dynamic and distributed production planning methodology is proposed. To customize the approach, various analyses and specifications have to be made and for that reason some important characteristics and criteria for analysing production control philosophies will be given.     

The social construction of the meaning of acute stressors: a qualitative study of the personal accounts of police officers using a stress counselling service

The police profession is one in which acute stressors are encountered more frequently than in other occupations. Using the personal accounts of 35 police officers attending an in-house stress counselling clinic, the aim of the present study was to provide a qualitative examination of how the institutional context of policing influenced the ways in which acute stressors signified to individual police officers experiencing felt distress. Using the framework of Rational Emotive Behaviour Therapy as an analytical tool, it is argued that beliefs contributing to the experience of felt distress are related to the way in which policing as both an identity and an activity is constructed through the police organizational culture. Not only do these constructions influence the ways in which officers perceive themselves and their environments, but they also operate at the collective level to 'normalize' some emotional responses and to 'pathologize' others which, it is argued, could impact upon the outcomes of interventions such as stress counselling.     

The moderating role of social support in Karasek's job strain model

This paper examines whether social support is a boundary-determining criterion in the job strain model of Karasek (1979). The particular focus is the extent to which different sources of social support, work overload and task control influence job satisfaction, depersonalization and supervisor assessments of work performance. Hypotheses are tested using prospective survey data from 80 clerical staff in a university setting. Results revealed 3-way interactions among levels of support (supervisor, co-worker, non-work), perceived task control and work overload on levels of work performance and employee adjustment (self-report). After controlling for levels of negative affect in all analyses, there was evidence that high levels of supervisor support mitigated against the negative effects of high strain jobs on levels of job satisfaction and reduced reported levels of depersonalization. Moreover, high levels of non-work support and co-worker support also mitigated against the negative effects of high strain jobs on levels of work performance. The results are discussed in terms of the importance of social support networks both at, and beyond, the work context.     

Job insecurity, coping resources and personality dispositions in occupational strain

This paper presents research on the relationships between the work-related stressor of perceived job insecurity and various indicators of occupational strain, taking into account employees' personality dispositions (trait negative and positive affectivity) and coping resources. Respondents were 222 Australian public servants surveyed during organizational restructuring that involved downsizing and threat to job certainty. The research was formulated within an adaptation of Osipow, Doty, and Spokane's (1985) framework of stress-strain-coping that included the possible direct as well as moderating effects of personality dispositions in reporting occupational strain (Parkes, 1990). Findings from hierarchical regression analyses indicate consistent significant independent effects of personality dispositions, coping resources and perceived job insecurity on various indicators of strain. There was also support for the moderating roles of negative affectivity and self-care in the relation between perceived job insecurity and physical strain. Implications for the role of dispositional factors, especially negative affectivity, and the utility of various coping resources in accounting for occupational strain in times of threatened job security are discussed.     

Job stress, job strain, and psychological withdrawal among Dutch university staff: towards a dualprocess model for the effects of occupational stress

This study examined the antecedents of job strain (emotional exhaustion, health complaints) and withdrawal behaviour (e.g. lowered organizational commitment) among a cross-sectional sample of 131 academic staff members of the law department of a large Dutch university. Conservation of resources theory (Hobfoll, 1989) provided the theoretical background for this study. Strains and withdrawal behaviours were expected to be most prominent among those who reported having few resources and/or who reported high job demands. Structural equation modelling revealed that this was indeed the case. As predicted, differential patterns of effects emerged for job demands and job resources. Analysis of the effects of four job-specific stressors revealed that especially the structural aspects of a staff member's teaching task (e.g. the number of students in their classes) contributed strongly to perceived job demands. Theoretical and practical implications of the study are discussed.     

Dermal Uptake of 18 Dilute Aqueous Chemicals: In Vivo Disappearance‐Method Measures Greatly Exceed In Vitro‐Based Predictions

Average rates of total dermal uptake (K_up) from short‐term (e.g., bathing) contact with dilute aqueous organic chemicals (DAOCs) are typically estimated from steady‐state in vitro diffusion‐cell measures of chemical permeability (K_p) through skin into receptor solution. Widely used (“PCR‐vitro”) methods estimate K_up by applying diffusion theory to increase K_p predictions made by a physico‐chemical regression (PCR) model that was fit to a large set of K_p measures. Here, K_up predictions for 18 DAOCs made by three PCR‐vitro models (EPA, NIOSH, and MH) were compared to previous in vivo measures obtained by methods unlikely to underestimate K_up. A new PCR model fit to all 18 measures is accurate to within approximately threefold (r = 0.91, p < 10^?5), but the PCR‐vitro predictions (r > 0.63) all tend to underestimate the K_up measures by mean factors (UF, and p value for testing UF = 1) of 10 (EPA, p < 10^?6), 11 (NIOSH, p < 10^?8), and 6.2 (MH, p = 0.018). For all three PCR‐vitro models, log(UF) correlates negatively with molecular weight (r² = 0.31 to 0.84, p = 0.017 to < 10^?6) but not with log(vapor pressure) as an additional predictor (p > 0.05), so vapor pressure appears not to explain the significant in vivo/PCR‐vitro discrepancy. Until this discrepancy is explained, careful in vivo measures of K_up should be obtained for more chemicals, the expanded in vivo database should be compared to in vitro‐based predictions, and in vivo data should be considered in assessing aqueous dermal exposure and its uncertainty.     

Systems Resilience for Multihazard Environments: Definition,Metrics, and Valuation for Decision Making

The United Nations Office for Disaster Risk Reduction reported that the 2011 natural disasters, including the earthquake and tsunami that struck Japan, resulted in $366 billion in direct damages and 29,782 fatalities worldwide. Storms and floods accounted for up to 70% of the 302 natural disasters worldwide in 2011, with earthquakes producing the greatest number of fatalities. Average annual losses in the United States amount to about $55 billion. Enhancing community and system resilience could lead to massive savings through risk reduction and expeditious recovery. The rational management of such reduction and recovery is facilitated by an appropriate definition of resilience and associated metrics. In this article, a resilience definition is provided that meets a set of requirements with clear relationships to the metrics of the relevant abstract notions of reliability and risk. Those metrics also meet logically consistent requirements drawn from measure theory, and provide a sound basis for the development of effective decision‐making tools for multihazard environments. Improving the resiliency of a system to meet target levels requires the examination of system enhancement alternatives in economic terms, within a decision‐making framework. Relevant decision analysis methods would typically require the examination of resilience based on its valuation by society at large. The article provides methods for valuation and benefit‐cost analysis based on concepts from risk analysis and management.     

Employees' perceptions of organizational restructuring: the role of social support

Organizational change and restructuring is often perceived as leading to increased occupational stress, impacting negatively on the psychological well-being of employees. This pragmatic study investigates the role of social support and dispositional affect as moderators of role stress post-restructuring for employees in a public utility company. A total of 176 employees, including 37 managers, 60 graded staff and 78 industrial staff completed a self-report questionnaire, approximately 1 year postrestructuring, retrospectively assessing role conflict, ambiguity, overload and positive and negative feedback pre- and post-restructuring. Results suggested that overall role stress increased for managers/ senior officers and graded staff, but not for industrial staff. Social support was linked with lower role stress, more positive feedback and less negative feedback at post-restructuring. For certain role stressors this impact was moderated by dispositional affect, but the effect was not consistent across occupational groups. Positive affect enhanced the effect of manager support in reducing role conflict for graded staff, and the effect of co-worker support in increasing positive feedback and reducing negative feedback for industrial staff. Findings suggest that managers should pay particular attention to support and feedback for employees during periods of chronic occupational stress following organizational restructuring.