The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

The Legacy of War: An Intergenerational Perspective

Children of combat veterans are affected to varying extents by the physical and psychological aftermath of war as experienced by the parent. Traumatic experiences exist on a continuum; trauma related messages can be communicated by a parent who does not have Post Traumatic Stress Disorder. An intergenerational perspective explores the complex family processes by which those who did not experience the actual events come to exhibit varying degress of emotional, psychological and behavioral manifestations of their parents' traumatic experiences.     

Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

Condom use negotiation in heterosexual African American adults: responses to types of social power-based strategies

This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually active African American adults attending an inner-city community center. Participants completed a semistructured qualitative interview in which they were presented with six negotiation strategies based on Raven's 1992 Power/Interaction Model of Interpersonal Influence. Results showed that female participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Male participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of participants indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention efforts are discussed.     

The truncation-by-death problem: what to do in an experimental evaluation when the outcome is not always defined

Although experiments are viewed as the gold standard for evaluation, some of their benefits may be lost when, as is common, outcomes are not defined for some sample members. In evaluations of marriage interventions, for example, a key outcome--relationship quality--is undefined when a couple splits up. This article shows how treatment-control differences in mean outcomes can be misleading when outcomes are not defined for everyone and discusses ways to identify the seriousness of the problem. Potential solutions to the problem are described, including approaches that rely on simple treatment-control differences-in-means as well as more complex modeling approaches.     

Correlates of gay and lesbian couples' relationship satisfaction and relationship dissolution

A sample of committed gay and lesbian cohabiting couples engaged in two conversations after being apart for at least 8 hours: (a) an events of the day conversation and (b) a conflict resolution conversation. Physiological data were collected during the conversations and a videotape record was made. Couples viewed the videotapes and rated their affect during the interaction. The video records were coded with a system that categorized specific affects displayed. Models derived from physiology, from the perception of interaction, and from specific affective behavior were related to relationship satisfaction, and to the prediction of relationship dissolution over a 12-year period. Results supported previous findings that satisfaction and stability in gay and lesbian relationships are related to similar emotional qualities as in heterosexual relationships.     

Unintended Population Consequences of Policies

Unintended population consequences of policies stem from three sources: (1) A policy overshoots its original goal; (2) different policies conflict, so that the implementation of one policy inhibits implementation of another policy; (3) negative consequences of a policy are unforeseen, or are anticipated but judged unlikely to be severe or considered less important than the positive aims of the policy. Examples from Singapore, South Africa, Italy, the U.S., and the former Soviet Union are discussed.