制约高校体育保健课程发展的因素剖析

采用问卷、访谈等方法对浙江省15所高校体育保健课程的发展现状进行了调查分析。结果表明：（1）教学目标欠全面、明确;（2）部分高校教学文件缺乏,教师专业功底不深;（3）个别院校无独立开班,课堂教学多数采用的是统一模式;（4）教学内容不均衡;（5）评价体系单一。同时对出现的问题也提出了发展建议。     

我国医药卫生法制体系建立健全刍议

针对《中共中央国务院关于深化医药卫生体制改革的意见》的相关内容,论述了我国医药卫生法制建设的现状及存在的问题,对建立健全医药卫生法制体系提出了建议。     

社会保障基金长期财务随机预测模型的比较与选择

为了测算分析社会保障制度的可持续发展,世界上不少国家建立了社会保障基金长期财务预测模型。与确定性财务预测模型相比,随机预测模型有利于阐明预测结果所面临的不确定。美国在运用随机预测模型对社会保障基金的财务状况做出预测方面走在世界最前端,我国对社会保障基金随机预测模型的研究基本处于空白。本文对美国社会保障署和国会预算办公室采用的社会保障基金长期随机预测模型进行了比较分析,对两种模型的选择给出了建议,最后提出了我国建立社会保障基金长期预测模型的一些建议。     

Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services

Twikirize JM, O'Brien C. Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services Uganda reintroduced free healthcare in 2001, but today, nine years later, less than 30 per cent of the population are using these services. This study investigated why rural households were under‐utilising the government's free health services and turning to community health insurance instead. A survey carried out on 260 randomly selected households was triangulated with qualitative data gained from 3 focus groups and 12 in‐depth interviews. The findings showed that 21 per cent of the households always accessed the government's free health services, while 79 per cent used private health services. The reasons given were poor quality services, including frequent drug stock‐outs, unmotivated and insufficiently trained health personnel, and overcrowding. Factors influencing enrolment in community health insurance included easier access to healthcare, financial protection against the cost of care, better quality care and benefits related to mutual assistance. This has both practical and policy implications, which are discussed in this article.     

构建老人福利机构危险管理机制——日本经验之启示

"养儿防老"是中国传统的养老模式,长期以来老人的养老主要依靠子女来解决,但是随着生活方式的改变、家庭规模的日趋小型化,老人的长期照顾问题受到了社会的广泛关注。近年来国家制定了相关的政策、制度以及服务来满足老人及其家人的需求,然而老人福利机构及所提供的照顾服务,其服务质量离人性化照顾服务仍有一段距离。就现阶段而言,老人福利机构所提供照顾服务的质与量,均有提升与改善的空间。日本是亚洲第一个施行公共性长期照顾保险的国家,其施行之初也面临着一些与我国同样的问题,为提升长期照顾机构的服务质量,日本厚生劳动省在介护保险制度施行后的2002年,就开始倡导老人福利机构应建立危险管理机制的理念,并于2006年修订老人长期照顾福利机构管理规则,规定老人福利机构应建立危险管理机制,以提升照顾服务质量。有鉴于此,本文将对日本老人长期照顾福利机构建立危险管理机制的过程、基本架构,以及相关课题做系统说明,为我国老人福利机构经营管理提供参考,也可为我国未来在探讨老人长期照顾问题之际,提供必要的配套依据。     

Likelihood inference based on EM algorithm for the destructive length-biased Poisson cure rate model with Weibull lifetime

In this article, we consider the destructive length-biased Poisson cure rate model, proposed by Rodrigues et al., that presents a realistic and interesting interpretation of the biological mechanism for the recurrence of tumor in a competing causes scenario. Assuming the lifetime to follow the Weibull distribution and censoring mechanism to be non-informative, the necessary steps of the EM algorithm for the determination of the MLEs of the model parameters are developed here based on right censored data. The standard errors of the MLEs are obtained by inverting the observed information matrix. A simulation study is then carried out to examine the method of inference developed here. Finally, the proposed methodology is illustrated with a real melanoma dataset.     

The impact of health insurance cost-sharing method on healthcare utilisation in China

In current Chinese health insurance programmes, there are two types of cost-sharing methods: the time-of-service copayment policy and the reimbursement policy. In contrast to the copayment participants, reimbursement participants need to pay for all medical expenses in advance. We study the effect of the reimbursement policy on the utilisation of healthcare services in China. The theoretical analysis indicates that the medical consumption of low income households will be less than the optimal consumption level when enrolled in a reimbursement programme instead of a copayment programme. Empirically, using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that the total inpatient expenditure of the reimbursement participants is 12.7% lower than that of copayment enrolees, and the reimbursement arrangement negatively impacts low-income and rural populations. Therefore, reimbursement participants, those who are financially constrained, are more likely to suffer the up-front payment burden and finally reduce their healthcare needs.     

A Medicare Adult Day Care Model

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting hem were: services to be provided directly, 14.6%; multidisciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings. implications for Medicare funding policy are discussed.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Sequencing and Scheduling Appointments with Potential Call‐In Patients

This paper studies appointment scheduling for a combination of routine patients who book well in advance and last‐minute patients who call for an appointment later that same day. We determine when these same‐day patients should be scheduled throughout the day, and how the prospect of their arrivals affects the appointment times of the routine patients. By formulating the problem as a stochastic linear program, we are able to incorporate random and heterogeneous service times and no‐show rates, ancillary physician tasks, and appointment delay costs for same‐day patients who prefer to see the doctor as early as possible. We find that the optimal patient sequence is quite sensitive to the no‐show probabilities and the expected number of same‐day patients. We also develop two simple heuristic solutions to this combinatorial sequencing problem.