Fairness of the national health service in Italy: a bivariate correlated random effects model

The primary purpose of this paper is to comprehensively assess households’ burden due to health payments. Starting from the fairness approach developed by the World Health Organization, we analyse the burden of healthcare payments on Italian households by modeling catastrophic payments and impoverishment due to healthcare expenditures. For this purpose, we propose to extend the analysis of fairness in financing contribution through a generalized linear mixed models by introducing a bivariate correlated random effects model, where association between the outcomes is modeled through individual- and outcome-specific latent effects which are assumed to be correlated. We discuss model parameter estimation in a finite mixture context. By using such model specification, the fairness of the Italian national health service is investigated.     

Nursing a Grievance? The Role of Healthcare Assistants in a Modernized National Health Service

The complex division of labour in health care has encouraged the analysis of occupational boundary disputes between separate professions. Less attention has been directed at the divisions in individual occupational groups but in a context of intensive health sector workforce reform there has been a growth in lower status occupations. This article extends debate about lower status occupations by exploring the manner in which nurses and healthcare assistants engage in boundary work to advance their occupational interests. The UK government's modernization agenda has encouraged a more prominent role for healthcare assistants and the findings confirm that this agenda has reinforced occupational boundary disputes between nurses and healthcare assistants. Tensions between nurses and healthcare assistants took particular forms influenced by gendered notions of caring work. The consequences of these boundary management strategies in terms of work undertaken, pay and status are also explored.     

Mobilising patients towards transnational healthcare markets – insights into the mobilising work of medical travel facilitators in Delhi

ABSTRACT

Medical travel facilitators play an important role in mobilising patients towards transnational healthcare markets. However, little is known about the actual mobilising work of medical travel facilitators located at destination sites, such as Delhi, India. The following ethnographic study suggests conceptualising medical travel facilitators as brokers who are productive of a mobility infrastructure. This allows categorising three mobilisation strategies: direct patient mobilisation, channel partner mobilisation and patient testimonial mobilisation. These strategies draw attention to practices that build trust over distance, the power of word-of-mouth and the importance of nurturing personal relationships that translate into transnational channels that direct people to particular destinations.     

高校工会建立师德师风长效机制的措施研究

高校在整个社会道德建设中具有特殊重要的地位,它是培养创造性人才的摇篮,是传播精神文明的重要阵地。高校工会在师德师风建设过程中的积极努力,对于架构长期的有效机制确保师德师风建设的有效开展具有十分重要的积极意义。文章通过探讨高校工会在师德师风建设中的各项措施,旨在更好推动高校师德师风建设。     

Long-Term Care Insurance in Japan

Abstract

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan? This article presents answers to these questions.     

Healthcare Experiences of Latinos in a Nontraditional Destination Area

The purpose of this study was to describe the health and healthcare experiences of immigrant Latinos compared to USA-born Latinos, Whites, and African Americans in Greater Cincinnati, Ohio, a nontraditional immigrant destination area. Immigrant Latinos had significantly worse physical and mental health than other groups and significantly more barriers to healthcare. Latinos rated the degree to which their town is socially accepting of Latinos. Lower social acceptance was correlated with worse mental health and more barriers to healthcare. Geographic information system (GIS) mapping techniques revealed geographic patterns in the association between social acceptance of Latinos and health outcomes.     

The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

高校毕业生城乡基层就业的长效机制研究

大学生基层就业既是缓解大学生就业压力,也是解决基层人才匮乏问题的有效路径。当前,大学生基层就业受到多重行为因素影响,主观认知上存在待遇水平、发展空间、地域差别、就业观念、生活环境等因素影响,客观上受到政策支持力度、经济发展状况、社会和家庭观念等因素制约,其中待遇水平和政策支持力度是两个关键影响因素。对浙江省高校毕业生的实际研究发现,构建促进高校毕业生到基层就业的长效机制应从创建大学生基层就业的人文关怀服务体系、政策扶持体系、资金融通支持体系以及教育培训体系四个维度入手。     

“That Model is Sooooo Last Millennium!” Residential Long-Term Care as a System,Not a Place

The current quandary with the design of existing long-term care settings results from focus on structures (“institutions”) instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences, and the home. Supported by analyses of the commonalities, socio-historical and political contexts, core values, and fallacies of social and medical models in existing and emerging long-term care options, a holistic model is proposed based on new core values that facilitate community and family integration and that asserts dignity and personhood as universal attributes in an array of settings.