Agreeing on more than chicken soup: Intra-household decision-making and treatment for child psychopathology

Using a large, U.S. dataset it is shown that children are more likely to receive needed mental health specialty treatment when women have greater decision-making power, as measured by an index of wife-favorable divorce laws and by the sex ratio at the time of marriage. Stratified analyses show that this effect is modified by the degree of marital conflict. Marriages characterized by high conflict conform more closely to the unified household model. The paper then presents a model of household decision-making consistent with these results that incorporates both objective determinants of bargaining power as well as the role of violent coercion in maintaining otherwise unsustainable equilibria. Implications for improving children’s access to mental health treatment are offered.

Designing Referral Network Structures and Decision Rules to Streamline Provision of Urgent Health and Human Services*

This study uses fully factorial computer simulation to identify referral network attributes and referral decision rules that streamline the routing of people to urgent, limited services. As an example of a scenario, the model represents vaccine delivery in a city of 100,000 people during the first 30 days of a pandemic. By modeling patterns of communication among health care providers and daily routing of overflow clients to affiliated organizations, the simulations determine cumulative effects of referral network designs and decision rules on citywide delivery of available vaccines. Referral networks generally improve delivery rates when compared with random local search by clients. Increasing the health care organizations’ tendencies to form referral partnerships from zero to about four partners per organization sharply increases vaccine delivery under most conditions, but further increases in partnering yield little or no gain in system performance. When making referrals, probabilistic selection among partner organizations that have any capacity to deliver vaccines is more effective than selection of the highest‐capacity partner, except when tendencies to form partnerships are very low. Implications for designing health and human service referral networks and helping practitioners optimize their use of the networks are discussed. Suggestions for using simulations to model comparable systems are provided.     

Health Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally*

This article is motivated by the gap between the growing demand and available supply of high‐quality, cost‐effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences—including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end‐to‐end, supply chain–centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain–centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A‐framework, that is founded on three constructs—affordability, access, and awareness—to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device–based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high‐quality, cost‐effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article.     

我国人口流动中的健康选择机制研究

利用2008年中国流动与健康调查数据,对农村留守人口、农村外出返乡人口、乡城流动人口以及城镇居民等不同流动特征群体之间的健康差异进行比较,并系统检验了我国人口流动过程中的两种健康选择机制——"健康移民"(healthy migrant)效应和"三文鱼偏误"(salmon bias)效应。模型分析结果表明,我国人口流动存在着较为明显的"健康移民"和"三文鱼偏误"选择效应。在控制被访者的年龄、性别、主要社会经济特征以及相关健康行为后,流动人口自评一般健康、慢性病状况、经常性身体不适和肺活量等健康指标显著优于农村留守人口,乡城流动人口患有慢性病和出现经常性身体不适的可能性也显著低于农村返乡人口。在控制相关变量后,乡城流动人口与城镇居民的健康状况(除慢性病和心率过高症状外)不存在显著差别。     

人口因素对公共医疗服务效率的影响——区域差异与动态变化

本文基于2002～2010年我国31个省市的面板数据,在DEA—Tobit两阶段分析框架下研究了人口因素对我国区域公共医疗服务效率的动态影响。首先,通过数据包络分析方法（DEA）测算了各省份医疗卫生体系的综合技术效率、纯技术效率和规模技术效率。在此基础上,利用受限因变量Tobit模型对效率值及人口规模、人口密度、受教育程度、城市化率等人口因素之间的关系进行了检验。研究结果表明：人口规模、人口密度与医疗体系的综合服务效率显著正相关,尽管受教育程度和城市化率与综合效率关系并不明显,但是对医疗体系的规模效率和纯技术效率仍然存在显著影响。     

The Potential Impact of Discrimination Fears of Older Gays,Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care

ABSTRACT

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

The risk of under-insurance in the Finnish statutory pension scheme for self-employed workers: A trajectory analysis

Using unique data on the contribution base, we investigate under-insurance within the statutory pension scheme for self-employed workers in Finland. Under-insurance is defined as the difference between pension-declared income and tax-declared income. The trajectory modelling technique applied has allowed us to estimate the levels of under-insurance for different subgroups and to identify possible explanatory factors. Under-insurance is found to be persistent and large. The analysis reveals six distinctive and homogenous sub-groups of self-employed workers. Close to 84 per cent of these workers pay too little in contributions, often leading to inadequate protection against personal risks. Especially for lower-income self-employed workers, this points to myopic behaviour as regards contributing to the self-employed statutory pension scheme and calls for fine-tuned economic incentives.     

Modelling school participation based on the theory of planned behaviour / Modelamiento de la participación escolar basado en la teoría del comportamiento planificado

This study evaluated a predictive model of school participation based on Ajzen’s theory of planned behaviour. Attitudes towards social justice, perceived control and subjective norm on school participation were tested, mediated by the behavioural intention in favour of social justice in a sample of 443 secondary school students. The proposed model showed good fit (χ² = 597.740, df = 342; RMSEA = .041). The behavioural intentions towards social justice and perceived behavioural control were directly related to school participation. An indirect effect of perceived control on participation was detected, mediated by behavioural intention, but no evidence was found of the indirect effect of either attitude or norm on school participation.     

Caring Adults: A Brief Report Assessing Adults’ Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Abstract

Objectives: As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults’ needs with regard to engaging in sexual health conversations with youth and young adults.

Methods: A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results: Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants’ comfort.

Conclusions: To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.