建国后30年浙江农村合作医疗制度的历史考察

从1950年代至1970年代,浙江农村合作医疗制度从萌芽、发展到兴盛经历了一个复杂的历史过程。浙江农村合作医疗制度是浙江农村合作化及人民公社化运动的衍生物,并相伴始终。此长彼长,此消彼消。考察这一段历史,有助于我们在理论及实践两方面对恢复和重建中国农村合作医疗制度作进一步思考。     

临床共情的基本路径研究

目的：开展临床共情基本路径研究,调查共情基本路径执行现状,为共情临床实践提供建议。方法：利用自行设计的调查问卷,采用分层随机抽样方法,对江苏省8所公立医院825名临床工作者和在这些医疗机构就诊的807例患者的临床共情基本路径现状进行调查和分析,对医务工作者和患者共情的认知状况进行比较。结果：在临床共情基本路径中的神态、情绪、倾听、微笑环节,医务工作者与患者的认知存在偏差;在耐心、专注、语言、告知、解释环节临床工作者均表现不佳。结论：临床工作者各路径环节表现不佳,需结合临床共情路径的内涵和实施方法,促进临床共情实践的实现和发展。     

日本老年护理保险制度改革及经验启示

在人口老龄化危机日趋严重的背景下,日本对现行社会保障体系进行了全面的制度设计和整合。在进行养老和医疗保险制度改革的基础上,又推进了老年护理保险制度改革。本文首先研究了日本护理保险制度改革的背景;其次,分析了其现状、改革框架以及发展方向;最后在借鉴日本护理保险制度的经验基础上,分析了中国建立护理保险制度的必要性并提出相关的政策建议。     

Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BackgroundAlthough midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters.ObjectiveThe objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care.Research designThe qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters.FindingsSocially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional.ConclusionThis research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.     

社区照顾：应对我国老龄化社会的城市养老新模式

解决未来我国城市社区养老问题是解决城市老龄化问题的关键。这里在深刻分析传统的城市家庭养老模式面临严峻挑战和院舍式养老所存在缺陷的基础上,提出应借鉴国外福利国家的“社区照顾”养老服务模式,作为应对我国未来城市老龄化养老问题的对策,以进一步推动我国城市社区养老社会化的发展,实现未来城市社会的“老有所养,老有所乐”。     

基于管理式医疗的全民社会医疗保险初探

管理式医疗是美国占主导地位的医疗保险形式,可以看成是医疗保险公司运用期权思想管理风险的一种风险管理模式.深入剖析了我国医疗保险现存的问题,在公平与效率兼顾的基础上,借鉴美国管理式医疗的风险管理方法,提出了适合我国国情的全民社会医疗保险模式的构想,即以政府委托社会保障部门作为管理式医疗组织者,通过买入社区医疗服务网络这个买方期权,对冲其对投保人承担的卖出买方期权的风险,建立社会保障部门、社区医疗服务机构和投保人三方三位一体的风险管理模式.     

谈发展中的高校社区医疗保健

就高校医疗保健机构如何适应社会主义市场经济、如何适应国家的卫生体制 3项改革、适应高等教育发展等问题 ,探讨了高校医疗保健的现状及高校社区医疗保健的任务。从社区卫生诊断角度出发 ,研究了高校社区具有的特点 ,提出了健全高校社区医疗保健机构的对策 ,把高校的医疗机构演变成社会化的公益的社区卫生服务机构作为奋斗目标     

大学生的临终关怀意识与死亡态度

我国的临终关怀事业正在起步阶段,民众的临终关怀意识有待提升。基于问卷调查,探讨大学生的临终关怀意识及其与死亡态度和生活满意度之间的关系,结果显示,大学生临终关怀意识水平不高,89.6%的大学生不知道临终关怀如何实施;68.3%的大学生处于不镇定的死亡态度;病情告知、继续治疗、临终关怀认知、临终关怀接纳、死亡态度和生活满意度之间存在复杂的相关关系。Logistic回归分析提示,性别、是否配合家人假装不知道自己的病情以及生活满意度对死亡态度得分有较为显著的预测性。引导大学生参与临终关怀志愿活动,广泛开展科普宣传活动,可有效提升大学生的临终关怀意识,这对我国临终关怀事业的健康发展具有重要意义。     

多渠道医疗门诊挂号的时间策略研究

现阶段多种门诊挂号方式并存时,根据患者特性制定不同的等待时间策略尤为重要。本文考虑门诊挂号的三种渠道：直接排队挂号渠道、电话预约挂号渠道与O2O预约挂号渠道。在价格外生前提下,综合考虑患者的渠道偏好程度、时间敏感性与提前支付敏感性,基于效用理论构建患者的渠道选择模型。根据该模型推导得出不同市场条件下医院的需求,医院再据此制定患者的等待时间策略以达到利润最大化的目的。研究发现：当医院仅开通单一挂号渠道时,若患者的时间敏感度越大、渠道偏好程度越小,等待时间均越小;开通某两种挂号渠道时,还需考虑患者对两种渠道的偏好比例,偏好某种渠道的患者比例增加,选择该渠道的患者等待时间增加,选择另一渠道的患者等待时间减小;同时开通三种渠道时,最偏好某渠道的患者比例越大,选择该渠道的患者的等待时间也越大;在所有情况下,患者对提前支付的敏感度均不影响最优等待时间的制定。     

Motherhood Penalties and Living Arrangements in China

Past research on the “motherhood wage penalty” has been based on data from nuclear families, leaving open the possibility that the motherhood wage penalty may be lower or even absent in multigenerational families. In this article, the wage gap between mothers and nonmothers is examined in nuclear and multigenerational families in the context of contemporary China, which has a long tradition of patriarchal families. Using 1993 to 2006 China Health and Nutrition Survey data, the magnitude and variation of motherhood penalty is explored with fixed effects models among 1,058 women. The results show that each additional child lowers hourly wages by about 12%. In addition, the motherhood penalty is largest for women living with their husbands' parents, smaller for women not living with parents, and nil for women living with their own parents.