正确处理好医卫公益性与医保基础性的关系

深化医改要以健全医保体系为基础,推进公立医院改革要以完善医保支付制度为重要推手.深化医改与推进医保能否协调同步,关键在于能否处理好医疗服务的公益性与基本医保的基础性关系.     

以人为本的高校德育新模式

传统的高校德育模式偏重于“道德理论”、“道德知识”和“政治伦理”的灌输,缺乏自身应有的稳定性、逻辑性和科学性,在价值取向上难以摆脱社会本位和政治伦理的倾向。改革高校德育就必须构建“以人为本”的现代高校德育新模式,重视生命关怀,关注学生生命及其生命的生存状况和生存意义,进一步完善德育课程体系,拓宽德育内容,塑造大学生的健康人格和积极向上的人生价值观。     

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.     

Maternal Employment,Community Contexts,and the Child‐Care Arrangements of Diverse Groups

Integrating family and child data from the Early Childhood Longitudinal Study–Birth Cohort with contextual data from the census, this study examined associations among maternal employment, aspects of communities related to child‐care supply and demand, and the early care and education arrangements of 4 year olds in Mexican‐origin, Black, and White families. Children with employed mothers were more likely to be in informal care arrangements than in early childhood education, regardless of racial/ethnic background. For children in Mexican‐origin families, selection into informal care over early childhood education was more likely in zip codes with greater demand for care as measured by higher female employment. Utilization of parent care versus early childhood education was also more likely for children in Mexican‐origin and Black families in zip codes with higher female employment. Constraints associated with maternal employment thus hindered children from enrolling in early childhood education, and community contexts posed challenges for some groups.     

Family Characteristics and Mate Selection: Evidence From Computer‐Assisted Dating in Japan

Research on mate selection rarely considers singles' preferences for their future partners' family configurations and experiences. Using online dating records from a matchmaking agency in Japan, a society with a strong emphasis on family and kinship, we examine how singles' responses to date requests correspond to potential mates' family circumstances. Results showed that singles' preferences for potential partners' family characteristics stem from a concern about future obligations toward the partner's family and stereotypes associated with certain family traits. Singles are less likely to accept requests from those from large families, which are seen as traditional. Being from a large family, however, hampers individuals' dating chances more if they are firstborn and have no brothers, two conditions that make them the designated child to care for elderly parents. We also find that Japanese singles seek partners with more of the universally valued family traits rather than traits similar to their own.     

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

ABSTRACT

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.