基于分层广义线性模型的非寿险费率厘定精算模型研究

非寿险业务中的损失数据结构日益复杂,呈现异质性与相关性并存的异象。分层广义线性模型能够突破传统费率厘定精算方法仅分析风险个体同一保单年损失数据的局限,可以提高复杂结构损失数据预测的准确性。基于分层广义线性模型等方法,研究具有多年损失数据的非寿险费率厘定问题,并以车险和工伤补偿保险的两组损失数据为例进行实证分析。研究结果表明,相对于GLM而言,考虑随机效应后GLMM的拟合优度大幅改善,GLMM与HGLM可以更有效地反映不同风险个体的差异,并有利于揭示风险个体在多个保险期内损失的异质性与相关性。     

基于生存分析法的医疗电子病历系统采纳与扩散研究

医疗电子病历系统作为中国医疗信息化建设的核心,关注其采纳与扩散机理,对推进医疗卫生信息化建设,以及实现有意义地使用具有重要的理论和实践意义。基于云南省222家医院信息化建设的调研数据,运用半参数生存分析法即Cox回归模型探讨医院采纳电子病历系统的影响因素及扩散机理。研究表明,教学状态、医院规模和建院时间均为有利因素,即这三个因素积极促进医院采纳电子病历系统;时间×规模为不利因素,即它对医院采纳电子病历系统有负向影响;地理位置在分层和删减样本的模型分析中均表现为不利因素;医院等级影响并不明显。     

《恶棍来访》中的后现代媒介元素

美国当代女作家珍妮弗·伊根的作品《恶棍来访》斩获2011年普利策文学奖,该小说融入丰富的媒介元素,以细腻的笔锋和锐意的形式创新折射出后现代社会文化的变迁。从超文本、多声部和电子媒体叙事三个层面来阐释文本建构的策略,体现出数字化时代下,媒介元素对文学创作的影响,彰显出作者对渐趋逝去的"X一代"的人道主义关怀。     

临床医学专业认证背景下完善教学质量监控体系的认识与思考

随着医学教育国际化进程的发展,医学院校的教学质量要通过具有医学特色的质量监控体系得以实现。专业认证作为医学教育质量的一种外部审核机制,是医学教育改革与发展的保障。因此,在认证标准的指导下,加强教学质量监控、健全教学质量监控制度、深化教学质量监控指标体系的建设势在必行。文章主要对如何更新教育理念,构建更加科学、合理、高效的教学质量监控体系进行阐述,分析临床医学专业本科教育标准的内涵建设,针对当前医学院校教学质量监控体系中存在的问题进行分析,研究当前质量监控体系发展的趋势,完善教学质量监控体系的建设,为医学资源的全球化发展提供人才支持。     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

Medicaid expansion and ethnoracial disparities in health insurance coverage

ABSTRACT

Medicaid expansion, as part of the Patient Protection and Affordable Care Act (PPACA), was touted by many policymakers as a potentially powerful force for reducing ethnoracial disparities in health insurance coverage. Using a unique county-level dataset at two time points (before and after the passage of the PPACA), we test whether Medicaid Expansion predicted change in ethnoracial disparities. Specifically, we use fixed-effect regression models to predict the Black-white, Hispanic-white, and Asian-white disparities in health insurance coverage. Using states that did not expand Medicaid as a counterfactual, our models show that this policy expansion was not significantly associated with a decrease in ethnoracial health insurance disparities. Overall, these findings suggest the need for scholars and policymakers to be more cautious and tempered about Medicaid expansion’s relationship with ethnoracial disparities in health insurance coverage. We discuss the implications of these findings for research on ethnoracial health insurance disparities, as well as policy efforts to increase coverage in minority communities.     

Social model of emotional labour and client satisfaction: exploring inter- and intrapersonal characteristics of the client−provider encounter

As part of healthcare organisations’ efforts to improve client satisfaction, special attention is directed to care providers’ expression of authenticity through genuine emotional displays in care encounters. The study’s aim was to test a mediating–moderating model for predicting clients’ satisfaction. The model combined intrapersonal forces (the healthcare provider’s level of caring and emotional load) and interpersonal forces (meeting the client in a team of professionals or alone, and client?provider similarity), as predictors of emotional labour strategies, and subsequent client satisfaction. Clients’ evaluation of whether or not the emotional displays were authentic was intended to moderate the link between emotional labour and client satisfaction. The sample consisted of 103 healthcare providers’ encounters with clients’ family members, randomly selected from five nursing homes. Data were collected by validated questionnaires at three time points. Mixed linear model analyses generally supported the proposed model. Meeting a client’s family in teams, ethnic similarity, and providers’ caring and emotional load stimulated higher levels of deep acting. Meeting clients alone and less emotional load involved more surface acting. These findings offer empirical support for the social interaction explanation of emotional labour, pointing to the importance of social characteristics of the service encounter in shaping emotional labour strategies and maintaining client satisfaction.     

公务员养老保险制度探析

公务员退休制度是社会保障制度的重要组成部分,而退休安置中的养老保险制度又是其重中之重。针对现行的公务员养老保险制度,提出了应变“国家保障”为“社会保障”的观点,并对此做了详尽的阐述。     

网络医学教育资源的应用研究

互联网上拥有非常巨大的医学教育资源库。网络技术的发展将使医学教学内容及手段产生根本性的改变。利用这些医学信息资源是医学教育发展的趋势,是现代医学学生必须掌握的技能。     

中国社会保障研究中的"效率"与"公平"

公平与效率作为社会发展的两大目标,任何一个社会系统的正常运行都离不开它,但在不同的社会发展阶段,它们又存在着一定的冲突,这时,社会保障能起着一种媒介作用,使经济、社会得以协调发展。