A Demonstration of Methods for Studying Negotiations Between Physicians and Health Care Managers*

Decision analysis was used to study negotiations in the health care context. This paper found that analytical methods could answer several important questions related to complex negotiations, including whether contracts promote the interest of both parties, whether a decision aid could better meet the priorities of both parties, and whether one negotiator is more successful than the other in repeated negotiations. The paper concluded that micro-health care negotiations can be traced and studied with existing mathematical theories of negotiation.     

Refusal of recommended maternity care: Time to make a pact with women?

Background

The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care.

中国政府决策能力评价及其优化研究——以医疗卫生体制改革决策为例

决策能力是政府能力之制高点,对政府履行职能、实现使命以增进和维护公共利益至关重要。审视中国医改决策进程,中国政府体现了较强的政策学习与调适能力和智力与技术资源动员整合能力,决策环境协调能力明显提升;但其决策价值导向能力曾出现摇摆偏移,在利益整合能力、目标获取与锁定能力、政策定位与供给能力、经济资源汲取能力、资源配置能力等方面仍有很大提升空间,必须通过优化和强化政府决策能力来改善政府决策效度。     

隔代照顾的生物社会学动因及影响分析

当前社会环境下,儿童照顾给工作和家庭平衡带来压力和挑战。隔代照顾成为缓解这一压力的流行方式而得到了广泛的关注,学术界产生了许多研究成果。其中,生物社会学视角在国外隔代照顾研究中有较多的应用。但是在国内采用这一视角进行的实证研究非常少。本研究以中国健康与养老追踪调查(CHARLS)2015年的数据为资料,通过生物社会学的视角并使用广义Logistic模型和广义线性模型对四类儿女双全的祖辈的隔代照顾的积极性进行分析。结果表明亲缘选择假设不能完全解释四类祖辈照顾孙辈的积极性的差异。虽然从整体上看女性祖辈比男性祖辈更积极地照顾孙辈,但是父系女性祖辈照顾孙辈的积极性并没有像亲缘选择假设所推断的那样显著低于母系女性祖辈。同时,分城乡的回归结果表明城镇地区四类祖辈的积极性没有显著差异,而在乡村地区父系女性祖辈的照顾强度显著高于其他三类祖辈。因此,亲缘选择理论可以解释照顾者性别差异的部分原因,而无法阐明父系和母系的宗族差异。此外,照顾者的工作状态、婚姻状态、受教育水平、子女的经济支持、子女的数量和子女的年龄都是影响隔代照顾积极性的显著因素。需要注意的是虽然生物社会学理论有其独特的价值,但是将它用于社会研究也有明显的局限性。因此,这一理论仍然有许多亟待探索和完善的空间。     

Children in Educational Residential Care: A Cohort Study of Israeli Youth

Abstract

This article reports preliminary findings from a national cohort study in Israel on the educational outcomes of 82,342 Jewish citizens born in 1981. We compare the educational outcomes of 2002 alumni of youth villages and their peers in the general population with respect to differences among cultural subgroups. The Israeli Central Bureau of Statistics generated the database by combining different official data files based on a personal identification number that each Israeli citizen receives. This database covers the entire cohort and includes information on their background and educational status. The findings indicate that the educational status of alumni of youth villages at the age of 27 is less positive compared to that of their peers in the general population. Cultural differences are discussed with respect to the role of youth villages as a means for upward mobility of disadvantaged youth, and implications for policy and future research are suggested.     

Life after Growing Up in Care: Informing Policy and Practice through Research

Abstract

Existing research on the impact of growing up in care focuses upon either the care experience itself or the period of transition from care to independence. Our knowledge of outcomes largely ceases when former residents of the care system reach their early twenties. There are strong social justice reasons for extending research into the older adult lives of such young people. We know a great deal about the multiple disadvantages that such individuals face as children. But research is largely silent about their subsequent adult lives. While we must be cautious in drawing causal links to the childhood care experience as the time period since life in care extends, we know that early experiences can affect care-leavers across their life course—just as childhood experience affects all adults in a variety of ways. In this review, we highlight evidence drawn from research in Australia, the United Kingdom, Canada, Ireland, and the United States, with particular attention paid to the first two of those countries. We use a wide range of sources and identify areas for further consideration, including access to personal records, mental health, education, and parenting. By doing so, we seek to open up this area for further research with the hope that such research will lead to an increasing recognition of care-leavers' needs and thus to improvements in social policy and service provision.     

Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.     

What’s the Relationship Got to do with It? Understanding the Therapeutic Relationship in Therapeutic Foster Care

The therapeutic relationship is increasingly recognized as important to understanding how process variables contribute to treatment outcomes. In this paper, we examine the therapeutic relationship between children with serious emotional and behavioral disorders and their treatment providers in the context of an observational study of Therapeutic Foster Care (TFC). Our findings suggest that the quality of the relationship between the treatment parent and youth in a TFC setting is significantly associated with better emotional and behavioral functioning for the youth. It appears from these findings that the quality of the relationship between the youth and treatment parent in a TFC setting is at least one of the mechanism or process factors that contribute to improved functioning for the youth.     

“光棍节”网络购物意愿的影响因素

影响日常网络购物意愿的因素,除商品质量外,网购成本、网购风险、网商服务等对大学生光棍节网络购物意愿无显著影响,体现出大学生光棍节网络购物具有非理性的一面,存在从众购买、冲动购买的现象。然而,对258名大学生的调查发现,大学生在光棍节越感觉情感寂寞与孤独越不会在光棍节进行网络购物。要实现对大学生光棍节网络购物的合理引导,需要高校、大学生自身及网商的共同努力。