再析我国“看病贵看病难”现象

长期以来,＂看病贵,看病难＂一直成为政府、业界、学者、百姓普遍关注和争论的焦点、热点话题。究其原因,表面上看似乎是医疗服务供方的原因,但事实上在我国更为重要的却是医疗服务需方（医疗保险基金支付不足）的问题。然而政府似乎对医疗服务供方采取的措施多一点,而对医疗保险需方采取的措施少一些。由于国力有限,政府不可能保证每个公民都能享有基本医疗保险。但如果不能从根本上解决医疗服务需方经费不足的问题,那么＂看病贵看病难＂现象会依然存在,绝不仅仅是单靠药品降价、招标采购等措施就能解决的。文章试图通过对＂看病贵看病难＂现象的深层分析,提出解决这一问题的一些措施与建议。     

基于DtSBM模型的中国医疗卫生服务效率动态评价

在现有动态DEA模型DSBM的基础上,构建了时期效率最优的DtSBM模型,并以省（市）为决策单元（DMU）运用该模型对中国31省（市）（除港、澳、台）2008-2015年的医疗卫生服务效率进行动态评价。通过对各省（市）医疗卫生服务各时期的最优效率值（即时期效率）和所有时期的整体效率值（即整体效率）的测算,从医疗卫生服务效率的角度验证了中国自2009年开始正式实施的"新医改"具有显著效果;按东、中、西部区域划分时,东部医疗卫生服务效率最高,西部次之,中部最低;通过对决策单元各项投入产出指标需改进百分比的分析,提出了相对效率值较低的无效决策单元——山西省、黑龙江省、吉林省、辽宁省和陕西省改进其医疗卫生服务效率的方向和目标。     

Rural homelessness: its effect on healthcare access,healthcare outcomes,mobility, and perspectives of novel technologies

Rural homelessness is an undeniable public health issue that is understudied in the research literature. The purpose of this study was to determine the sociodemographics, physical and mental health status, barriers to access to care, and perspectives on potential technological advances of homeless individuals. A structured 45–90?min interview was utilized to gather demographic, physical health, mental health, mobility, and technology use data from a sample of 75 homeless individuals within three shelters in three micropolitan Nebraska cities. Individuals in this region were more likely to be white, unmarried, and mobile who have various physical and mental health disorders. Adherence to treatment of mental health disorders ranged from 43–60 percent. This population had increased employment, access to healthcare services, and use of technology than predicted. Leaders from all over the country can use these data to help improve state and local efforts to better cater to this vulnerable population's needs.     

Portuguese healthcare reforms in the context of crisis: External pressure or domestic choice?

As a result of the recent economic crisis, in 2011, Portugal signed a Memorandum of Understanding with the European Central Bank, the European Commission, and the International Monetary Fund (the “Troika”). In exchange for Troika's financial assistance, the Memorandum required the implementation of a specific set of reforms targeted at the healthcare sector. The literature on policy reforms in the context of crisis and conditionality argues that governments have restricted room to manoeuver in responding to external pressure. We challenge this view, finding that even in cases of conditionality and strong external pressures, crisis can be used as a window of opportunity for reforms substantially shaped by domestic policy choices. In the case of Portuguese health reforms, these choices were based on pre‐existing reform plans aimed on resolving country‐specific deficiencies of the healthcare system and were enabled by the two main political parties' strategies of tacit cooperation and blame avoidance. The article emphasizes the need for more fine‐grained analysis of welfare reforms in the crisis that pays equal attention to the institutional characteristics and the political context of the affected countries.     

A Paradigm Shift in Healthcare: An Open Door for Organizational Behavior Management

The United States spends more money on healthcare each year than any other country in the world (OECD, 2015). Despite high costs, the quality of healthcare is below average, resulting in a society that is far from “getting what it pays for.” High costs and poor quality have resulted in a recent paradigm shift from traditional fee-for-service systems where hospitals and providers were paid by volume of patients to value-based care, to where they are now paid by quality of care (Andel, Davidow, Hollander, & Moreno, 2012). This shift has pressured organizations to improve quality of care at a rapid pace. This paper seeks to assess how Organizational Behavior Management has helped address the quality of healthcare thus far and discuss avenues for future research and practice.     

Hiding in Plain Sight: Insights about Health-Care Trends Gained through Open Health Data

ABSTRACT

The open data movement constitutes an approach to achieving accountability for government organizations. Government agencies at the Federal and State levels have released open health data consisting of de-identified patient outcomes, costs and ratings. We applied big data analytics to understand patterns and trends in open health data. We envision the use of this data by concerned citizens to understand trends in health expenditures. We have built an open-source tool, BOAT (Big Data Open Source Analytics Tool, https://github.com/fdudatamining) to facilitate analytical exploration of open health data sets. We used BOAT to analyze data from the New York Statewide Planning and Research Cooperative System and determined that there has been a significant increase (40 percent) in the incidences of mental health issues amongst adolescents from 2009–2014. We analyzed costs for hip replacement surgery for 168,676 patients is in New York State, and showed that 88% of these patients had surgery costs of less than $30,000. This figure helps in understanding the decision by The California Public Employees’ Retirement System to cap hip replacement reimbursements at $30,000, resulting in significant savings. Our tool could enable researchers, hospitals, insurers and citizens to obtain an unbiased view on health-care expenditures, costs and emerging trends.     

Mitigating the U.S. Drug Shortages Through Pareto‐Improving Contracts

Drug shortages have been a major challenge facing the US pharmaceutical industry and government in recent years. Although the problem has drawn tremendous attention from the government and media, limited academic research has been devoted to this problem, and few solutions have been proposed based on rigorous research. This study addresses the drug shortage problem from a supply chain perspective, a key aspect missing in the literature, and proposes to mitigate shortages through drug purchase contracts. By modeling the drug supply chain, we capture the objectives of various supply chain parties, and investigate Pareto‐improving contracts that mitigate drug shortages, improve drug manufacturer's and group purchasing organization (GPO)'s profits, and cut government spending and healthcare providers’ costs. We explore structural properties of key supply chain decisions and the Pareto‐improving contracts, and conduct scenario analysis with realistic industry data to evaluate shortage mitigation solutions. Our analysis shows that increasing drug prices only, a solution advocated by many, is not very effective in shortage mitigation. Price increases must be paired with strengthened failure‐to‐supply clauses (called the IPS approach) to achieve consistent and significant shortage reduction as well as Pareto improvement. Across all scenarios tested, a 30% price increase under IPS can lead to a minimum, average, and maximum shortage reduction of 25%, 53%, and 70%, respectively. Our analysis also shows the impacts of IPS on different parties in the supply chain and the impacts of various model parameters on shortage mitigation. The IPS approach rewards reliability of drug supply, which is in line with the FDA's strategic plan to reward quality, but is easier to achieve in this regulation‐based industry. Interactions with the government and industry practitioners indicate that IPS also challenges the current mindset in pharmaceutical contracting.     

The human right to health: exploring disability,migration and health

Across the globe, an estimated one billion people are on the move today, of whom 244 million are international migrants. Not only have global horizons expanded in the realm of work and study; global conflict and exploitation have resulted in forced migration. Migration is a political issue, which raises questions of identity, citizenship, diversity and integration and is utilised to play upon the fear of the stranger, the ‘Other’ and difference in contemporary society. Disabled migrants are a hidden population whose experiences are often overlooked or subsumed within wider debates around disability and ethnicity. This article considers the intersection of disability and migration in contemporary society through the lens of healthcare access. Reflecting on the impact of citizenship rights on the realisation of human rights in the context of contemporary migration, using health as an example, the article considers the implications for disabled migrants, focusing primarily on the European Union.     

Lost in translation? Communication challenges in minority families’ and healthcare workers’ interactions

A fundamental principal in the Norwegian welfare system is to provide equal access to healthcare services for all residents, regardless of their ethnicity, language, knowledge, function, or belief. However, many service recipients experience a gap between these ideals and everyday realities. In this article I investigate how this gap affects minority families of disabled children who do not master the majority language and healthcare workers. The data I use in my investigation draw on a qualitative study of minority families of disabled children and healthcare workers. The findings that emerge out of these data are categorized into: linguistic difficulties, expectations and assumptions, and culture-bound services. I use these findings to illuminate how language difficulties and stereotypical assumptions within the Norwegian healthcare system make it difficult for minority families to access healthcare services, and how healthcare services lack an effective way to meet minority families’ needs.     

Under What Conditions do Lesbians Disclose Their Sexual Orientation to Primary Healthcare Providers? A Review of the Literature

Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature was undertaken to answer this question and to provide insight into the ways healthcare professionals can play an active role assisting their lesbian patients in “coming out.” Thirty empirical studies met the inclusion criteria and were reviewed. Collectively, these separate studies have found that a myriad of internal (patient attributes) and external (healthcare context, patient–provider relationship) factors influence disclosure. The discussion highlights the critical role of healthcare professionals in supporting disclosure.