Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

MODEL-ASSISTED HIGHER-ORDER CALIBRATION OF ESTIMATORS OF VARIANCE

In survey sampling, interest often centres on inference for the population total using information about an auxiliary variable. The variance of the estimator used plays a key role in such inference. This study develops a new set of higher‐order constraints for the calibration of estimators of variance for various estimators of the population total. The proposed strategy requires an appropriate model for describing the relationship between the response and auxiliary variable, and the variance of the auxiliary variable. It is therefore referred to as a model‐assisted approach. Several new estimators of variance, including the higher‐order calibration estimators of the variance of the ratio and regression estimators suggested by Singh, Horn & Yu and Sitter & Wu are special cases of the proposed technique. The paper presents and discusses the results of an empirical study to compare the performance of the proposed estimators and existing counterparts.     

辩证地认识政府预算收支的平衡原则

政府预算收支原则 ,是政府组织预算收入 ,按排预算支出的指导思想。平衡原则是我国预算收支的支配性原则。本文辩证的分析了非均衡原则的缺陷 ,平衡原则对经济的调节功能及存在的局限性 ,从理念论述了政府预算平衡应选择的辩证方式     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

城市公共空间与大众健康--19世纪英国城市公园发展的启示

在城市发展和改造过程中,英国近代城市先后着手进行城市公共空间———公园建设,从而掀起了一场造园运动。这场运动既是英国城市发展的必然结果,同时也是解决城市环境问题、提高大众健康水平的需要。而公园等公共空间的建设,为居民提供了一个锻炼与休闲的空间,有利于提高居民的健康水平。健康的人居环境,为各阶层民众提供了聚会的场所,体现了社会成员和谐相处的精神,成为英国资本主义成熟的重要表现之一。     

大学生自我表露的比较研究

目的:考察主动到心理咨询中心求助的大学生自我表露和孤独状况并与普通大学生的资料进行比较;考察来访者对咨询员的自我表露与其他目标人的表露之差异。结果发现:求询大学生与普通大学生的自我表露相比显著地低;求询大学生对咨询员的表露比其他目标人的表露显著地高;求询大学生的孤独感明显地高于普通大学生;心理咨询在大学生发展过程中起着重要的作用。     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

民营经济的资金需求：陕西个案研究

在对陕西4个地市进行调研的基础上,估算了该省民营经济的资金需求总量,并分析了其资金需求的结构。结果表明,民营经济的资金存在需求总量难以满足和供求结构失衡的矛盾,在目前国有金融体系支持有限的情况下,民营经济对民间资本产生了强烈的需求。因此解决民营经济融资困境的出路在于有效搭建民间资本投入到民营经济的桥梁和通道。     

延边地方财政对区域经济增长的影响

在延边地方财政支出结构中,生产性支出的比重相对低,这对区域经济增长会产生短期效果影响。利用区域经济增长与地方财政支出之间因果关系模型实证分析延边地区的结果,证实了这一结论。为了区域经济的稳定增长,延边地区应适当提高生产性支出的比重。     

社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。