离散选择试验中试验设计步骤的实现——基于SAS宏程序的应用

正离散选择试验与试验设计离散选择试验(discrete choice experiment,DCE)是基于经济学的需求理论和效用理论进行研究的,最初应用于经济学、市场营销领域,近十几年被越来越多地应用到卫生领域。DCE在卫生领域中的应用主要有两方面,一是在卫生人力政策研究中的应用,主要用于测量卫生服务人员的工作意愿~([1-3])。如国内有研究者运用DCE研究乡镇卫生院护理人员的工作偏好,发     

吸引和稳定农村基层卫生人员的影响因素及其干预策略研究进展*

目的总结国内外有关农村基层卫生人员吸引和稳定的影响因素及其主要干预策略的研究进展,为改善我国农村基层卫生人员的招募和留用提供参考。方法对国内外基层卫生人力资源现状、离职意愿和工作意愿、工作选择的影响因素、主要干预策略和效果以及离散选择实验方法的应用等进行文献复习和研究。结果农村基层卫生人员尤其是骨干人员招募难、留用难,且存在较高的离职意愿,个人、工作和生活等相关因素是选择或留在农村基层的主要考虑因素。国内外采取了多种有效的干预措施,但缺乏对干预效果的评价。结论农村基层卫生人员招募难、留用难限制了我国农村基层卫生人力资源整体素质的提升,必须采取具有成本效果的干预策略加以改善。     

离散选择实验在农村地区卫生人员工作偏好研究中的应用

近年来,离散选择实验越来越多地被应用到卫生人员对农村地区工作特征偏好的研究中。2012年发布的《如何在农村和偏远地区开展吸引和留住卫生人员的离散选择实验：带有案例分析的用户指南》对离散选择实验应用步骤进行了系统阐述。基于上述指南,结合近年国内外相关文献中的创新性发展,对离散选择实验用于测量农村地区卫生人员工作偏好的应用步骤进行整理。     

基本药物制度推行中政府部门协调机制研究

国家基本药物制度是在国家大力推行新型医疗卫生改革的背景下,深化医药卫生体制改革五项重点工作之一。在其制定实施过程中涉及到卫生、财政、价格及人力资源和社会保障等多个部门,旨在探讨基本药物制度制定实施过程中各部门的协调机制,通过文献研究的方法根据传统行政机构间协调机制的经验,分析在我国基本药物制度制定实施过程中所存在和运用的协调机制的优点与不足,并结合国内外相关经验,对基本药物制度制定和实施中的协调机制提出建议。     

农村地区吸引和稳定卫生人员研究的理论框架

本文提出了一个研究吸引和稳定农村地区卫生人员的理论框架。该框架以卫生人员的工作意愿及其影响因素为核心,同时兼顾分析劳动力市场供需关系和强制性人力资源政策对卫生人员工作选择的影响。在我国深入开展卫生体制改革的历史潮流中,希望这一分析有助于政策制定者和研究人员加强对卫生人力资源,尤其是农村地区卫生人员吸引和稳定的重视和研究。     

特尔菲法（Delphi）用于山区卫生人力资源管理指标的筛选

卫生人力资源管理是90年代卫生管理者研究的热门,尤其是加强山区农村的卫生人力管理的研究,对于振兴农村卫生事业。抓好初级卫生保健,搞活农村卫生经济,提供更佳的卫生服务,具有十分重大的意义。宣汉县是四川省有名的山区县之一。该县的卫生人力资源目前主要存在着质量差、数量少、资源困难,流失严重,结构失调,增长失衡等弊端。本文针对该县卫生人力资源的现状,列出了管理雏形指标24项,拟用特尔菲法于1992年3月～1992年6月对24项指标进行了筛选,有15个指标被选中,入选率为62.5%。结果表明,此方法在山区卫生人力资源管理中的应用是可行的。     

卫生评价指标体系研究进展

目的对近年来国内外卫生指标体系的研究进行综述。方法收集和复习国内外有关文献,从不同方面对其进行比较和分析。结果本文从建立卫生评价指标体系的原则与要求、卫生评价指标体系的作用与功能、研究方法和步骤、重要研究成果、常用指标以及建立卫生评价指标体系过程中的主要问题等六个方面对近年来国内外在建立卫生工作、健康水平等评价指标体系研究中的进展情况进行了综述。结论国外现有的卫生指标体系各有特点,指标的选择还应根据国情的不同、时期的不同进行。     

构建学习型国家集群提升欧洲卫生人力资源规划水平

该文对卫生人力资源规划(HWF)的不同维度及决定因素进行研究,该研究有助于提升卫生人力资源规划特征相似的国家集群的交互情境学习。该文采用新的评分方法,该方法利用2012年欧盟大型研究项目"Matrix研究"得来的35个欧洲国家的数据,依据各国卫生人力资源规划的特征和类型来给各国评分。卫生人力资源规划的衡量维度有三个:(1)监控卫生人力资源数量和动态的数据基础设施;(2)界定和实施卫生人力资源市场监管的机构;(3)预测卫生人力资源供需缺口和失衡的模型的有效性。研究结果显示,卫生人力资源规划的三个维度呈弱相关,这表明不同国家的卫生人力资源投资方式不同。决定因素分析结果显示,卫生人力资源市场较大的国家,其国家卫生医疗服务、流动性、初级卫生保健等方面在卫生人力资源规划三个维度上的得分要高于其他国家。因此,对卫生人力资源规划特征相似的国家进行聚类可以推动各国交互情境学习,提升卫生人力资源规划水平。     

郑州市卫生防保人力资源发展预测

<正> 卫生人力资源是众多卫生资源中的主体因素。卫生人力资源发展预测,是对今后某一时期人员的发展趋势做出判断。它是为国民经济和社会发展战略规划服务的,是制定卫生事业发展规划的决策依据之一。目前预测方法很多。1982年华中工学院邓聚龙教授首创灰色系统理论,建立灰色模型,成功地用于工农业与经济领域预测,最近有人应用灰色模型进行卫生人力预测,取得较好效果。本文试图应用灰色动态模型对郑州市卫生防保人力资源发展数量进行预测,以探讨发展趋势。资料来源和方法     

卫生人力资源需求预测方法学研究——基于卫生人力规划的视角

探讨提高卫生人力资源(HHR)需求预测水平的方法,为制定我国卫生人力资源规划及其政策提供科学、合理有效的理论指导或依据。方法:对清华数据库中的中文知识仓(CNKI)(农业科技知识仓除外)进行相关文献检索,并对该类数据库所收载的HHR预测成果(1994-2010)的方法学进行分析与评价。结果:共检索到全文中同时出现"卫生人力资源"和"预测方法"的论文96篇,其中有关HHR需求预测方法的综述性研究成果各14项(14.6%),有关HHR需求预测方法的应用性研究成果共计32项(33.3%),期它成果51项(52.1%)。结论:卫生人力资源需求预测方法多样,且各方法均有各自的特点和优势,但在实际运用中因各方法均存内在缺陷和缺少对卫生人力的分类预测等而导致了我国HHR浪费与紧缺现象并存。要想使卫生人力规划科学、合理和有效,除完善需求预测技术外,更重要的是须要根据病种和社会经济、文化等因素的动态变化规律以及卫生服务发展的客观规律建立分类人才需求预测方法。     

Transforming Latent Utilities to Health Utilities: East Does Not Meet West

Discrete choice experiments (DCEs) are a promising alternative to more resource‐intensive preference elicitation methods such as time trade‐off (TTO), as pairwise comparisons are more amenable to online completion, which can save time and money. However, modeling DCE data produces latent utilities which are on an unknown scale. Therefore, latent utilities need to be transformed to a full health–dead scale before they can be used in quality‐adjusted life year calculations. We aimed to explore transformation functions from DCE‐derived latent utilities to TTO‐derived health utilities. We used EQ‐5D‐5L valuation data from eight different countries that collected both DCE and TTO data by using a standardized protocol. Results found less variation in the function that transformed latent utilities to health utilities in the western countries than in the eastern countries. While a global transformation function is not recommended, results suggest that regional transformation functions could potentially be used to derive health utilities from DCE data. Copyright © 2016 John Wiley & Sons, Ltd.     

社区卫生服务员工中职业紧张与倦怠的调查分析

目的弄清社区卫生服务员工职业紧张与职业倦怠的现状,探讨两者之间的关联。方法采用依据工作要求-自主模式与付出-回报失衡模式理论开发的简明职业紧张问卷和Maslach的职业倦怠问卷的修订版,对上海市的1397名社区卫生服务员工进行调查。运用多元Logistic回归分析不同职业紧张因子与职业倦怠的关联。结果有77.1%人被评定为职业紧张,有19.3%人呈现付出回报失衡,职业倦怠阳性率高达77.3%。职业倦怠均分为2.17±0.91,其3个维度情感耗竭均分为2.23±1.46,人格解体为1.04±1.15,个体成就感得分为3.78±1.36。高要求低自主是个体成就感降低的保护因子,以低D/C组为对照,中等与高组的OR值分别为0.54(95%CI=0.37~0.78)和0.42(95%CI=0.25~0.72)。社会支持是职业倦怠的保护因子,以低社会支持组为对照组,中、高社会支持组OR值分别为0.69(95%CI=0.47~1.00)和0.52(95%CI=0.35~0.77);付出回报失衡是职业倦怠的危险因子,以低付出回报失衡为对照,中等组的OR值为2.48(95%CI=1.33~4.62);高失衡组OR值为4.91(95%CI=1.78~13.6)。内在投入是情感耗竭和人格解体的危险因子。结论预防职业倦怠需要降低职业紧张程度,缓解付出回报失衡,同时增加社会支持。     

Health Care Coverage and the Health Care Industry

Objectives. We examined rates of uninsurance among workers in the US health care workforce by health care industry subtype and workforce category.Methods. We used 2004 to 2006 National Health Interview Survey data to assess health insurance coverage rates. Multivariate logistic regression analyses were conducted to estimate the odds of uninsurance among health care workers by industry subtype.Results. Overall, 11% of the US health care workforce is uninsured. Ambulatory care workers were 3.1 times as likely as hospital workers (95% confidence interval [CI] = 2.3, 4.3) to be uninsured, and residential care workers were 4.3 times as likely to be uninsured (95% CI = 3.0, 6.1). Health service workers had 50% greater odds of being uninsured relative to workers in health diagnosing and treating occupations (odds ratio [OR] = 1.5; 95% CI = 1.0, 2.4).Conclusions. Because uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status, the fact that nearly 1 in 8 health care workers lacks insurance coverage is cause for concern.For complex socioeconomic reasons, private health insurance, typically provided by an employer, is “the dominant mechanism for paying for health services” in the United States.^1(p79) According to the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute, analyses of data from the Current Population Survey (CPS) show that, in 2006, 54% of the US civilian, noninstitutionalized population had employer-sponsored health insurance; 5% had private, nongroup health insurance; and 26% had public health insurance coverage. Approximately 46 million US residents (16% of the population) are currently uninsured.² Numerous studies have shown that, relative to people with health insurance, uninsured people receive less preventive care, are diagnosed at more advanced disease stages, and, once diagnosed, tend to receive less therapeutic care and have higher mortality rates.^3–8Although national uninsurance trends are well-documented, the rate of uninsurance within the health care workforce has received scant attention. Given that health care employment rates are increasing at a more rapid pace than overall employment rates, this lack of attention is especially worrisome. According to the Bureau of Labor Statistics, nearly half of the 30 occupations in which employment opportunities are growing fastest are health care occupations. For example, whereas the Bureau of Labor Statistics projects that overall employment will increase about 10% from 2006 to 2016, employment opportunities for personal and home care aides are projected to increase nearly 51%, and opportunities for physical therapist assistants are expected to increase by a third. The Bureau of Labor Statistics also projects that, by 2016, new job opportunities for registered nurses will increase by approximately 24% (approximately 587 000 new jobs).⁹Although the overall employment outlook for health care workers is promising, what is less clear is to what degree employment in health care is associated with health insurance coverage. A 2001 General Accounting Office report suggested that one fourth of nursing home aides and one third of home health care aides were uninsured.¹⁰ The Kaiser Family Foundation reported that the uninsured rate among workers in the health and social services industry was 23% in 2007.¹¹ On the basis of a review of the literature in the health and human services occupations, Ebenstein concluded that the health insurance plans offered to direct care workers in the developmental disabilities field are “inferior … with less coverage and more out-of-pocket expenses” and that fewer direct care workers “are able to afford health coverage even if they are eligible.”^12(p132)Taking a more comprehensive look at the US health care workforce, Himmelstein and Woolhandler¹³ used 1991 CPS data to estimate uninsurance rates among physicians and other health care personnel. They reported that, overall, 9% of health care workers were uninsured, along with more than 20% of nursing home workers. Examining CPS data from 1988 to 1998, Case et al. found that uninsurance rates among all health care workers rose from 8% to 12%, that rates increased more for health care workers than for workers in other industries, and that rates differed according to occupation and place of employment.¹⁴ For example, occupation-specific uninsurance rates were 23.8% among health aides, 14.5% among licensed practical nurses, and 5% among registered nurses, whereas place-specific rates were 20% among nursing home workers, 8.7% among medical office workers, and 8.2% among hospital workers.¹⁵In their studies, Himmelstein and Woolhandler¹³ and Case et al.¹⁴ used national-level data to estimate uninsurance trends among health care workers. However, these trends were not adjusted for health care workers'' social, demographic, or economic characteristics, which would have helped explain variation across categories or over time. Moreover, with the growth of the health care workforce, estimates from these older studies probably do not reflect the current situation. As a result, the picture of uninsurance as it pertains to the health care workforce lacks the precision and currentness necessary for sound policy decisions. In an effort to expand knowledge in this area, produce more up-to-date estimates, and provide support for possible policy decisions, we used data from the National Health Interview Survey (NHIS) to examine uninsurance among workers in the health care industry.     

Health care experiences and preferences of uninsured workers

An exploratory study of the experiences, beliefs, and preferences of uninsured workers found that uninsured workers are active in seeking solutions to their health care needs and have decided opinions about health care. They use a cost-benefit analysis in deciding which health problems warrant professional attention. However, uninsured workers also exhibit a contradictory pattern of behaviors and beliefs. They say their health is good, yet many have illnesses that they neglect. They are satisfied with the health care services they use, yet they want health insurance because they believe it provides more choice and ensures better care and treatment. They express few negative feelings about Medicaid, yet even among the poorest of these workers, few have recently used Medicaid. These findings can inform policy options being considered.     

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services

OBJECTIVES: This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW: Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS: The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.     

Job characteristics and problems related to home care services for the elderly. A comparison among employment categories in Sapporo

OBJECTIVE: The aims of this study were to describe job characteristics for daytime and shift workers in home care services for the elderly and to clarify health care in the work setting, social support, and job satisfaction and possibilities. METHODS: A self-reported questionnaire was given to 433 home care workers, both full time and part time (more than 15 hours), at 35 institutions that provide home care services to residents of Sapporo (return rate; 80.2%). The following issues were investigated: job content (physical care, assistance with housework, and advice), specialty, job satisfaction, possibilities, job training, health care and social support. The results were compared among employed types: full-time and part-time daytime and shift workers using the t-test or the Fisher's test. RESULTS: The participants demonstrated high dissatisfaction with wages, physical uneasiness themselves and limited social support from their supervisors. Especially full-time workers were dissatisfied with the payment, whereas part-time workers complained about insufficient attention to the prevention of lumbago. It was found that part-time daytime workers were given insufficient on-job-training and education for prevention of infection, and that full-time shift workers greatly wished to leave the employment. However, the home care workers were satisfied with their job itself and expected to continue their work. Furthermore, half of the part-time workers hoped to work full time. CONCLUSIONS: Health management and educational training for part-time workers may be necessary to improve the quality of care services and protection of health. Promotion of full time employment and reconsideration of working condition might be necessary to provide sufficient home care services.     

Disclosure of HIV status in the workplace: considerations and strategies.

Maintaining a role in the workplace despite significant health concerns can be important in meeting an individual's emotional and economic needs. This qualitative research study reviewed the workplace experiences and disclosure decisions of 18 HIV-positive individuals. The most frequently cited reasonsfor disclosing HIV status were to explain choices they were making as they interviewed for a job and concerns about their job performance and the needfor accommodations. For individuals who disclosed their HIV status to selective members of the workplace or disclosed to no one, the primary reasons given were preference for privacy, nature of the work environment, andfear of possible consequences. The practice, policy, and research implications for social workers are also discussed.