公立医院治理的委托代理关系探索

目前我国公立医院治理结构是两权分离的,资产的所有者和经营者是分开的。国家委托给医院,医院再委托给医院管理者。多层委托代理的关系,加之委托人与代理人的效用函数不同、信息不对称等原因,两权分离产生道德风险、委托代理问题,从而会损害委托人的利益。公立医院不以营利为目的,其经营业绩不能单纯以赢利来考量,而应多考虑社会效益和社会公平,要实现公立医院的有效治理就得建立完善的激励监督机制：医院资本和人才市场的建立完善．有助于在要素所有者之间的公平竞争,有助于医院内部利益团体的互相制衡,进而有助于建立科学的公立医院治理结构。     

公司法人治理结构对医院产权制度改革的启示

作者首先阐述了法人治理结构的内涵与产生，随后就医疗机构独具特色的双重委托代理关系、结构问题应该成为医院放权式改革的重点、公司法人治理结构的基本策略和主要方法及国外医疗行业治理结构相关问题即谁应成为病人的代理如何通过合理的报酬设计使代理人同委托人利益一致等进行描述，最后就治理结构对我国公立医院产权制度改革的启示作了论述。     

“管办分离”语境下的公立医院管理体制研究

在"管办分离"语境下解读我国公立医院管理体制改革的目标。分析目前公立医院管理体制中存在产权主体缺位,多层级多委托人的委托—代理关系,权益关系不清晰,外部约束机制不健全等问题。并从公立医院的治理结构角度系统探讨公立医院的体制改革思路。     

我国公立医院委托-代理问题探析

我国公立医院的委托代理层次较多、代理链较长，再加上政府作为委托人和代理人的双重身份，使得公立医院委托代理关系缺乏有效的激励、约束机制。优化医院的外部经营环境，创新医院的内部运营机制，尤其是进行审计委托关系链的重构，强化审计监督独立性，可在一定程度上解决我国公立医院委托代理链过长所带来的问题，从而完善公立医院委托代理中的激励约束机制。     

基于委托代理关系的公立医院员工激励机制分析

文章阐述了基于委托代理关系研究激励机制的重要性,分析了公立医院中委托代理关系的类型,指出基于委托代理关系的激励机制在公立医院中的作用,并具有系统性、复杂性和绩效评价的不确定性等特点。在此基础上探讨了激励机制设计所面临的挑战,包括:激励机制尚未系统化;委托人与代理人的目标利益不一致;忽视对员工的绩效管理等。最后根据我国公立医院运行现状和上述的主要问题提出了相应对策,这对公立医院设计合理的激励机制,实现医院的科学发展具有一定意义。     

基于双层多任务委托代理模型的公立医院公益性研究

政府—医院管理层—医务人员之间存在的双层委托代理关系,不仅意味着代理链条延长带来的治理困难.而且在每层委托代理中,代理人都面临多任务,使公益性任务的目标出现两次异化.文章首次将双层多任务委托代理模型引入公立医院公益性问题的分析之中,在借鉴Holmstrom和Milgrom的多任务委托代理模型的基础上,提出了解决两层委托代理关系中多任务委托代理问题的建议.     

公立医院法人治理结构与改革

随着国务院医改近期重点实施方案的出台，公立医院法人治理结构的改革模式也渐渐明朗。公立医院法人治理结构改革是创新公立医院体制机制的关键任务之一，是维护公立医院公益性的重要制度保障。针对公立医院法人治理结构的内涵作了阐述，从公立医院的多层委托代理关系、产权制度等多角度分析了我国公立医院法人治理结构的现状和问题，提出了我国公立医院法人治理结构改革的具体措施。     

论产权改革中国有民营医院法人治理结构的构建

目前我国正在进行原公立医院产权制度的改革.对于其中产生的国有民营医院,我们认为其首要目标是经济目标,运营方式也将是企业化的.在国有民营医院两权分离的条件下,为完成国有资产的保值增值,必须在医院内部构建起科学的法人治理结构.为此,需要在运作机制上保障国有民营医院的委托人能够对代理人进行有效的约束和激励.     

我国公立医院法人治理结构下的管理者激励机制探讨

建立管理者有效激励机制、化解公立医院法人治理结构下的委托代理问题是公立医院体制改革的重要保障.该激励机制通过弥合管理者与所有者的价值及行为取向差异,促使管理者自觉、自愿地履行并实现公共利益.由于机制建立过程中存在效益目标不明晰、绩效水平难于考量等难题,在分析公立医院管理者激励机制设计的基本思路,以及公立医院管理者激励机制设计的主要问题的基础上,提出需以公共利益为导向设置董事机构,加强效益评价指标体系和外部监管制度建设.同时创新激励手段,从而提高公立医院法人治理结构下的整体绩效.     

公立医院“公法人化”治理制度设计研究

公立医院公法人化的治理结构实际上是委托代理关系的一组合约安排,其核心是激励约束机制的建立。激励机制关键要解决激励相容问题和参与约束问题。约束机制的有效运转则需要增加监督的参与者,加强监督的信息化水平,建立长期的绩效管理协议,促使委托与代理人之间重复博弈。激励约束机制的实施还需要出资人代表制度的保障。而出资人代表的职能落实则需要考虑其人员组成和适宜的规模。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.