新医改以来我国社区卫生服务中心卫生人力资源配置现状分析

目的 了解新医改以来我国社区卫生服务中心卫生人力资源配置现状和问题,为我国合理配置社区卫生人力资源提供依据。方法 运用描述性分析方法分析我国社区卫生服务中心人力资源的数量、结构,利用洛伦兹曲线和基尼系数分析我国社区卫生服务中心人力资源分布的公平性。结果 2009－2015年,我国社区卫生服务中心卫生人员以省为单位的东、中、西部地区卫生服务中心卫生技术人员Gini系数从0.331 1下降到0.294 6;社区卫生人员数量有所增加,新增卫生人员291.24万人,其中社区卫生人员20.97万人,占新增卫生人员的7.2%;2015年社区卫生服务中心执业(助理)医师本科及以上学历占比为39.8%,医护比从2009年的1.4改善为2015年的1.2。结论 新医改以来,我国社区卫生服务中心人才队伍总的来说向好的趋势变化,我国东、中、西部社区卫生服务中心的卫生人员分布公平上存在的差异在逐步缩小,但仍存在人员数量不足、学历、职称、医护比结构失衡问题。     

Sibling Relationships,Fairness, and Conflict Over Transfer of the Farm

Fairness and conflict over the transfer of the family farm were examined from the perspective of the younger generation. Thirty‐six farm successors and one of his or her off‐farm siblings completed measures on conflict over transfer, fairness of transfer, rules of fairness, and family warmth. Strong support was found for the hypothesis that lower scores on family warmth, disagreement on fairness, and disagreement on rules of fairness were predictive of conflict over transfer. Implications are discussed in terms of interventions with farm families.     

The private rejection of unfair offers and emotional commitment

In a series of experiments, we demonstrate that certain players of an economic game reject unfair offers even when this behavior increases rather than decreases inequity. A substantial proportion (30–40%, compared with 60–70% in the standard ultimatum game) of those who responded rejected unfair offers even when rejection reduced only their own earnings to 0, while not affecting the earnings of the person who proposed the unfair split (in an impunity game). Furthermore, even when the responders were not able to communicate their anger to the proposers by rejecting unfair offers in a private impunity game, a similar rate of rejection was observed. The rejection of unfair offers that increases inequity cannot be explained by the social preference for inequity aversion or reciprocity; however, it does provide support for the model of emotion as a commitment device. In this view, emotions such as anger or moral disgust lead people to disregard the immediate consequences of their behavior, committing them to behave consistently to preserve integrity and maintain a reputation over time as someone who is reliably committed to this behavior.     

Neural signatures of fairness‐related normative decision making in the ultimatum game: A coordinate‐based meta‐analysis

The willingness to incur personal costs to enforce prosocial norms represents a hallmark of human civilization. Although recent neuroscience studies have used the ultimatum game to understand the neuropsychological mechanisms that underlie the enforcement of fairness norms; however, a precise characterization of the neural systems underlying fairness‐related norm enforcement remains elusive. In this study, we used a coordinate‐based meta‐analysis on functional magnetic resonance imaging (fMRI) studies using the ultimatum game with the goal to provide an additional level of evidence for the refinement of the underlying neural architecture of this human puzzling behavior. Our results demonstrated a convergence of reported activation foci in brain networks associated with psychological components of fairness‐related normative decision making, presumably reflecting a reflexive and intuitive system (System 1) and a reflective and deliberate system (System 2). System 1 (anterior insula, ventromedial prefrontal cortex [PFC]) may be associated with the reflexive and intuitive responses to norm violations, representing a motivation to punish norm violators. Those intuitive responses conflict with economic self‐interest, encoded in the dorsal anterior cingulate cortex (ACC), which may engage cognitive control from a reflective and deliberate System 2 to resolve the conflict by either suppressing (ventrolateral PFC, dorsomedial PFC, left dorsolateral PFC, and rostral ACC) the intuitive responses or over‐riding self‐interest (right dorsolateral PFC). Taken together, we suggest that fairness‐related norm enforcement recruits an intuitive system for rapid evaluation of norm violations and a deliberate system for integrating both social norms and self‐interest to regulate the intuitive system in favor of more flexible decision making. Hum Brain Mapp 36:591–602, 2015. © 2014 Wiley Periodicals, Inc .     

公立医院绩效工资分配公平性方法研究

公立医院绩效工资分配的公平性是调动医务人员积极性、建立公益性绩效分配体系的关键.分类设计绩效工资、计分法确定各类群体的差距、处理好医护差距、群体内别差距、改革收支结余计提绩效工资的核算方式等综合方法能够体现分配的公平性.     

卫生筹资的垂直公平和累进性研究

探讨测算与分析卫生筹资垂直公平性的方法，以及如何量化某种卫生筹资渠道累进或累退的程度，并模拟测算和分析不同经济发展水平的两个地区卫生筹资的垂直公平和累进程度。     

Analysis of predictors of success in the MRCP (UK) PACES examination in candidates attending a revision course

Objective

To determine factors that predict success of candidates taking a revision course in preparation for the MRCP (UK) PACES (practical assessment of clinical examination skills) examination.

Design

A questionnaire survey of candidates attending a PACES revision course. Results were correlated with subsequent pass lists published by the Colleges of Physicians

Setting and subjects

Candidates attending courses in June and October 2002. In total, 523 candidates completed questionnaires, evenly balanced between UK and overseas graduates.

Results

Of 483 candidates who took the examination immediately after the course, 219 (45.3%) passed. UK graduates were more likely to pass (67.0%) than overseas graduates (26.2%) (p = 0.003, odds ratio 5.72). For UK graduates, pass rates were higher for white candidates (73%) than for ethnic minorities (56%) (p = 0.012, OR 2.15) and for those who passed at the first attempt in the MRCP (UK) part 2 written paper (p = 0.003, OR 2.90). For overseas graduates, those who had been qualified for less than eight years were more likely to pass (p = 0.001, OR 2.78). More overseas (45.7%) than UK (30.8%) graduates were confident that they would pass, but confidence did not predict success.

Conclusion

Among candidates taking a revision course, UK graduates are more likely to pass the PACES examination than non‐UK graduates. Ethnic minority UK graduates seem to have a significantly poorer success rate, although this requires confirmation in an independent sample. If confirmed, these differences merit further investigation to assess whether they reflect genuine differences in ability.     

新疆护理人力资源配置公平性实证分析

[目的]调查2009年新疆护理人力资源配置情况并进行公平性评价,为新疆护理人力资源合理配置提供实证依据。[方法]采用卫生经济学中的Lorenz曲线和GINI系数对2010年《新疆统计年鉴》相关数据进行分析。[结果]新疆不同地区之间护理人力资源人口与地理分布的Lorenz曲线均分布在绝对公平线附近,人口分布的GINI系数为0.13,地理分布的GINI系数为0.38。[结论]新疆护理人力资源存在短缺,新疆护理人力资源各地区人口分布和地理分布的公平性处于相对公平状态,但地理分布的公平性存在较大的改进空间。     

Contribution of case‐mix classification to profiling hospital characteristics and productivity

Case‐mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case‐mix groups at 469 hospitals (1 721 274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case‐mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.     

政府保障公平市场提高效率——社会主义市场经济规律下的医改路径分析

中国已实现了由计划经济向市场经济的转型,在社会主义市场经济的大背景下,医药卫生行业必须遵循客观经济规律,政府和市场的两只手互为补充、互相协作,政府保障公平,市场发挥效率,共同推进医药卫生体制改革.