四川省三州地区卫生人力资源配置与公平性评价分析

目的:了解2011-2017年四川省三州地区卫生人力资源配置现状,为三州地区卫生人力资源的合理配置提供参考。方法:利用千人卫生人力资源拥有量指标、基尼系数和卫生人力资源密度指数(HRDI)分析卫生人力资源配置现状及其公平性。结果:三州地区千人卫生人力资源拥有量呈增长趋势;基尼系数大多超过0.4,仅护士按人口分布的基尼系数较小;卫生人力资源密度指数较小,需要量、缺乏量及缺乏比例均较大。结论:三州地区卫生人力得到一定程度改善;但配置公平性较差,尤其按地理、经济分布很不均衡;医护人员短缺,需要重点投入。     

Towards Cost-Value Analysis in Health Care?

By describing societal value judgements in health care in numerical terms one may in theory increase the precision of guidelines for priority setting and allow decision makers to judge more accurately the degree to which different health care programs provide societal value for money. However, valuing health programs in terms of QALYs disregards salient societal concerns for fairness in resource allocation. A different kind of numerical valuation of medical interventions, that incorporates concerns for fairness, is described. The usefulness to decision makers of such numerical information remains to be tested. This revised version was published online in August 2006 with corrections to the Cover Date.     

山西省新型农村合作医疗家庭筹资公平性分析

目的：探索山西省新型农村合作医疗试点县卫生筹资公平性以及灾难性卫生支出家庭对筹资公平性的影响。方法：采用WHO《2000年世界卫生报告》中所介绍的卫生服务筹资公平性方法。结果：山西省新型农村合作医疗试点县卫生筹资贡献率HFC0为26．91％，卫生筹资公平性指数FFC为0．6828；剔除灾难性卫生支出家庭后．榆社、娄烦县的HFC均有所下降。筹资公平性分别提高了7．32％和7．40％。结论：山西省试点县农民家庭合作医疗筹资公平性相当于国内平均水平；灾难性卫生支出家庭是影响新型农村合作医疗筹资公平性的因素。     

The Emerging Hazard of AI‐Related Health Care Discrimination

Artificial intelligence holds great promise for improved health‐care outcomes. But it also poses substantial new hazards, including algorithmic discrimination. For example, an algorithm used to identify candidates for beneficial “high risk care management” programs routinely failed to select racial minorities. Furthermore, some algorithms deliberately adjust for race in ways that divert resources away from minority patients. To illustrate, algorithms have underestimated African Americans’ risks of kidney stones and death from heart failure. Algorithmic discrimination can violate Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act when it unjustifiably disadvantages underserved populations. This article urges that both legal and technical tools be deployed to promote AI fairness. Plaintiffs should be able to assert disparate impact claims in health‐care litigation, and Congress should enact an Algorithmic Accountability Act. In addition, fairness should be a key element in designing, implementing, validating, and employing AI.     

The agencies method for coalition formation in experimental games

In society, power is often transferred to another person or group. A previous work studied the evolution of cooperation among robot players through a coalition formation game with a non-cooperative procedure of acceptance of an agency of another player. Motivated by this previous work, we conduct a laboratory experiment on finitely repeated three-person coalition formation games. Human players with different strength according to the coalition payoffs can accept a transfer of power to another player, the agent, who then distributes the coalition payoffs. We find that the agencies method for coalition formation is quite successful in promoting efficiency. However, the agent faces a tension between short-term incentives of not equally distributing the coalition payoff and the long-term concern to keep cooperation going. In a given round, the strong player in our experiment often resolves this tension approximately in line with the Shapley value and the nucleolus. Yet aggregated over all rounds, the payoff differences between players are rather small, and the equal division of payoffs predicts about 80% of all groups best. One reason is that the voting procedure appears to induce a balance of power, independent of the individual player''s strength: Selfish subjects tend to be voted out of their agency and are further disciplined by reciprocal behaviors.     

不同收入分层视角下居民卫生服务利用的公平性分析*

目的分析宁夏银川市居民卫生服务利用及其公平性,为促进不同收入水平下居民的卫生服务利用公平性提供政策建议。方法采用分层随机抽样的方法,入户问卷调查18岁及以上的银川市居民。应用频数与构成比的方法描述被调查居民的一般情况。运用两周患病率、慢性病患病率、两周就诊率和住院率分析居民卫生服务利用情况,运用集中指数CI反映不同收入阶层居民卫生服务利用的公平性分布。结果本次研究调查显示,被调查整体居民的两周患病率为14.27%,集中指数为-0.011 5,偏向低收入人群。慢性病患病率为13.08%,集中指数为0.040 4,偏向高收入人群。居民两周就诊率为12.49%,集中指数为-0.006 1,绝对值近似为0,较公平。居民住院率为9.71%,集中指数为-0.015 0,倾向于发生在低收入人群。结论不同收入水平居民的卫生服务利用公平性仍需改善,建议政府及相关部门加强健康教育宣传力度,大力发展经济,提高低收入人群的经济能力,出台相应的控费政策。     

从博弈论角度探究医疗支付运用DRGs支付方式的有效性

当前医改的一块"硬骨头"是如何改进医疗支付方式。笔者从博弈论角度探究医院管理中现行医疗支付方式存在的问题,探讨DRGs支付方式的有效性分析DRGs将有助于打破当前医院管理的"纳什均衡",并有利于增进医院管理的效率与公平,是医院管理的一种有效探索。     

脑脊液细胞学变化对重度CO中毒患者预后的评价

急性CO中毒是当今世界发病和死亡人数最多的急性职业中毒.重度CO中毒患者经过积极抢救治疗,多数患者可完全恢复,但少数出现持续性植物状态[1].由于中毒患者脑组织受损的程度和面积无量化的生化指标和特殊的检测手段,患者的预后常难以判断.重度CO中毒患者预后的影响因素较多,与中毒剂量,昏迷时间,有无并发症等因素都相关.     

论卫生经济政策的伦理价值基础

卫生经济政策是价值选择的结果,卫生经济政策研究必须重视价值问题.卫生经济政策的伦理价值基础受相关价值原则及其伦理依据制约.当前我国卫生经济政策应建立在"健康公平"、"卫生公正"等伦理价值原则基础之上.卫生经济政策的制定、实施的出发点和归宿必须体现这些价值取向.     

Use of the Paired-Comparison Technique to Determine the Most Valued Qualities of the McMaster Medical Programme Admissions Process

The Undergraduate Medical Programme at McMaster University selects students using a comprehensive set of tools. Attempts to modify the selection process over many years have been impeded by an inability to reconcile very strongly held views among stakeholders as to the importance of the selection tools and, indeed, the very purposes of the admission process. The objective of this study was to identify key 'qualities' of the selection process and to measure their relative importance to admissions process assessors. Through a qualitative review of internal research documents, Medical Programme Admissions Committee meeting minutes, memos and accreditation surveys eight qualities of the admissions process were identified: validity, fairness, accessibility, comprehensiveness, affordability, legal defensibility, contribution to class diversity and the role of the process as a public statement of the Programme's values. Faculty, students and community admissions assessors were surveyed, by mail, using a paired-comparisons technique. The overall response rate was 58%. By a wide margin, all three groups of admissions assessors valued validity and fairness most highly. The least valued qualities were affordability and the role of the process as a statement of our values. Possible applications of this approach to the admissions process deliberations are discussed.