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1.

Objective

The aim of the study was to estimate the effect of the state-based reinsurance programs through the section 1332 State Innovation Waivers on health insurance marketplace premiums and insurer participation.

Data Source

2015 to 2022 Robert Wood Johnson Foundation Health Insurance Exchange Compare Datasets.

Study Design

An event study difference-in-differences (DD) model separately for each year of implementation and a synthetic control method (SCM) are used to estimate year-by-year effects following program implementation.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

Reinsurance programs were associated with a decline in premiums in the first year of implementation by 10%–13%, 5%–19%, and 11%–17% for bronze, silver, and gold plans (p < 0.05). There is a trend of sustained declines especially for states that implemented their programs in 2019 and 2020. The SCM analyses suggest some effect heterogeneity across states but also premium declines across most states. There is no evidence that reinsurance programs affected insurer participation.

Conclusion

State-based reinsurance programs have the potential to improve the affordability of health insurance coverage. However, reinsurance programs do not appear to have had an effect on insurer participation, highlighting the need for policy makers to consider complementary strategies to encourage insurer participation.  相似文献   
2.
The aim of this article was to compare disability policies in Japan and Sweden. Social protection in the two countries has taken different directions. Policy orientation in Japan is ‘productivist’, paternalistic, family-oriented, and firmly involves medical expertise in assessing eligibility to disability services. In practice, social services in Japan is the result of negotiations between social service staff at the local level, volunteer agencies and private contributors. In Sweden, social services, were established as social rights, financed by public money, and distributed by public sector agencies or out-sourced to private providers. Such support, assessed by social workers, were intended to facilitate daily life and achieve “good living conditions”. While Japan's disability services are characterized by the medical model and improving physical accessibility, practices in Sweden are based on a social relational model perspective of disability services combined with increasing ‘deservingness ethics’.  相似文献   
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Despite evidence on the benefits of health enhancing physical activity (HEPA), only few countries have developed “health in all policies” and specifically integrated HEPA policies. Paucity of studies have questioned the role of public national actors in PA policies enactment and delivery, the barriers and levers for adopting cross-sectoral HEPA. The present work seeks at comparing France and Belgium in regard to their competencies of ministries promoting HEPA, the presence of leadership and coordination in HEPA policies implementation, their key public legal entities working on HEPA. Expert interviews and document analysis were realized to complete the HEPA policy audit tool in each country. Results have shown that HEPA cross-sectoral policies are at their early stage. A broad diversity of sectors was implicated in HEPA policies: sport, health, transport, environment, and education, but often with weak activity. No leadership or coordination exist to implement HEPA policies, although different public legal entities could work on this aim. Ministries relationships were principally coming from formal co-interventions mandated by national public plans in France, where in Belgium relationships were punctual. Lobbying within each sector and in key public legal entities to promote HEPA is needed, and the development of official national coordination is essential.  相似文献   
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While medical and recreational cannabis use is becoming more frequent among older adults, the neurocognitive consequences of cannabis use in this age group are unclear. The aim of this literature review was to synthesize and evaluate the current knowledge on the association of cannabis use during older-adulthood with cognitive function and brain aging. We reviewed the literature from old animal models and human studies, focusing on the link between use of cannabis in middle- and old-age and cognition. The report highlights the gap in knowledge on cannabis use in late-life and cognitive health, and discusses the limited findings in the context of substantial changes in attitudes and policies. Furthermore, we outline possible theoretical mechanisms and propose recommendations for future research.The limited evidence on this important topic suggests that use in older ages may not be linked with poorer cognitive performance, thus detrimental effects of early-life cannabis use may not translate to use in older ages. Rather, use in old ages may be associated with improved brain health, in accordance with the known neuroprotective properties of several cannabinoids. Yet, firm conclusions cannot be drawn from the current evidence-base due to lack of research with strong methodological designs.  相似文献   
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ObjectiveTo evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used.MethodThe Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater.Results176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72).ConclusionsThis Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.  相似文献   
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《Value in health》2020,23(5):540-550
ObjectivesGiven the potential of real-world evidence (RWE) to inform understanding of the risk–benefit profile of next-generation sequencing (NGS)–based testing, we undertook a study to describe the current landscape of whether and how payers use RWE as part of their coverage decision making and potential solutions for overcoming barriers.MethodsWe performed a scoping literature review of existing RWE evidentiary frameworks for evaluating new technologies and identified barriers to clinical integration and evidence gaps for NGS. We synthesized findings as potential solutions for improving the relevance and utility of RWE for payer decision-making.ResultsPayers require evidence of clinical utility to inform coverage decisions, yet we found a relatively small number of published RWE studies, and these are predominately focused on oncology, pharmacogenomics, and perinatal/pediatric testing. We identified 3 categories of innovation that may help address the current undersupply of RWE studies for NGS: (1) increasing use of RWE to inform outcomes-based contracting for new technologies, (2) precision medicine initiatives that integrate clinical and genomic data and enable data sharing, and (3) Food and Drug Administration reforms to encourage the use of RWE. Potential solutions include development of data and evidence review standards, payer engagement in RWE study design, use of incentives and partnerships to lower the barriers to RWE generation, education of payers and providers concerning the use of RWE and NGS, and frameworks for conducting outcomes-based contracting for NGS.ConclusionsWe provide numerous suggestions to overcome the data, methodologic, infrastructure, and policy challenges constraining greater integration of RWE in assessments of NGS.  相似文献   
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