HEALTH CARE AND IDEOLOGY: A RECONSIDERATION OF POLITICAL DETERMINANTS OF PUBLIC HEALTHCARE FUNDING IN THE OECD

In this article, we examined if partisan ideology and electoral motives influence public healthcare expenditure (HCE) in countries of the Organization for Economic Cooperation and Development. We distinguished between the effects on the growth of the expenditures and its adjustment to violations of a long‐run equilibrium linking HCE with macroeconomic and demographic trends. Regarding the influence of partisan ideology, we found that if governments are sufficiently long in power, right‐wing governments spend less on public health than their left‐wing counterparts. Furthermore, if a right‐wing party governs without coalition partners, it responds more strongly to deviations from the long‐run HCE equilibrium than left‐wing governments. With regard to electoral motives, we found that health expenditure increases in years of elections. Independent of their partisan ideology, single‐party (minority) governments induce higher (lower) growth of public HCE. Each of these political factors by its own may increase (decrease) HCE growth by approximately one percentage point. Given an average annual growth of HCE of approximately 4.1%, political factors turn out to be important determinants of trends in public HCE. Copyright © 2013 John Wiley & Sons, Ltd.     

PREFERENCES FOR THE NORMATIVE BASIS OF HEALTH CARE PRIORITY SETTING: SOME EVIDENCE FROM TWO COUNTRIES

The present paper concerns the criteria people would prefer for prioritising health programmes. It differs from most empirical studies as subjects were not asked about their personal preferences for programmes per se. Rather, they were asked about the principles that should guide the choice of programmes. Four different principles were framed as arguments for alternative programmes. The results from population surveys in Australia and Norway suggest that people are least supportive of the principle that decision makers should follow the stated preferences of the public. Rather, respondents expressed more support for decisions based upon health maximisation, equality and urgency. Copyright © 2012 John Wiley & Sons, Ltd.     

THE EFFECT OF NATIONAL HEALTH INSURANCE ON MORTALITY AND THE SES–HEALTH GRADIENT: EVIDENCE FROM THE ELDERLY IN TAIWAN

Using the difference‐in‐difference‐in‐differences method, we examine the effect of the National Health Insurance (NHI) on mortality, self‐assessed health, and functional limitations of the elderly and seek to determine whether the effect is spread equally across health classes. We find that the NHI only has an effect on the death hazard, and it is the least healthy who benefit the most. The death hazard falls by 16–48% and 3–9% for the least health and the healthiest, respectively. The decline in the hazard ratio for the least healthy among the uninsured is 58% greater than that of their counterparts among the insured. Moreover, female participants benefit more from the NHI than male participants. We find no significant effect of the NHI in the SES–health gradient except for the education–death hazard gradient. The gap in the education‐death hazard gradient between the insured and previously uninsured is significantly reduced by 7–31% after 1995. The hazard ratio among the less‐educated in the treatment group also falls by 55% relative to that in the comparison group. The NHI appears to have prolonged lives but has failed to improve the functional limitations, which might have contributed to the rapid increase in the demand for long‐term caregivers in recent years. Copyright © 2012 John Wiley & Sons, Ltd.     

CHILD CARE SUBSIDIES,MATERNAL HEALTH,AND CHILD–PARENT INTERACTIONS: EVIDENCE FROM THREE NATIONALLY REPRESENTATIVE DATASETS

A complete account of the US child care subsidy system requires an understanding of its implications for both parental and child well‐being. Although the effects of child care subsidies on maternal employment and child development have been recently studied, many other dimensions of family well‐being have received little attention. This paper attempts to fill this gap by examining the impact of child care subsidy receipt on maternal health and the quality of child–parent interactions. The empirical analyses use data from three nationally representative surveys, providing access to numerous measures of family well‐being. In addition, we attempt to handle the possibility of non‐random selection into subsidy receipt by using several identification strategies both within and across the surveys. Our results consistently indicate that child care subsidies are associated with worse maternal health and poorer interactions between parents and their children. In particular, subsidized mothers report lower levels of overall health and are more likely to show symptoms consistent with anxiety, depression, and parenting stress. Such mothers also reveal more psychological and physical aggression toward their children and are more likely to utilize spanking as a disciplinary tool. Together, these findings suggest that work‐based public policies aimed at economically disadvantaged mothers may ultimately undermine family well‐being. Copyright © 2013 John Wiley & Sons, Ltd.     

强化健康宣教在改善老年糖尿病患者生存质量方面的效果观察

[目的]探讨强化健康宣教在改善老年糖尿病患者生存质量方面的效果。[方法]选取2009年1月~2010年12月于某院进行治疗的140例老年糖尿病患者为研究对象,将其随机分为对照组(常规宣教组)70例和观察组(强化宣教组)70例,后将两组患者治疗前后的治疗依从性、相关知识掌握情况及SF-36评分进行统计及比较。[结果]观察组的治疗依从性及相关知识掌握情况均优于对照组,SF-36评分高于对照组,P﹤0.05或P﹤0.01,为有显著性差异或有非常显著性差异。[结论]强化健康宣教可以改善老年患者的治疗依从性和相关知识掌握情况,在改善老年糖尿病患者生存质量方面的效果明显。     

我军部队人员口腔医疗需要十年变化

目的 :为了解我军部队人员口腔医疗需要情况 ,探索口腔疾病发病规律和口腔医疗保健现状。方法 :将部队人员口腔医疗需要情况按需要后送医疗的程度分为 4类 ,采用分层抽样方法设立调查点 ,对陆军、海军、空军部队调查点人员分别进行口腔健康检查 ,填写记录。结果 :1993年共调查人数为 12 95人 ,共有 76 .9%人需要按期后送口腔医疗 ,有 4 4 .4 %人需要及早后送口腔医疗 ,有 2 .0 %人需要紧急后送口腔医疗 ,有 7.4 %人不需要后送口腔医疗。2 0 0 3共调查人数为 12 6 9人 ,共有 4 8.6 %人需要按期后送口腔医疗 ,有 4 5 .6 %人需要及早后送口腔医疗 ,有 2 .1%人需要紧急后送口腔医疗 ,有 2 8.6 %人不需要后送口腔医疗。结论 :我军部队人员的口腔医疗需要十分普遍 ,目前应加强。改善口腔疾病医疗条件、加强口腔疾病预防工作、建立口腔疾病防治程序。     

家庭护理干预对精神分裂症患者社会功能及生活质量的影响

目的探讨家庭护理干预对精神分裂症患者社会功能及生活质量的影响。方法将120例精神分裂症患者分为研究组和对照组各60例,对照组按常规治疗护理和电话随访;研究组在此基础上由课题组成员至少每月上门进行家庭干预1次,实施6个月。于干预前后采用社会功能缺陷筛选量表(SDSS)和生活质量综合评定问卷-74(GQOLI-74)评定干预效果。结果干预后两组SDSS量表评分均较干预前下降,(p<0.01),且研究组较对照组下降更显著(p<0.01)。两组GQOLI-74评定问卷中除物质生活无显著性差异(p>0.05),躯体功能、心理、社会功能和生活质量总体评分研究组明显高于照组(p<0.01)。结论家庭护理干预能有效改善精神分裂症患者的社会功能,提高其生活质量。     

影响妇幼卫生服务提供的因素分析

目的:对“计划生育/生殖健康“项目资料进行分析,以探讨妇幼卫生服务提供的主要影响因素,为改善妇幼卫生服务提供依据.方法:资料来源于“生殖健康/计划生育“项目终期评估,统计方法采用主成分分析法分析资料.结果:将原始资料经过处理,建立指标体系;运用主成分分析法从18个指标中提取了6个主成分,方差累积贡献率为79.66%.影响妇幼卫生服务提供的因素主要有产后访视率、住院分娩率、高危孕产妇住院分娩率、卫技人员占全院人数的比例等.结论:运用主成分分析,可综合反映影响妇幼卫生服务提供的因素.     

VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE

Using data from Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate the determinants of voluntary private health insurance (VPHI) among the over 50s in 11 European countries and their effects on healthcare spending. First, we find that the main determinants of VPHI are different in each country, reflecting differences in the underlying healthcare systems, but in most countries, education levels and cognitive abilities have a strong positive effect on holding a VPHI policy. We also analyse the effect of holding a voluntary additional health insurance policy on out‐of‐pocket (OOP) healthcare spending. We adopt a simultaneous equations approach to control for self‐selection into VPHI policy holding and find that, only in the Netherlands, VPHI policyholders have lower OOP spending than the rest of the population, whereas in some countries (Italy, Spain, Denmark and Austria), they spend significantly more. This could be due to not only increased utilisation but also cost‐sharing measures adopted by the insurers to counter the effects of moral hazard and to keep adverse selection under control. Copyright © 2012 John Wiley & Sons, Ltd.     

不同企业青年管理人员心理健康与生存质量测试研究比较

[目的]了解处于不同地区的企业青年管理人员的心理健康情况。[方法]使用SCL-90和SF-36量表对受调查人员进行测试,并与常模比较。[结果]北京企业青年管理人员在人际关系、抑郁、焦虑、敌对和偏执等因子得分较标准得分分别有显著差异(P﹤0.05)和极显著差异(P﹤0.01)。山东企业青年管理人员在强迫症状、人际关系、抑郁等因子得分较标准得分分别有显著差异(p﹤0.05)和极显著差异(P﹤0.01)。北京企业青年管理人员在MH项目得分较标准得分有极显著差异(P﹤0.01)。山东企业青年管理人员在GH项目得分和标准得分有显著差异(P﹤0.05),在VT、SF和MH项目得分和标准得分差异有统计学意义(P﹤0.01)。山东企业青年管理人员在GH项目得分和北京得分差异有统计学意义(P﹤0.05),在VT、SF和MH项目得分和北京得分差异有统计学意义(P﹤0.01)。[结论]两企业的青年管理人员心理健康情况较好,北京某企业的青年管理人员的生存质量明显好于山东某企业的青年管理人员。     

信阳市1999～2003年死亡孕产妇文化程度与其保健服务利用的相关性分析

目的：探讨死亡孕产妇文化程度与其保健服务利用的相关性，以便采取有针对性的干预措施，有效降低孕产妇死亡率。方法：对信阳市1999-2003年236例死亡孕产妇的监测报告卡内容进行资料整理和统计学分析。结果：本市1999年-2003年孕产妇死亡率呈整体下降趋势，由74．06／10万下降到61．43／10万。引起孕产妇死亡的前3位病因分别是产科出血（占51．35％）、妊娠高血压综合征（占17．37％）和羊水栓塞（占12．19％）。随着死亡孕产妇文化程度的提高，其死亡率越低、分娩地点选择县以上医院的概率越高、越重视孕早期检查和产前检查、不可避免因素引起死亡的概率越高，同时死亡孕产妇文化程度同孕产妇死亡率呈负相关。结论：死亡孕产妇文化程度与其围生期保健服务利用存在较好的相关性，孕产妇文化程度是影响孕产妇死亡率的关键因素。     

PUBLIC AND PRIVATE HEALTH INSURANCE IN GERMANY: THE IGNORED RISK SELECTION PROBLEM

We investigate risk selection between public and private health insurance in Germany. With risk‐rated premiums in the private system and community‐rated premiums in the public system, advantageous selection in favor of private insurers is expected. Using 2000 to 2007 data from the German Socio‐Economic Panel Study (SOEP), we find such selection. While private insurers are unable to select the healthy upon enrollment, they profit from an increase in the probability to switch from private to public health insurance of those individuals who have experienced a negative health shock. To avoid distorted competition between the two branches of health care financing, risk‐adjusted transfers from private to public insurers should be instituted. Copyright © 2013 John Wiley & Sons, Ltd.     

Advocacy at the End of Life: Meeting the Needs of Vulnerable Latino Patients

This research explores health care professionals' understanding of the problems that arise in managing a terminal condition impacting the Latino population and conceptualizes the components of patient advocacy that address gaps in end-of-life care for patients and their family members. Limited research exists regarding patient advocacy from the perspectives of health care providers working with vulnerable Latino populations utilizing a public sector health care system. Forty-six semi-structured interviews were conducted with providers from different disciplines including medicine, nursing, social work, and chaplaincy. Although roles and responsibilities vary among health providers, it is imperative that all providers become aware of the need for patient advocacy. Doing so is not only in the best interest of vulnerable Latino populations but also has overarching financial benefits and positive outcomes for patients, administrators, and public health care systems. Social workers are the ideal professionals to assume leadership roles and share their knowledge of how to advocate effectively for the most vulnerable populations.     

DISCLOSING TOTAL WAITING TIMES FOR JOINT REPLACEMENT: EVIDENCE FROM THE ENGLISH NHS USING LINKED HES DATA

For the last decade, stringent monitoring of waiting time performance targets provided English hospitals with incentives to reduce official waiting times for elective surgery. It is less clear whether the total amount of time patients waited in secondary care, from first referral to outpatient clinic until treatment, has also fallen. We used Hospital Episode Statistics inpatient data for patients undergoing total joint replacement during a period of active monitoring of targets (between 2006/7 and 2008/9) and linked it to outpatient data to reconstruct patients' pathway in the 3 years before surgery and provide alternative measurements of waiting times. Our findings suggest that although official waiting times decreased drastically in our study period, total waiting time in secondary care has not declined. Patients with shorter official waits spent a longer time in a ‘work‐up’ period prior to inclusion in the official waiting list, and socio‐economic inequities persisted in waiting times for joint replacement. We found no evidence that target policies achieved efficiency gains during our study period. Copyright © 2013 John Wiley & Sons, Ltd.     

Temporal trends in place of death for end‐of‐life patients: Evidence from Toronto,Canada

Understanding the temporal trends in the place of death among patients in receipt of home‐based palliative care can help direct health policies and planning of health resources. This paper aims to assess the temporal trends in place of death and its determinants over the past decade for patients receiving home‐based palliative care. This paper also examines the impact of early referral to home‐based palliative care services on patient's place of death. Survey data collected in a home‐based end‐of‐life care program in Toronto, Canada from 2005 to 2015 were analysed using a multivariate logistic model. The results suggest that the place of death for patients in receipt of home‐based palliative care has changed over time, with more patients dying at home over 2006–2015 when compared to 2005. Also, early referral to home‐based palliative care services may not increase a patient's likelihood of home death. Understanding the temporal shifts of place of death and the associated factors is essential for effective improvements in home‐based palliative care programs and the development of end‐of‐life care policies.     

Differential impacts of care‐giving across three caregiver groups in Canada: end‐of‐life care,long‐term care and short‐term care

Using data from Statistic Canada's General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care‐giving among three groups of caregivers providing informal care either in the caregiver's or recipient's home, or in other locations within the community: (i) those providing end‐of‐life (EOL) care (n = 471); (ii) those providing long‐term care (more than 2 years) for someone with a chronic condition or long‐term illness (n = 2722); and (iii) those providing short‐term care (less than 2 years) for someone with a chronic condition or long‐term illness (n = 2381). This study lays out the variation in sociodemographic characteristics across the three caregiver groups while also building on our understanding of the differential impacts of care‐giving through an analysis of determinants. All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of ‘fair or poor’ self‐assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care‐giving, more so than both short‐term and long‐term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care‐giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long‐term or short‐term caregivers. This provides the evidence for the assertion that EOL care‐giving is the most intense type of care‐giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short‐term and long‐term caregivers.