HEALTH INSURANCE TAX CREDITS,THE EARNED INCOME TAX CREDIT,AND HEALTH INSURANCE COVERAGE OF SINGLE MOTHERS

The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low‐income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference‐in‐differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference‐in‐difference‐in‐differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three‐quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take‐up of ?0.42. Copyright © 2013 John Wiley & Sons, Ltd.     

EMPLOYMENT AND HEALTH INSURANCE COVERAGE FOR RURAL LATINO POPULATIONS

Rural Latino populations continue to grow in part due to relocation of food processing industries to rural America along with other manufacturing and large retail stores. We use data from the Current Population Survey to examine the labor force participation of rural Latino population and the role rural employers play in providing health insurance coverage. We found that while rural Latinos are more likely to be uninsured, the meat packing industry has higher health insurance coverage rates than other rural employers such as construction and retail. Local communities recruiting new businesses to their rural communities need to explore the role that employers will play in providing health insurance coverage. Lack of adequate coverage will have an impact on the income, resources, and day-to-day activities of physicians, hospitals and traditional safety net providers.Lynn A. Blewett, PhD is Associate Professor in the Division of Health Services Research and Policy, School of Public Health, University of Minnesota and Director of the State Health Access Data Assistance Center (SHADAC), a research policy center supported by a grant from the Robert Wood Johnson Foundation. Michael Davern, PhD is Assistant Professor in the Division of Health Services Research and Policy, School of Public Health, University of Minnesota and Research Associate with SHADAC. Holly Rodin, MPA is a Research Assistant with SHADAC     

COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS

Market‐based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non‐hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within‐market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market‐specific environments should be considered in developing polices to promote competition. Copyright © 2013 John Wiley & Sons, Ltd.     

BORROWING TO COPE WITH ADVERSE HEALTH EVENTS: LIQUIDITY CONSTRAINTS,INSURANCE COVERAGE,AND UNSECURED DEBT

This article uses data from the Health and Retirement Study for 1998–2010 to investigate whether households respond to the financial stress caused by health problems by increasing their unsecured debt. Results show both the probability of having unsecured debt and the amount of debt increase after an adverse health event among households with low financial assets, who are uninsured, or who have less generous health insurance. The effect of health problems on borrowing is caused by both medical expenditures and disruptions to the income stream. Unsecured debt seems to remain on some households' balance sheets for an extended period. Copyright © 2012 John Wiley & Sons, Ltd.     

BANKRUPTCY,MEDICAL INSURANCE,AND A LAW WITH UNINTENDED CONSEQUENCES

Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, guaranteeing a standard of medical care to anyone who entered an emergency room. This guarantee made default a more reliable substitute for medical insurance. I construct a tractable structural model of the medical insurance market and find that repealing EMTALA would increase the fraction of the population with insurance while decreasing its price. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

PARENTAL INCOME AND THE DYNAMICS OF HEALTH INEQUALITY IN EARLY CHILDHOOD—EVIDENCE FROM THE UK

Recent research documents that socioeconomic health inequality has its origins in early childhood, that is, children from high‐income families have better health than their peers from low‐income families. In this article, we investigate the determinants of the evolution of socioeconomic health inequality in the UK. We analyze the relation between household income and both the prevalence and the consequences of adverse health conditions by following up infants throughout early childhood. We find evidence for the hypothesis that parental income operates through two different channels: it reduces the likelihood of incurring certain illnesses and it cushions the consequences of health conditions. Our results also indicate that a higher household income increases the probability that children fully recover from some diseases within a given period. Copyright © 2012 John Wiley & Sons, Ltd.     

孕产期保健保偿制三级管理的做法

本文阐述了张家口市在完善保健保偿制的基础上,于1990年对孕产期保健保偿制实行三级管理和三级质量控制的做法。一级是市孕保办对县(区)孕保办的管理和质量控制:二级是县(区)孕保办对辖区内地段保健、医疗单位及乡(镇)卫生院的管理和质量控制;三级是地段保健、医疗单位对本单位有关科室,乡(镇)卫生院对责任乡村医生和接生员的管理和质量控制。通过实践,收到了较好的效果。     

新兵睡眠质量与一般健康状况的相关性

目的了解新兵睡眠质量与一般健康状况的关系,为制定改善新兵睡眠质量措施提供参考。方法应用匹兹堡睡眠质量指数(PSQI)量表和一般健康问卷(GHQ-28)对某部200名新兵进行问卷调查。结果本组新兵的睡眠异常检出率为17.0%,高于地方男性人群(9.7%)及2010年新兵(6.0%)(P0.01);一般健康状况疑似阳性检出率为53.1%,高于普通市民(19.5%)及2010年新兵(29.3%)(P0.01);GHQ-28 A、B因子与主观睡眠质量(SSQ)、睡眠时间(SDu)、睡眠效率(HSE)、睡眠干扰因素(SDi)、白天功能障碍(DD)及PSQI总分均呈正相关(r为0.464~0.874,P0.01);C因子与入睡潜伏时间(SL)、SDi、应用催眠药物(USM)呈正相关(r为0.308~0.545,P0.05或P0.01);D因子与SL、USM呈正相关(r为0.398~0.742,P0.01);GHQ-28总分与SSQ、SDu、SDi、USM、DD及PSQI总分呈正相关(r为0.261~0.731,P0.05或P0.01)。结论新兵的睡眠质量和一般健康状况均不容乐观,改善新兵的一般健康状况有助于提高其睡眠质量。     

成都市饮用水水质监测状况及健康风险初评

[目的]了解近两年成都市饮用水的水质卫生状况及其可致的健康风险水平。[方法]根据供水方式的不同对2008~2009年成都市饮用水及源水进行分层随机抽样,检测砷、耗氧量、总大肠菌群等11项指标,并采用美国EPA推荐的模型对饮用水中主要有害化学物质进行健康风险初步评价。[结果]共检测水样190份(源水25份,饮用水165份),合格率为72.6%,其中饮用水合格率为69.1%,源水合格率为96.0%;饮用水的主要污染物为大肠菌群和锰,其合格率分别为72.7%和92.7%;饮用水合格率农村分散式供水(19.2%)﹤乡镇集中式供水(72.5%)﹤城市集中式供水(98.4%),差异均有统计学意义(P﹤0.01),不合格的饮用水多位于山区且多采用地下水为源水;饮用水中砷、六价铬等8种有害物质累计致癌风险的P50和P95分别为128.3×10-6和299.1×10-6,均低于国际辐射防护委员会(ICRP)推荐的通过饮水途径最大可接受风险水平(5×10-5/年,以70年计为3.5×10-3),主要致癌风险因子为砷、六价铬和铅;累计非致癌风险的P50和P95分别为0.3904和1.0016,主要非致癌风险因子为砷、镉和铅。[结论]本研究初步阐明了成都地区饮用水的卫生状况、水质健康风险水平和污染物的主次,对该地区饮用水水质改善和健康风险管理提供了帮助。     

我国全面建设小康社会的健康素质指标体系及标准研究

目的：为建立一个以人为本、与经济发展、社会进步相适应的小康社会国民健康素质指标体系与标准。方法：采用社会学研究方法，进行Delphi调查，专家小组论证。结果：建立了一组包括目标指标与措施保障指标两部分共15个细目的健康素质指标体系与标准。结论：随着时间的推移，建立的指标标准参考值还需观察变化趋势，分析数量规律，进行修正完善。     

PUMPS,GERMS AND STORAGE: THE IMPACT OF IMPROVED WATER CONTAINERS ON WATER QUALITY AND HEALTH

Applying a randomized controlled trial, we study the impact of improved water transport and storage containers on the water quality and health of poor rural households. The results indicate that improved household water infrastructure improves water quality and health outcomes in an environment where point‐of‐source water quality is good but where recontamination is widespread, leading to unsafe point‐of‐use drinking water. Moreover, usage rates of 88% after 7 months are encouraging with regard to sustainable adoption. Our estimates suggest that the provision of improved household water infrastructure could ‘keep clean water clean’ at a cost of only 5% of the costs of providing households with improved public water supply. Given the general consensus in the literature that recontamination of water from improved public sources is a severe public health problem, improved transport and storage technologies appear to be an effective low‐cost supplement to the current standard of financing public water supply for poor rural communities. Copyright © 2012 John Wiley & Sons, Ltd.     

安徽农村育龄妇女婚姻质量与生殖健康相关知识的关系

[目的]了解安徽农村已婚育龄妇女婚姻质量状况与生殖健康相关知识现状,探讨两者之间的关系,为进一步做好农村妇女保健工作提供依据.[方法]运用Olson量表修改形成的婚姻质量量表,通过方便整群抽样的方法抽取安徽3县3个乡镇的农村已婚育龄妇女,由经过培训的调查员对其进行入户面访.[结果]共收集有效问卷1221份,应答率为87.3%.育龄妇女对生殖健康知识的总知晓率为44.99%,其中性卫生、安全套、生育和性病知识的知晓率分别为74.02%、48.76%、41.11%和20.56%.婚姻质量的各个维度与知识的掌握情况存在不同程度的关联,尤以夫妻交流、解决冲突的方式、性生活、角色平等等因子与知识掌握情况的相关性强.但知识与婚姻质量的关联性有随文化程度升高而减弱的趋势.生殖健康相关知识与婚姻质量存在相关关系.[结论]妇女的生殖健康不单纯是生物学问题,也与婚姻质量等多因素有关联.干预工作中应进一步研究和运用.     

贵州省苗族、仡佬族及汉族的健康状况和生命质量分析

[目的]了解贵州省苗族、从仡佬族及汉族的健康状况和生命质量,分析影响健康的主要因素,找出可能存在的卫生问题,为制定社会卫生策略提供依据。[方法]采用现况调查的方法,通过分层随机抽样,对3个民族的居民进行入户调查,收集人口学,社会经济,疾病频率,卫生服务利用以及生命质量等一系列指标,采用有序资料的Logistic回归对影响生命质量的因素进行分析。[结果]在调查的583名居民中,苗族、仡佬族、汉族的两周患病率分别为22.0%,27.7%,26.9%。慢性病患病率3个民族分别为15.7%,34.3%和24.4%。通过对生命质量影响因素的多元分析发现,收入、医疗支出、婚姻状况、两周患病率、慢性病患病率等是影响生命质量的因素。[结论]少数民族地区收入偏低,人群卫生知识较为贫乏,提高其卫生常识迫在眉睫。     

水面舰艇和核潜艇长航对艇员焦虑、抑郁情绪及睡眠质量的影响

目的 :了解长航对水面舰艇和核潜艇艇员焦虑、抑郁情绪和睡眠质量的影响 ,为改善长航艇员的心理健康状况提供依据。方法 :(1)研究对象分水面舰艇组和核潜艇组 ,并以岸勤组为对照 ;(2 )用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、匹兹堡睡眠质量指数 (PSQI)进行评定。结果 :(1)SAS评分 ,两长航组艇员航后较航前和岸勤组均增高 (P <0 .0 1) ;SDS评分 ,水面舰艇组航后仅较航前增高 (P <0 .0 5 ) ,核潜艇组航后较航前和岸勤组均增高 (P <0 .0 1)。 (2 )焦虑发生率 ,水面舰艇组航前为 8.77% ,航后增至 2 8.0 7% (P <0 .0 1) ,核潜艇组航前为 6 .0 6 % ,航后4 3.4 3% (P <0 .0 1) ;抑郁发生率 ,水面舰艇组航前 4 .39% ,航后 2 1.0 5 % (P <0 .0 1) ,核潜艇组航前 7.0 7% ,航后 4 4.4 4% (P <0 .0 1)。 (3)PSQI总分与水面舰艇组SAS、SDS均分间相关系数 (r)分别为 0 .4 792和 0 .4 6 75 ,与核潜艇组SAS、SDS均分间r分别为 0 .4 498和 0 .4 983,(P <0 .0 5 )。两长航组的SAS与日间功能之间 ,核潜艇组SDS与睡眠质量、睡眠障碍、日间功能之间也呈正相关 (P <0 .0 5 )。结论 :水面舰艇和核潜艇长航均可致艇员焦虑、抑郁情绪发生率增高和睡眠质量变差 ,且程度以核潜艇长航为著。睡眠质量变差与焦虑和抑郁的严重程度