The effect of inpatient hospice units on hospice use post-admission

The objective of this study was to determine whether having a hospice unit within the hospital increases the proportion of terminally ill patients who use hospice services (including home, nursing home, or inpatient hospice) post-admission. Using medical record data abstracted for 232 randomly selected patients with terminal cancer admitted to six community hospitals in Connecticut, we found that patients admitted to a hospital with a hospice unit were more likely to use hospice services (i.e., home hospice, nursing home hospice, or inpatient hospice) post-admission than patients admitted to a hospital without a hospice unit (unadjusted OR 5.7, 95% CI 3.1, 10.6). This effect persisted after adjusting for patient age, gender, marital status, documented discussions of prognosis, prior hospice use, and type of cancer.     

The effect of market structure on HMO premiums

We examine the effects of HMO market structure on HMO premiums from 1988 to 1991. More competition, measured by the number of HMOs in the market area, reduces HMO premiums. Although this effect does not appear for IPAs before the highest level of competition is reached, it appears throughout the competitive range for Group HMOs. More market penetration, measured by the percent of the market area population enrolled in HMOs, reduces premiums for IPAs. Since the goal of managed competition is to reduce health care costs by creating competition among managed health care plans, our results offer encouragement for managed competition advocates.     

Dietary variety and its effect on food intake of elderly adults

BACKGROUND: Older people frequently have poor food intake. This present study investigated the effect of dietary variety on food intake in younger and older people. METHODS: Eighteen young adults (mean age = 26 years) and 18 older adults (mean age = 70 years) consumed four consecutive courses of sandwiches on two occasions. In the plain treatment, each course of sandwiches was of the same type, while in the variety treatment four courses, each of a different type of sandwich, were served. Each time the participants were presented with a serving of sandwiches and asked to eat as much as they liked. RESULTS: In the plain condition, the older adult group consumed more than their young counterparts. This situation was reversed for the variety condition when the young group ate more than the older adults. Interestingly, the older adult group ate more when a variety of sandwiches was presented. This may be contrary to what is predicted by the sensory-specific satiety model of eating behaviour. CONCLUSIONS: This study suggests that presenting the older people with a varied meal may be a valid strategy to improve food intake in this group.     

The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use

OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN: We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS: Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS: The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.     

非正式照料对老年人医疗费用支出的影响及政策建议

随着我国人口老龄化加剧,医疗费用上涨,老年人沉重的医疗费用负担引起了社会的广泛关注,看病难、看病贵的现象愈演愈烈。为了寻求减轻老年人医疗负担的新路径,本文利用中国健康与养老追踪调查(CHARLS)数据,采用IV-Tobit模型,考察非正式照料对老年人医疗费用支出的影响。研究结果表明:非正式照料对老年人的门诊和住院费用分别具有显著的负向影响,由此可见,非正式照料能够在一定程度上减轻老年人的医疗费用负担。     

Practice variation in long‐term care access and use: The role of the ability to pay

Practice variation in publicly financed long‐term care (LTC) may be inefficient and inequitable, similarly to practice variation in the health care sector. Although most OECD countries spend an increasing share of their gross domestic product on LTC, it has received comparatively little attention to date compared with the health care sector. This paper contributes to the literature by assessing and comparing regional practice variation in both access to and use of institutional LTC and investigating its relation with income and out‐of‐pocket payment. For this, we have access to unique individual‐level data covering the entire Dutch population. Even though we found practice variation in the use of LTC once access was granted, the variation between regions was still relatively small compared with international standards. In addition, we showed how a co‐payment measure could be used to reduce practice variation across care office regions and income classes making the LTC system not only more efficient but also more equitable.     

放疗患者临终关怀实践中的问题探讨

通过对实际案例的分析讨论,从放射治疗的终末期病人需要进行临终关怀、放射治疗理念与临终关怀理念的冲突、为病人的临终关怀做准备方面进行了分析,提出借鉴国外经验在综合医院开展临终关怀的设想。     

The labour market costs of community care

This paper reports an empirical investigation into the influence of informal care responsibilities on the labour supply of women. The objective is to examine the argument that the UK policy of caring for the chronic sick 'in the community' involves a nontrivial opportunity cost in the form of the forgone labour supply of the informal carers upon which it relies. We find that informal carers who care for less than 20 h per week are, in fact, more likely to participate in the labour market, but tend to work for fewer hours per week than otherwise similar noncarers. Informal carers who care for 20 h or more a week are less likely to participate, but only slightly. However, when they do undertake formal employment, they tend to earn less per hour and work for fewer hours per week.     

上海市安宁疗护政策扩散研究——基于56份安宁疗护政策的文本分析

安宁疗护在改善终末期患者及其家属的生活质量、提高医疗资源效率、提升社会福利水平上发挥着重要作用。本文以政策扩散理论为框架,以上海市2012—2021年56份安宁疗护政策文本为研究对象,利用NVivo、ArcGIS、ROST、UCINET软件,分别从时间、空间、内容、组织维度研究安宁疗护政策扩散现象,分析多重维度下上海市安宁疗护政策扩散的外部表现特征。研究发现：在时间维度上,政策扩散速度由慢变快再减慢,近似表现为“S”型分布;在空间维度上,呈现出吸纳—辐射相结合的试点型扩散;在内容维度上,既有政策领域的拓展,也有政策的细化与深化;在组织维度上,参与主体数量众多且类型多元、部门间协作紧密。该发现丰富了政策扩散理论知识图谱,拓宽了安宁疗护领域的研究视角,为深化开展全国安宁疗护服务工作提供借鉴。     

The effect of managed care on use of health care services: results from two contemporaneous household surveys

This paper estimates treatment effects of managed care plans on the utilization of health care services using data from two contemporaneous, nationally representative household surveys from the USA. The paper exploits recent advances in simulation-based econometrics to take the endogeneity of enrollment into managed care plans into account and identify the causal relationship between managed care enrollment and utilization. Overall, results from the two surveys are remarkably similar, lending credibility to their external validity and to the econometric model and estimation methods. There is significant evidence of self-selection into managed care plans. After accounting for selection, an individual enrolled in an health maintenance organization (HMO) plan has 2 more visits to a doctor and has 0.1 more visits to the emergency room per year than would the same individual enrolled in a nonmanaged care plan.     

Understanding the gap between need and utilization in outpatient care—The effect of supply-side determinants on regional inequities

The present study analyzes the effect of supply-side determinants on regional inequities in outpatient care. Inequities are measured by the degree of disparity between need for and actual utilization of outpatient health services in the 412 German districts. Outpatient care needs of each district are determined by applying the regression model of the German risk structure compensation scheme. We find that supply-side factors account for half of the model's coverage of regional inequities. The remaining regional variance explained by the model may be attributed to socioeconomic and (socio-)geographic determinants as well as price effects. Our findings call for strengthening the role of GPs as coordinators in the health care system, countering the geographic maldistribution of physicians and introducing adequate programs to improve the level of care in socially deprived districts. The study also highlights the importance of differentiating between need, demand and utilization of health services in order to understand the root causes of inequities.     

The end of life and the family: hospice patients’ views on dying as relational

The end of life is a highly emotive and critical period in the life course and families often play a central role during this time. Despite significant sociological work on dying as a relational experience, there has been little exploration of the significance of contemporary family structures and relations. In this article, drawing on the accounts of twenty hospice in‐patients, we explore how the end of life (in this case within an in‐patient unit) is mediated by family dynamics and expectations. Participants’ accounts reveal a range of interpersonal experiences, including: pressures and strains on families and patients; differentiation in family responses to and involvement in the dying process; and tensions between individual and family preferences/desires. We argue that family dynamics strongly influence individual experiences near death and that the focus on individual preferences and the management of disease in palliative care contexts must be augmented with sophisticated and nuanced understandings of the family context. We suggest that sociological conceptual explanations of shifts in social and family life, such as individualisation and ontological security, may also help us better understand the ways families approach and respond to the dying process.     

The effect of dietary supplementation in continuing-care elderly people: nutritional, anthropometric and biochemical parameters

The effectiveness of dietary supplementation for frail elderly subjects in continuing care was assessed by using nutritional measures of anthropometry and biochemistry and an 8-week period of nutritional supplementation.
Of 20 recruits six died and the remaining subjects were divided into treatment and control groups. The treatment group were supplemented with a nutritionally complete drink. Build Up, 2 units daily, and up to 1500 k) daily from glucose polymer. Food intake was measured for 3 days at the start and end of the study using validated food-intake records.
Significant differences were seen in anthropometric measures triceps skin fold thickness and arm muscle circumference in the supplemented cohort ( P <0.05), but for no other anthropometric and biochemical measures. Glucose polymer intake varied greatly between individuals, range 539–1396 kJ, mean 931 kJ ± 113.7.
Before supplementation dietary intake did not reach current recommendations for most nutrients, but after supplementation only vitamin D intake was inadequate. The study concludes a role exists for dietary supplementation in frail elderly, but further studies to outline benefits and optimum methods are required.     

老年护理医院从业人员临终关怀知识、服务行为与态度调查

目的分析老年护理医院从业人员临终关怀知识的掌握程度及对临终关怀服务行为与态度的认知，从而对老年护理医院设置临终关怀病房及进行相关人员培训提供参考依据。方法采用问卷和电子调查表格对本市53所老年护理医院不同职称、不同岗位的1081名从业人员进行调查分析。结果所有从业人员认为老年护理医院仍应以护理医疗为主，但临终关怀已受到一定重视；27．4％的从业人员认为心理护理是临终关怀服务的主要内容，但心理治疗技能较缺乏。结论临终关怀服务是老年护理医院服务内容的重要组成部分，需加强从业人员临终关怀知识和技能的培训，全面拓展加快临终关怀服务。     

循证护理用于原发性肝癌晚期患者临终关怀效果观察

目的：探讨如何做好肝癌患者的临终关怀护理工作。方法：对某院收治的32例原发性肝癌终末期患者,依据循证护理原则,实施最佳关怀和支持护理。结果：患者疼痛减轻,肝性脑病改善,顽固性腹水及自发性腹膜炎部分得到控制,焦虑、恐惧、悲观等不良情绪缓解,严重营养不良改善。结论：临终关怀可有效提高原发性肝癌晚期患者的生活质量。     

不同养老模式下老年人生命质量研究 ——以乌鲁木齐市为例

[目的]了解乌鲁木齐市不同养老模式下老年人健康相关生命质量(HRQOL),并分析不同养老模式及一般人口学因素对老年人生命质量的影响.[方法]采用欧洲五维健康量表(EQ-5D-3L)对社区居家、机构养老、医养结合养老老年人进行生命质量调查,并分析其影响因素.[结果]单因素分析显示:子女经济支持是影响老年人生命质量的重要因...