公立医院公益性测量与评价体系研究

公益性在公立医院绩效体系中的反映,主要包含在医疗服务的数量、质量、效率、均次费用和社会满意度5个方面。坚持公益性和社会效益原则是公立医院改革的方向,对公立医院改革的评价包括3个方面：政府评价、社会评价、自身评价。     

Prospective study on the reciprocal relationship between intimate partner violence and depression among women in Korea

This study aimed to examine the bi-directional relationship between intimate partner violence (IPV) and depression using prospective data. Data from the Korean Welfare Panel Study (KOWEPS) were used to test whether IPV was associated with an increased overall level of depression and with the rate of change over time in depressive symptoms and whether this model of change in depressive symptoms was associated with subsequent incidences of IPV.This study utilized data from 3153 married women who participated in the KOWEPS from 2006 through 2009. The KOWEPS is a panel study of a nationally representative sample of Korean households. The women's responses to multiple questions adopted from the Conflict Tactics Scale (CTS) were used to create a dichotomous IPV variable at Wave1 and Wave4. The CESD-11 was used to measure the women's level of depression. We utilized a latent growth model (LGM) of depression using IPV at Wave1 as a predictor and IPV at Wave4 as an outcome predicted by the model parameters of the LGM of depression.We found that after controlling for the effects of age, education, social support and income, IPV at Wave1 was positively associated with overall depression levels and negatively associated with the growth rate of depression. Further, IPV at Wave4 was associated with the intercept and the slope of the depression LGM and with IPV at Wave1. The overall model fit the data well.This study indicated that experiencing IPV influences a woman's level of depression in terms of its overall level and rate of change, which, in turn, influences the victim's likelihood of experiencing subsequent IPV.     

Meeting report: Association of Clinical Embryologists

The inability of local National Health Service trusts to uniformly provide assisted reproduction technology (ART) services has resulted in what has come to be known as a ‘postcode lottery’. Older women and those with responsibility for children at home, often have to fund their own treatment. Recently, with the birth of babies to much older women, the mass media have debated whether those past menopausal age should be helped to achieve a pregnancy in this way. We argue that the time is right for interested professionals to enter the debate, especially in view of proposed revisions to the Human Fertilisation & Embryology Authority's code of conduct which requires clinics providing ART to consider the ‘welfare of the child’. With that change in mind, we set out the case for imposing upper age limits on those receiving ART in the United Kingdom.     

浅析医院文化建设——内强职工向心力,外树医院公益形象

上海市第一人民医院通过组织各类义诊、为社区群众提供爱心医疗服务、推出便民惠民措施、举办科普知识讲座、捐献造血干细胞等各种大型公益行动,树立了医院良好的社会形象;通过举办干部培训班和专题讲座,提高干部管理能力和沟通技巧;开展现场救援培训和技术比武,提高临床服务水平;召开老干部座谈会,进行党性教育,增强职工凝聚力。     

Cancer’s impact on employment and earnings—a population-based study from Norway

Introduction

Increased attention is being paid to the long-term health and well-being of people living with a history of cancer. Of particular concern is cancer’s effect on productivity and work ability, which in turn is important for persons’ financial situation, life satisfaction, and social relationships. We explored the extent to which Norwegian cancer survivors stay affiliated to working life compared to the cancer-free population, and quantified cancer-associated earning declines.

Methods and results

Logistic regression models were estimated to explore the impact of cancer on employment using register data covering the entire Norwegian population in 2001, 567,000 men and 549,300 women 40–59 years old, of whom 34,000 were diagnosed with cancer. These analyses revealed that a cancer diagnosis was strongly associated with not being employed. Log-linear regression models were used to estimate the effect of cancer on labor earnings in 2001 for those employed. Cancer was associated with a 12% decline in earnings overall. Leukemia, lymphomas, lung, brain, bone, colorectal, and head-and-neck cancer resulted in the largest reductions in employment and earnings. Earning declines were strongly associated with educational level. In addition, linear regression models were used to estimate differentials in earnings before and after cancer. These results accorded well with those from cross-sectional models.

Conclusion and implications for cancer survivors

Cancer survivors are less likely to be employed than the cancer-free population, and undertake modifications in their employment, e.g. reduce work-hours or hold lower-wage jobs, which result in reduced earnings. A social class gradient is present and must be addressed to accommodate appropriate intervention from welfare societies.     

Patients' ratings of the in-hospital discharge briefing and post-discharge primary care follow-up: The association with 30-day readmissions

ObjectiveWe examined whether patients' ratings of their in-hospital discharge briefing and their post-discharge Primary Care Physicians' (PCP) review of the discharge summary are associated with 30-day readmissions.MethodsA prospective study of 594 internal-medicine patients at a tertiary medical-center in Israel. The in-hospital baseline questionnaire included sociodemographic characteristics, physical, mental, and functional health status. Patients were surveyed by phone about the discharge and post-discharge processes. Clinical data and health-service use was retrieved from a central data-warehouse. Multivariate regressions modeled the relationship between in-hospital baseline characteristics, discharge briefing, PCP visit indicator, the PCP discharge summary review, and 30-day readmissions.ResultsThe extent of the PCPs' review of the hospital discharge summary at the post-discharge visit was rated higher than the in-hospital discharge briefing (3.46 vs. 3.17, p = 0.001) and was associated with lower odds of readmission (OR=0.35, 95% CI 0.26–0.45). The model that included this assessment performed better than the in-hospital baseline, the in-hospital discharge-briefing, and the PCP visit models (C-statistic = 0.87, compared with: 0.70, 0.81, 0.81, respectively).ConclusionsProviding extensive post-discharge explanations by PCPs serves as a significant protective factor against readmissions.Practice implicationsPCPs should be encouraged to thoroughly review the discharge summary letter with the patient.     

Projecting future supply and demand for physical therapists in Japan using system dynamics

ObjectivesJapan is the oldest country in the world, and its demand for medical care is expected to increase. Although a clear vision regarding the supply and demand for physical therapy services is necessary, there has been no research that forecasts the supply and demand for physical therapists in Japan. Consensus has not been reached on whether the supply of physical therapists is sufficient. This study projects this supply and demand to provide medical policymakers with basic data.MethodsA system dynamics model was created to predict the number of physical therapists working in hospitals and clinics in Japan from 2014 to 2040. The future demand for physical therapy was estimated using the rehabilitation service utilization data from Open National Database, a publicly available nationwide health claims database. Sufficiency rates (supply/demand) were calculated, and sensitivity analysis was conducted on supply-related parameters.ResultsThe number of physical therapists was projected to be 1.74 and 2.54 times greater in 2025 and 2040, respectively, than in 2014. The sufficiency rates were 1.72, 2.39, and 3.30 in 2015, 2025, and 2040, respectively. The sensitivity analysis revealed that attrition rates had the greatest effects on sufficiency.ConclusionsAlthough the current supply appears to be needed, considering the expected increase and uncertainty in medical needs. However, there is a possibility of a future oversupply, especially after 2025, when the rate of increase in demand will lessen. Further studies are required to evaluate the distribution of physical therapists among regions and specialties.     

Creating capabilities for societal participation in times of welfare state change? Experiences of people with disabilities in Finland

Societal participation is central for disability policies throughout the world. In a Finnish setting, it is firmly anchored in the welfare state's commitment to create equal capabilities, but it is also dependent on other prerequisites, such as an inclusive labour market. However, these commitments have become both increasingly important through efforts of strengthening the rights of people with disabilities as well as increasingly challenged by crumbling growth and recurrent austerity measures in social policy. This article explores societal participation of people with disabilities in Finland in times of the recent ratification process of the UN CRPD and welfare cuts, and investigates the subjective experiences of societal participation in a changing welfare state context. The data consists of 13 individual qualitative interviews among working-age people with different kinds of disabilities. The findings highlight the importance of state commitment for creating equal capabilities for societal participation and for removing barriers standing in its way. They also suggest that this commitment is becoming both strengthened by the UN CRPD and weakened by the economic crisis and austerity measures and that this may have an undermining effect upon capabilities for persons with disabilities to participate in society.     

论个人储蓄投资机制的阻滞及转换途径

从阻滞机制的存在为前提，分析了个人储蓄投资失衡的原因以及相应的转换途径。