Long‐Term Care Financing: Lessons From France

Context

An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market''s viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France''s very different approach to structuring public and private financing for long-term care could inform the United States’ long-term care financing reform efforts.

Methods

We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development.

Findings

France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income adjusted and amounts are low. Nevertheless, expenditures have exceeded projections, burdening local governments. Private supplemental insurance covers 11% of French, mostly middle-income adults (versus 3% of Americans 18 and older). Whether policyholders will maintain employer-sponsored coverage after retirement is not known. The government''s interest in pursuing an explicit public/private partnership has waned under President François Hollande, a centrist socialist, in contrast to the previous center-right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy.

Conclusions

American private insurers are showing increasing interest in long-term care financing approaches that combine public and private elements. The French example shows how a simple, cheap, cash-based product can gain traction among middle-income individuals when offered by employers and combined with a steeply income-adjusted universal public program. The adequacy of such coverage, however, is a concern.     

芦丁在杂化纳米材料修饰电极上的电化学行为及其应用

目的研究芦丁在多壁碳纳米管/石墨烯(MWCNTs/GR)杂化纳米材料修饰玻碳电极(GCE)的电化学行为及其含量测定。方法采用循环伏安法(CVs)、线性扫描伏安法(LSV)和示差脉冲伏安法(DPV)研究芦丁在该修饰电极上的电化学行为,并通过DPV测定曲克芦丁片和中药槐米中芦丁的质量分数。结果在优化条件下,芦丁在MWCNTs/GR/GCE上的氧化峰电流(Ipa)与浓度(c)在0.01~50.0μmol/L范围内呈良好的线性关系(r=0.998 4),检测限为4.6 nmol/L(S/N=3)。结论该修饰电极具有良好的重复性和稳定性,能应用于曲克芦丁片和中药槐米中芦丁的测定。     

门诊输液室健康教育效果观察

目的 探讨在门诊输液室加强健康教育,提高输液患者的遵医行为,提高患者对疾病相关知识的知晓率,调高患者对护理服务质量的满意度,改善护患关系.方法 选择212例输液患者随机分为观察组和对照组各106例.对照组采用常规的输液护理,观察组在常规输液护理的基础上加强健康教育,二组患者对遵医行为的依从性,以及对疾病、药物、及输液知识的知晓率和对护理服务质量的满意度进行比较.结果 观察组的遵医行为,疾病、药物、输液相关知识的知晓率,以及对护理服务质量的满意度明显提高.结论 加强门诊输液室患者的健康教育可以提高患者的遵医行为及相关知识的知晓率,提高输液患者满意度,改善护患关系.     

河南省中小学教师职业倦怠的现状及成因分析

目的:探讨河南省中小学教师职业倦怠现状、成因及对策。方法:采用教师职业倦怠量表、社会支持评定量表、总体幸福感量表和教师职业压力源问卷,于2013年采用分层随机整群的抽样方法,对560名中小学教师进行调查。结果:男性教师情感衰竭和去人格化程度高于女性(t=2.132和2.293,P<0.05);不同年龄段的教师情感衰竭和去人格化得分差异有统计学意义(F=15.722和5.573,P<0.05);不同教龄教师在情感衰竭和去人格化得分上差异有统计学意义(F=11.048和3.930,P<0.05);不同职称的教师在情感衰竭的得分上差异有统计学意义(F=11.751,P<0.001);中学老师的情感衰竭和去人格化得分高于小学教师(t=6.333和3.220,P<0.05);城市(县市)地区教师的情感衰竭和去人格化得分高于农村地区(t=5.124和2.315,P<0.05)。社会支持3个因子与去人格化呈负相关,与成就感低落呈正相关(P<0.05);除松弛与紧张因子外,总体幸福感的其他5个因子与情感衰竭、去人格化呈负相关,与成就感低落呈正相关(P<0.05);职业压力的6个因子与情感衰竭和去人格化呈正相关(P<0.05)。结论:中小学教师的社会支持度、总体幸福感和职业压力对中小学教师职业倦怠产生影响。     

高压氧对孤独症大鼠行为及外周血IL-1β、IL-6和IL-10水平的影响

目的:观察高压氧对丙戊酸钠孤独症模型鼠行为及外周血细胞因子水平的影响,探讨高压氧治疗孤独症的可能机制。方法:选取雌性Wistar大鼠,于孕第12.5天时腹腔注射丙戊酸钠600 mg/kg,产下的子代雄鼠20只,随机分为高压氧组和模型组,每组10只;正常对照组为腹腔注射等体积生理盐水的雌鼠产下的子代雄鼠10只。评价各组大鼠的生长和发育情况、运动活性、社会行为及学习记忆能力,采用ELISA法测定各组大鼠外周血IL-1β、IL-6和IL-10水平。结果:孤独症模型鼠生长发育迟缓、重复刻板行为、社会活动减少,高压氧组大鼠以上指标较模型组有所改善;模型组大鼠外周血中IL-1β、IL-6、IL-10水平升高,而高压氧组以上指标均较模型组下降(P均<0.05)。结论:孤独症的发病可能与细胞因子的表达水平异常有关;高压氧可能通过降低细胞因子IL-1β、IL-6、IL-10的水平,从而改善孤独症大鼠的生长发育及社会行为。     

Changing Physical Activity Behavior in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Objectives

To (1) systematically review the literature on behavioral interventions for people with multiple sclerosis (MS) that aim to change physical activity (PA) behavior; and (2) explore whether these interventions are clinically effective in improving PA, are theory based, and use established behavior change techniques (BCTs).

Effectiveness of a strength-oriented psychoeducation on caregiving competence,problem-solving abilities,psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial

BackgroundFamily caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.ObjectivesTo evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver’s depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors.DesignA prospective multi-centre and single-blinded randomised controlled trial stratified by survivors’ history of stroke.Setting and participantsAdult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong.MethodsThe design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests.ResultsWe recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers.ConclusionsFindings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors.