Addressing Racial and Ethnic Disparities in Health Care: Using Federal Data to Support Local Programs to Eliminate Disparities

To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data.     

市场机制下政府调节与医疗管制制度框架的构建

医疗机构分类管理的政策确定了我国医疗服务的市场取向.我国医疗市场服务因其特殊的技术经济特点也存在一般意义上的市场失灵,使政府管制这一非市场治理机制的产生与存在成为必要,以弥补与矫正市场缺陷,保证医疗服务市场的规范运行和卫生改革的顺利推进.     

Mortality of a municipal-worker cohort: IV. Fire fighters

Morbidity and mortality studies of fire fighters have produced varied and inconsistent findings regarding the potential chronic effects of fire fighting including respiratory disease, cardiovascular disease, and cancer. The mortality experience of 1,867 white male fire fighters who were employed for the City of Buffalo a minimum of five years with at least one year as a fire fighter was studied. Vital status was determined for 99% of the cohort, resulting in 470 observed deaths. The fire fighter cohort was characteristic of a healthy worker population. All-cause mortality was close to the expected standardized mortality ratio (SMR) = 95, and significantly lower than expected mortality was seen for all external causes (SMR = 67)--in particular, for suicide (SMR = 21) and respiratory diseases (SMR = 48). Significantly elevated SMRs were found for benign neoplasms (SMR = 417), cancer of the colon (SMR = 183), and cancer of the bladder (SMR = 286). Cause-specific mortality is presented by number of years employed, calendar year of death, year of hire, and latency. Cancer mortality was significantly higher in the long-term fire fighters, and risk of mortality from all malignant neoplasms tended to increase with increasing latency. Patterns in risk of mortality among fire fighters for cancers of the bladder, colon, and brain are intriguing. Additional follow-up of this cohort and initiation of cancer morbidity studies would be helpful in further clarifying the potential long-term effects of fire fighting on cancer risk.     

利用外国政府贷款医疗项目操作程序及需要注意的问题

综合了申请利用外国政府贷款医疗项目所涉及的部门、政策规定、申请程序、工作要求等,并按照实际工作中的大体操作顺序作了较为具体的介绍。     

公立非营利性医院建立法人治理结构理论探讨

回顾了医院法人治理结构问题的提出、内涵和理论发展,分析了公立非营利性医院建立法人治理结构的迫切性,并探讨了医院建立法人治理结构的主要内容和所面临的关键问题.     

Attitudes to social issues in medicine: a comparison of first-year medical students with first-year students in non-medical faculties

The emphasis on academic achievement in medical student selection has given rise to the fear that students entering medicine may comprise a homogeneous group with tendencies towards academic and scientific pursuits rather than humanistic and person-oriented health care. The Attitudes to Social Issues in Medicine (ATSIM) scale was administered to first-year Australian medical students and first-year students in other faculties including students with significantly lower academic performance measured by high school examination scores. The medical student group was found to be less conservative towards general social issues than students enrolled in commerce and science faculties and scored equally with arts students. Greater conservatism was, however, apparent in those areas which most closely affect the doctor's role. Medical students were less positive than other student groups in their attitudes towards increased government control of the medical profession, the contribution of allied health professionals and the importance of social aspects of illness. On attitudes to issues such as prevention and doctor-patient relationships which do not challenge the knowledge base or traditional role and status of the medical profession, however, medical students demonstrate equal or greater concern compared with other student groups.     

新政府会计制度下公立医院会计核算的难点及对策

2019年1月1日公立医院正式开始实施新政府会计制度,通过研究公立医院在新制度下会计核算的衔接问题以及适应问题,找出公立医院会计核算将面临的难点,如固定资产及其累计折旧核算方式、应付职工薪酬、科教项目核算等,并给出相应的解决对策,如利用信息化手段对应付职工薪酬进行资金分配、利用成本配比处理医院科教项目核算难点等,帮助公立医院能够在改革中进步,提升公立医院会计核算管理水平。     

Investigating the relationship between social care supply and healthcare utilization by older people in England

Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures (“front‐door” measures); and extended stays of 7 days or longer; and 21 days or longer (“back‐door” measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labor costs and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class, and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund). There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.     

创建爱婴市 强化爱婴行动

深圳市从１９９３年开展创建爱婴医院、争创爱婴市活动。主要做法：提高认识,加强领导,全面推进爱婴行动;部门协作,齐抓共管,形成社会系统工程;儿童优先,母亲安全,促进医院产科改革;建章立制,规范管理,巩固和发展－创建成果;进入社区,进入家庭,促进妇幼保健工作。到１９９６年底,全市有１０张以上产科床位的医疗保健机构３５间已全部通过市、省和国家爱婴医院三级评审;住院期间和４个月的母乳喂养率分别提高到９６．２％和５２．６％;孕产妇和婴儿死亡率分别降至１２．９／１０万和１３．４‰。     

政府卫生职责界定方法探讨

在总结现有相关研究的基础上，提出了划分政府卫生职责应遵循的9项基本标准或原则；围绕这些标准构建了一个直观而简便的分析模型；讨论了应用该模型确定政府卫生职责范围的具体而实用的方法。