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Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co‐payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio‐economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd. 相似文献
3.
管理人员职业紧张常模及转换表研制 总被引:1,自引:1,他引:0
目的中高层管理人员、一般管理人员职业紧张常模、应用表、分级标准研究。方法采用职业紧张量表(OSI-R),对中高层管理人员263例、一般管理人员569例,共计832例常模样本进行研究。结果首先,采用OSI-R量表分别研制了中高层管理人员、一般管理人员职业紧张常模;其次,在常模的基础上,分别研制了常模样本粗分转换为T分表。职业紧张程度分级职业任务和紧张反应问卷中,T分≥70分者,为高度职业紧张、紧张反应;T分在60分至69分范围内者,为中度职业紧张、紧张反应;T分在40分至59分范围内者,为适度职业紧张和紧张反应;处于正常范围。T分低于40分者,为相对缺乏职业紧张和紧张反应。在应对资源问卷中,T分低于30分者,表明高度缺乏应对资源;T分在30分至39分范围内者,表明中度缺乏应对资源;T分在40分至59分范围之间者,具有适度的应对资源,属于正常范围;T分≥60分者,表明有很强的应对资源。结论将职业紧张的模式结合中高层管理人员、一般管理人员职业紧张常模及应用表,分别针对不同个体主要紧张源、紧张反应、应对资源,采取有针对性的干预(组织、个体)措施,以降低中高层管理人员、一般管理人员职业紧张程度,保护和促进工作能力是职业卫生领域面临的重要任务之一。 相似文献
4.
目的通过2004年和2005年本校女教职工妇科查体结果的分析,发现女教职工中未被识别的疾病与致病因子,从而达到防病、治病的目的。通过两年查体结果的分析比较,进一步说明高校女教职工定期进行妇科查体的必要性。方法收集、整理2004年和2005年两年的妇科查体结果,并对不同年龄组的患病率进行分析、比较,查找原因。结果两年的查体结果表明,2005年各年龄段妇科疾病的发病率明显较2004年低,经卡方比较,差异有显著性。结论对女教职工实施定期的妇科查体,对及旱发现妇科疾病、及时进行适当的治疗、保障女教职工的身体健康起了重要作用。 相似文献
5.
This paper presents the use of iterative dynamic programming employing exact penalty functions for minimum energy control problems. We show that exact continuously non-differentiable penalty functions are superior to continuously differentiable penalty functions in terms of satisfying final state constraints. We also demonstrate that the choice of an appropriate penalty function factor depends on the relative size of the time delay with respect to the final time and on the expected value of the energy consumption. A quadratic approximation (QA) of the delayed variables is much better than a linear approximation (LA) of the same for relatively large time delays. The QA improves the rate of convergence and avoids the formation of ‘kinks‘. A more general way of selecting appropriate penalty function factors is given and the results obtained using four illustrative examples of varying complexity corroborate the efficacy of the method. 相似文献
6.
David Wesch John R. Lutzker Larry Frisch Michelle M. Dillon 《Journal of behavioral medicine》1987,10(1):91-101
This paper addresses an evaluation of an administrative decision to change the manner in which services were paid for at a Student Health Center (SHC). The impact of the change in payment was observed through monitoring the number of scheduled appointments at the SHC which the patient failed to attend, reschedule, or cancel. The impact was assessed through a comparison of the weekly no-show rates from the year prior to the change in payment practices through the year following the change. A time-series statistical package was used to analyze the no-show data. Collateral measures on the number of students attending the university, staff opinions, and usage of the SHC by different student groups were collected. Evaluations of the impact of administrative decisions on health-related behavior were discussed, in addition to a discussion of the usefulness of time-series models for this type of evaluation. 相似文献
7.
《Journal of the American Medical Directors Association》2022,23(8):1348-1353.e8
ObjectivesThe recently developed Hospital Frailty Risk Score (HFRS) allows ascertainment of frailty from administrative data. We aimed to compare the HFRS against the widely used FRAIL Scale and Frailty Index.DesignPopulation-based cohort study linked to Western Australian Hospital Morbidity Data Collection and Death Registrations.Setting and ParticipantsThe Health in Men Study with frailty determined at Wave 2 (2001/2004), mortality in the 1-year period following Wave 2, and disability at Wave 3 (2008). Participants were 4228 community-based men aged ≥75 years, followed until Wave 3.MeasurementsWe used multivariable regression to determine the association between each frailty measure and outcomes of length of stay (LOS), death, and disability. We also determined if the additional cases of frailty identified by one measure over the other was associated with these outcomes.ResultsOf 4228 men studied, the HFRS (n = 689) identified fewer men as frail than the FRAIL Scale (n = 1648) and Frailty Index (n = 1820). In the fully adjusted models, all 3 frailty measures were associated with longer LOS and mortality, whereas only the FRAIL Scale and Frailty Index were significantly associated with disability. The additional cases of frailty identified by the FRAIL Scale and Frailty Index had longer LOS and greater risks of death and disability. The fully adjusted hazard ratio for death among the additional cases of frailty identified by the FRAIL Scale (compared to being not frail on both HFRS and FRAIL Scale) was 2.14 (95% CI 1.48-3.08).Conclusions and ImplicationsThe HFRS is associated with adverse outcomes. However, it identified approximately 60% fewer men who were frail than the FRAIL Scale and Frailty Index, and the additional cases identified were also at high risks of adverse outcomes. Users of the HFRS should be aware of the differences with other frailty measures. 相似文献
8.
A Novel Iterative Penalty Method to Enforce Boundary Conditions in Finite Volume POD-Galerkin Reduced Order Models for Fluid Dynamics Problems 下载免费PDF全文
S. Kelbij Star Giovanni Stabile Francesco Belloni Gianluigi Rozza & Joris Degroote 《Communications In Computational Physics》2021,30(1):34-66
A Finite-Volume based POD-Galerkin reduced order model is developed for
fluid dynamics problems where the (time-dependent) boundary conditions are controlled using two different boundary control strategies: the lifting function method,
whose aim is to obtain homogeneous basis functions for the reduced basis space and
the penalty method where the boundary conditions are enforced in the reduced order
model using a penalty factor. The penalty method is improved by using an iterative
solver for the determination of the penalty factor rather than tuning the factor with a
sensitivity analysis or numerical experimentation.The boundary control methods are compared and tested for two cases: the classical lid driven cavity benchmark problem and a Y-junction flow case with two inlet
channels and one outlet channel. The results show that the boundaries of the reduced
order model can be controlled with the boundary control methods and the same order
of accuracy is achieved for the velocity and pressure fields. Finally, the reduced order
models are 270-308 times faster than the full order models for the lid driven cavity test
case and 13-24 times for the Y-junction test case. 相似文献
9.
王巍 《中国新药与临床杂志》2003,22(2):115-116
甲磺酸曲伐沙星及其Trovan片剂 通用名 :甲磺酸曲伐沙星 (trovafloxacinmesylate) ,商品名 :Trovan片剂 ,化学名 :(1α,5α ,6α) 7 (6 氨基 3 氮杂双环[3 ,1 ,0 ] 己 3 基 ) 1 (2 ,4 二氟苯基 ) 6 氟 1 ,4 二氢 4 氧 1 ,8 萘啶 3 羧酸单甲磺酸盐 ,结构式见图 1。 申请日 :1 998年 3月 1 7日。申请人 :美国辉瑞公司。申请号 :A US 980 3 1 70 2。授权日 :1 998年1 0月 2 7日 ,授权号 :B US 981 0 2 71 1。法定行政保护期 :自授权之日起 7.5a,到 2 0 0 6年 4月 2 7日。专利介绍 :专利号… 相似文献
10.
王巍 《中国新药与临床杂志》2003,22(9):567-568
文拉法辛缓释胶囊 通用名 :文拉法辛 (venla faxine)缓释胶囊。商品名 :怡诺思 (Efexor)缓释胶囊。化学名 :(R/S) 1 [2 (二甲胺 ) 1 (4 甲氧苯基 )乙基 ]环己醇盐酸盐。结构式见图 1。图 1 文拉法辛结构式 Fig 1 Structureofvenlafaxine 申请日 :1999年 4月 16日。申请人 :荷兰AHP制药有限公司。申请号 :A NL 990 4 16 10。授权号 :B NL 9912 2 32 1。授权日 :1999年 12月 2 3日。法定行政保护期 :从授权之日起 7.5a ,到 2 0 0 7年 6月2 3日止。专利介绍 :欧洲专利第 0 12 2 6 6 9号。商标注册 :在我国注册的商标为怡诺… 相似文献