Charity Care by Non-profit Hospitals: The Price of Tax-exempt Debt

In this paper, we study the effects of tax-exempt debt on the supply of charity care of non-profit hospitals. We hypothesize that hospitals using tax-exempt rather than taxable debt are forced to provide higher levels of charity care as a condition for gaining access to the tax-exempt market. The study uses a panel of 189 California non-profit hospitals. Hospital uncompensated care is regressed on the level of uncompensated care by other hospitals in the market, lagged values of tax-exempt and taxable debt and other control variables.The magnitude of the tax-exempt bond subsidy has a positive effect on the flow of charity care and varies positively with the charity care provided by other hospitals. We conclude that subsidies provided by tax-exempt debt are an effective media to increase the supply of charity care by hospitals. Regulators can use competition between non-profit hospitals in order to enforce the desired behavior.     

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.     

Determinants of knowledge management system adoption in health care

The demand for efficient knowledge management (KM) in health care is increasing because the complexity and scale of the knowledge generated from medical research and clinical practices have resulted in challenges of information overload and medical quality. These critical issues can be improved through the adoption of knowledge management systems (KMS). However, the adoption of technological innovations in health care demands an enhanced understanding of the lagged technology adoption status in the health care sector. This study uses empirical methods to investigate the determinants of KMS adoption on the basis of a national survey. Results suggest that KMS adoption is affected by organizational characteristics, KM enablers, and KMS characteristics. We emphasize that KMS adoption in health care is considerably complex because it largely depends on KM enablers and organizational characteristics and not solely on system characteristics. The implications of the findings for research and practice are outlined in this work.     

Accounting and Medicine: An Exploratory Investigation into Physicians’ Attitudes Toward the Use of Standard Cost-Accounting Methods in Medicine

Research studies demonstrate wide variation in how physicians diagnose and treat patients with similar medical conditions and suggest that at least some of the variation reflects inefficiencies and unnecessary medical costs. Health care researchers are actively examining ways to reduce variations in practice through standardization of medicine to reduce the cost of treatment and ensure the quality of outcomes. The most widely accepted form of this standardization is Evidence Based Best Practices (EBBP). Furthermore, financial health care providers such as hospitals and managed care organizations are investigating methods to tie resource usage to medical protocols in their efforts to monitor and control health care costs. Such proposals are contentious because they report on physicians’ medical practice behaviors (such as the number of tests ordered, use of specific therapies, etc.) and such reports could potentially be used to influence their clinical behaviors. The intent of this exploratory study was to examine physicians’ perceptions about linking a standard costing system to EBBP guidelines. The authors interviewed nine practicing physicians asking each physician to respond to the question, ‘As a physician working in a hospital environment, what are your reactions to and concerns with combining standard costing techniques with EBBP?’ The interviews were in-depth and free form in nature. The physicians’ responses were recorded and analyzed using Grounded Theory Methodology. Using this methodology the field data was categorized into two major themes. The most important theme centered on ethics and the second theme was concerned with the implementation and use of a standard cost system in regard to EBBP. If physicians’ worries about ethical dilemmas and implementation issues are not resolved, then it is likely that doctors would be unwilling to participate in any efforts to develop or use a standard cost-reporting system in medicine. While this study was exploratory in nature, it should provide future guidance to accountants, health care researchers and health care providers about physicians’ issues with the use of standard costing methods in medicine.     

构建RBRVS的医生绩效考评体系工作研究

通过建立医生绩效考评模型，构建激励、公平且又能体现医院技术服务价值理念的绩效分配机制。以RBRVS资源相对价值为基础，通过比较医疗服务中投入的各类资源要素、成本的高低来计算每次服务的相对值，结合服务量和服务费用总预算，计算出每项诊疗服务项目的医生绩效奖金。RBRVS绩效考评的实施，使医疗资源利用率得到有效提高，鼓励和引导临床开展新技术新项目，促使收入结构的进一步优化，降低医疗运行成本，提高科室的能力建设。在医生绩效分配中实现精细化管理，能为公立医院建立新型的薪酬激励机制提供一定的参考。     

不同居住方式对农村失独家庭养老需求的影响——基于四川省H县的调查

不同的居住方式对老年人的生活质量有很大的影响,对失独家庭更是如此。基于四川省H县8个镇的全样本302户问卷调查,对农村独居和非独居失独家庭4类16项养老需求进行Logistic回归分析。研究结果表明:农村独居失独家庭在物质经济、医疗保健服务、生活照料服务三个方面的养老需要均显著高于非独居失独家庭;在养老需求的16个项目上,除了对养老保险、医疗保险、住房、健康咨询、老年活动棋牌室的需要没有显著差异之外,两组失独家庭在其他项目上的需要均存在显著差异;整体来说,个体特征、经济特征对两组失独家庭的养老需要都有显著影响,但不同的特征对两组家庭各类养老需要影响的显著性有所差异。根据上述结论,针对两种居住方式的农村失独家庭在养老保障方面提出了地方政府、社会和家庭之间多元合作的具体政策建议。     

建立开放型社会医疗保障制度实证研究与理论探讨——京晋两地实例分析

通过对北京和山西两地居民基本社会医疗保险选择意愿的调查分析,对政府卫生支出进行估算,探索经济发展水平不同地区建立城乡统筹的基本社会医疗保险的必要性和可行性。运用2011年的实证调查数据,采用交叉列联表、回归分析等统计方法,分析、对比北京、山西居民对基本医疗保险的选择意愿及其人口学因素,估算统筹城乡医保后两地政府卫生支出的变化。结论是：按照户籍、是否就业划分的医保制度在两地均不能满足所有居民的医保需求;影响两地医保选择的共同人口学变量有户籍、是否有商业保险、家庭人数、家庭年收入;若允许居民自由选择现行三大医保,北京市需多投入119.929亿元,山西省政府可节约109.815亿元。在经济发展水平不同的京、晋两地将现行三种基本社会医疗保险制度转化为统一制度下的三种医保水平并允许居民自由选择,可以取得事半功倍的效果。     

灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

Examining the Landscape of Managed Behavioral Health Care Through the Market Paradigm

ABSTRACT

The purpose of this article is to examine the market paradigm's impact on private practicing social workers, psychologists and psychiatrists who are reimbursed for services by managed behavioral health care organizations (MBHCOs). Five hundred eighty-two private practitioners from across the nation responded to a mailed survey in which they were asked a series of questions concerning changes in their business practices subsequent to joining MBHCO provider panels. Results indicate that despite the concerns about MBHC, these practitioners have sustained their practices. The market paradigm's use in explaining MBHC's impact on the private practitioners was found to have limited utility.     

Knowledge,attitudes, and practices of family physicians and nurses regarding unintentional injuries among children under 15 years in Cairo,Egypt

Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals' role in childhood unintentional injury prevention hinders the development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes, and practices regarding unintentional injury prevention for children <15 in Cairo, Egypt. Approximately, 60% were familiar with the terms unintentional injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While >90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9% and 85.9%, respectively), while thinking counselling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers' knowledge, attitudes and practices regarding IPC, more training and provision of counselling tools are essential for improving IPC by Egyptian medical providers.     

医疗护理服务可及性对居家老人照料服务选择的影响研究——基于北京市的实证研究

利用课题组2018年在北京市的抽样调查数据,运用Logistic回归方法考察医疗护理服务可及性对居家老人照料服务选择的影响。结果发现,医疗护理服务的便捷性、可支付性与老人照料服务的选择显著相关。住所附近有医疗卫生机构、有提供上门护理服务的机构或是与家庭医生签约的老人,更倾向于选择社会照料服务;支付能力对照料服务的选择呈现"U"型效应:家庭支付能力较强或者经济自评相对不足的老人更倾向于选择社会照料服务。应通过优化医疗护理资源布局、建立并完善社会照料服务的价格机制等措施,推进高效、可持续的社会照料服务体系的构建。     

残疾人医疗保险政策比较分析——基于全国23省《关于促进残疾人事业发的展实施意见》比较

残疾人医疗保障是残疾人社会保障体系的重要组成部分,在保障残疾人医疗服务需求方面发挥着积极的作用。本文以残疾人医疗保险为主要研究对象,从残疾人医疗保险的覆盖面、保障范围、资金补贴、待遇给付四个方面比较分析了全国23个省、市、自治区《关于促进残疾人事业发展的实施意见》的有关政策,并从推动城乡均衡发展、全面提高保障水平、明确界定政府责任、合理划分各级财政责任等方面提出了完善我国残疾人医疗保险制度的政策建议。     

上海市闵行区浦江镇“流动人口孕产妇平产分娩点”六年评估

通过对上海市闵行区浦江镇流动人口孕产妇平产分娩点的建立、运行和效果的评估,探讨政府在解决流动人口卫生保健问题中的作用。特约分娩点的建立是一项成功的政策措施,向农民工提供低收费和优质的基本产科服务深受农民工欢迎。目前每月在浦江镇特约分娩点分娩的产妇稳定在600-800例左右,服务质量优良。这是在我国城市化进程改善进城农民保健中一项成功的政策措施,卫生局起主导作用。     

看病难，看病贵：不能解决，还是不想解决？——关于医改舍本求末、屡改屡败的沉重思考

看病难、看病贵的问题长期困扰着国民,政府主管部门采取的解决措施却是隔靴搔痒,投鼠忌器,职能部门归咎的原因讳莫如深,避实就虚。看病难、看病贵的真正原因是国家医疗卫生体制市场化改革滞后;国家医疗卫生行政部门因保护部门权益不想改革;公立医疗卫生服务行业人员因既得利益不热心改革。当前医患冲突不断升级,已经成为一个社会问题,影响社会的和谐和稳定。针对今后的医疗改革,推行医疗服务市场化是解决看病难、看病贵的根本;实施以技养医是解决看病难、看病贵的关键。     

Health Care Entrepreneurship in the Democratic Republic of the Congo: An Exploratory Study

In this empirical study, the authors explore entrepreneurship in the health care business in the Eastern Kasai Province of the Democratic Republic of the Congo (DRC) using cross-cultural literature and the resource-based view to ground its analyses. The data were collected using a questionnaire targeted toward the health care entrepreneurs in Mbuji Mayi, the capital city of the Eastern Kasai Province in July 2010, which yielded 68 responses. The results indicated that the entrepreneurs were predominantly middle-aged Congolese men with backgrounds in the health services field who had raised their startup capital mostly from personal savings or friends and family. Their businesses, which were mostly in the form of sole proprietorships, were likely to be located in areas underserved by public medical facilities and usually provided both curative and preventative medical services.     

农民工医疗保险：从国外经验谈我国政府责任的强化

农民工处于城乡二元分割体制的夹缝中,得不到最基本的医疗保障,不仅被城市医疗保障体系拒之门外,而且在实际操作上又不为新型农村合作医疗所接受。农民工医疗保障制度缺失凸显政府在促进社会公平、提供公共服务方面的“缺位”和“不到位”。促进社会公平、保障基本公共服务均等化是市场经济条件下当今政府的首要职责,也是各级政府职能部门增进服务意识,提高服务能力的工作重点所在。因此,在为农民工建构医疗保险制度过程中,首先应当澄清认识误区,明确政府的责任定位,在此前提下,对构建农民工医疗保险制度中的政府责任做如下定位：立法责任、制度责任、财政责任、组织责任、监督责任,并提出相应的对策建议。     

Exploring quality perceptions of health care operations: a study of public hospitals of Mauritius

Patient care has become increasingly important in the health care environment of Mauritius. Patients' satisfaction and their expectations of health care are valid indicators of quality health care. The present paper reports the results of a survey of patient satisfaction with heath care, administered by face-to-face interview to 300 in-patient adults discharged from five main regional hospitals based in Mauritius. It examines the predictors and level of patients' satisfaction across the five regional hospitals of Mauritius. In this study, a modified version of HEALTHQUAL scale was used for determining patient satisfaction with health care in the regional public hospitals. Multiple regression analysis was conducted to understand the relationships among patients' perceptions of in-patient services and their overall perceptions of health care quality, and also satisfaction with their care and willingness to return or recommend the same hospital's services to others. The dimensions labelled as "Patients' perceptions of ward/hospital environment" and "Patients' perceptions of medical and nursing staff" served a significant impact on nearly all measures of patient satisfaction in the regional public hospitals of Mauritius.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

The Relationship Between Ethical Ideology and Ethical Behavior Intentions: An Exploratory Look at Physicians' Responses to Managed Care Dilemmas

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth's (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners.