'The environment matters' and 'designing toward the whole'

A nurse/health care executive/architecture specialist and an artist/designer offer insights to creating environments that effectively support the delivery of care, the wellbeing of patients and their families, and the well-being of the health care workforce. The care environment is more than bricks, mortar, doors, windows, walls, and flooring. It is a sanctuary where healing can take place, where the spirit can be released, and where the provision of care, often fairly intimate, can happen through the connection between patient and care providers. Evidence-based design has brought forth the kind of inquiry and solutions that begin to address what an environment for healing requires. The interaction of built environment, staff, patients, families, and doctors is an overlapping ebb and flow that relies at its heart on the ability to hold all the parts as having equal priority.     

Social determinates of health: focus on substance use and abuse

Addiction is a progressive, chronic, and relapsing disorder of the brain that cannot be cured but can be treated. It is imperative to recognize the social overlay when planning to meet the health care needs of clients with addiction care needs. The implications for society are significant as addiction is a multifarious disease that costs the individual as well as the taxpayers. Administrators have the opportunity to provide education for all health personnel on early intervention and screening. Denial is a hallmark of the disease of addiction. Health care personnel must not be in denial about addiction because they can take action to prevent and treat addictions.     

Information technology, nurse staffing, and patient needs

As health care organizations increasingly adopt health information technology, time-sensitive data that track patients' requirements for nursing care and nurses' responsiveness to these needs might be available to support evidence-based nurse staffing decisions. care information technologies available in hospitals and on nursing units may provide valuable sources of information that can be translated into usable data. In this study, the usefulness of electronic data obtained from a nurse tracking call light system as a source of information for quality measurement was explored. The findings point to what might be under-utilization of existing health information technology to track patients' needs and nurses' responsiveness, patient census, and patient movements. The authors recommend health information technology be used less as support for other organizational systems and more as an administrative resource that can allow nurse executives to be more actively engaged within and across nursing environments.     

Optimal long-term care policy in an intergenerational exchange setting

We examine the optimality of public long-term care policy, incorporating an exchange game between elderly parents and adult children and transfer-seeking competition among siblings, instead of children's altruism. Results reveal that when children compete to obtain more valuable bequests from parents in exchange for elderly care, public long-term care policy is optimal if government can provide long-term care more efficiently than children can, thereby reducing parental bequests, possibly to zero. This is likely to be the case when children's wages are high. Formal long-term care might not be necessary if parents can receive adequate informal care in exchange for bequests to children with low wages.     

破解医改难题关键在于纠正市场与政府的双失灵——中国医疗体制改革的经济学分析

医疗卫生关系人们的生命健康,建立一个科学完善的医疗卫生体制是构建和谐社会的重要内容。目前,中国医疗卫生体制改革失败的事实要求我们深入分析其背后深层次的原因。中国医疗体制改革失败的根本原因在于市场与政府的双失灵,破解医改难题关键在于纠正市场与政府的双失灵。     

Nurses leading the response to the crisis of palliative care for vulnerable populations

All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.     

Technicity in nursing and the dispensation of thinking

While technology and health care delivery are inextricably and increasingly intertwined and technology has driven major advances in quality and efficiency in health care, technology does not replace the need for a thinking human being in care delivery. The term "technicity" refers to the tension created by the ability of humans to think versus their risk of being exploited as objects subservient to technologies. Drawing upon the philosophical works of Thoreau, Heidegger, and others, the authors pause on the conundrum created by expanding technology with the assumption that technological "improvements" should be evaluated with caution. Health care information systems are an example of tools that have improved our ability to collect and store information, but when systems "go down," staff can be rendered helpless. Similarly, technology can impose personal distance between the patient and provider in instances where staff are positioned as a mechanism for collecting data rather than a person interacting with another person. In some cases, health care providers function as navigators helping patients reach the correct pharmaceutical, rather than as teachers helping patients seek better health. Lastly, the tendency toward systems analysis in the context of the complex hospital environment leads solely toward uniform solutions rather than instances where a customized solution is warranted.     

Price and quantity in international comparisons of health care expenditure

An important omission from earlier cross-national comparisons of health care expenditure has been the failure to distinguish between price and quantity. Using recent data on purchasing power parities, the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 OECD countries. The article concludes that, contrary to what has been suggested in some recent articles, the relative price of health care is not correlated to the aggregate per capita income. The fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity. The relative price of health care has a rationing effect on the quantity of health care that is offered, with a price alasticity close to minus one. The latter finding means that the health care expenditure is not greater in countries with higherprices. Furthermore, the differences in health care expenditure or quantity between countries persist after correction for the relative price and the income level. Part of these differences can be explained by differences in the definition of health care in the various countries.     

Building a case for using technology: health literacy and patient education

The interplay of a mobile population can affect the quality of patient outcomes and the economics of health care delivery significantly. Helping patients with limited English proficiency understand the basics of self-care for optimal health will continue to be a challenge in the delivery of the highest quality nursing care. Becoming familiar with high-quality, peer-reviewed, and reliable health education materials and Web sites is the responsibility of every health care provider so that patients receive culturally and linguistically appropriate resources to support healthy lifestyles and choices.     

On the effect of income and relative price on demand for health care: EC evidence

This paper demonstrates that the relative price of health care could be used to explain the conflicting results of the empirical studies which attempt to measure the income elasticity of demand. Our empirical results, based on a conventional model and cross-national data set for the EC, show that whereas health care may be labelled as a luxury good, the large income effect can be interpreted as merely offsetting the price effect.     

ON THE PROBLEM OF PREVENTION

Disasters are often precipitated by insufficient preventive care. We argue that there is a problem of prevention in that this lack of care often stems from agents’ rational calculations. Positive experiences lead agents to underestimate the risks of disasters; technological improvements and redundancies designed for safety induce agents to reduce their care. Although lower care increases the chances of an accident, the number of redundancies can be adjusted to offset this. However, the accident probability remains constant even as ostensible improvements in safety are made. Checklists can be used to decrease the number of accidents.     

加强农民工医疗保障体系建设的对策建议

农民工为城乡社会的经济发展做出了巨大贡献,而自身则日益"边缘化",其医疗保障问题,日益成为社会各界关注的焦点。建立覆盖全民的分为三个层次城乡一体化医疗保障安全网:第一层次为基本医疗保障;第二层次为补充医疗保障及商业保险;第三层次为医疗救助,可以更好地发挥保障制度在构建和谐社会中的积极作用,最终的目标是构建城镇职工一体化的医疗保险体系。     

Means‐Tested Long‐Term Care and Family Transfers

One of the pervasive problems with means‐tested public long‐term care programs is their inability to prevent individuals who could afford private long‐term services from taking advantage of public care. They often manage to elude the means‐test net through ‘strategic impoverishment’. We show in a simple model how this problem comes about, how it affects welfare and how it can be mitigated.     

Childhood preventive care,adult healthcare and economic growth: The role of healthcare financing

We analyze the impact of healthcare financing on economic growth, focusing on the issue of the joint public–private financing of healthcare (co-payment). We use an overlapping-generations model with endogenous growth based on health human capital accumulation, where families pay for childhood preventive care and the government can either fully finance or co-finance adulthood curative care. From a growth maximizing perspective, distortionary taxes give an advantage to co-financing. Nevertheless, we prove that, if agents are assumed to be heterogeneous in preferences, full financing can become the best option.     

Factors influencing work productivity and intent to stay in nursing

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.     

北京市养老保障制度变迁与养老模式的比较研究

在人口老龄化浪潮席卷世界各国的同时,中国大城市也面临突出的老龄化问题,亟待完善养老保障体系成为应对人口老龄化的焦点。作为一线大城市,北京已经进入老龄化时期,需要在养老问题上有更为深入的思考。将养老问题分为生存保障和发展保障两个部分,以养老金、医疗和服务为具体形式,通过对制度层面和生活模式层面进行分析,发现当前适合北京的养老模式应为社区居家养老模式。     

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.     

Courage, leadership, and end-of-life care: when courage counts

As leaders, we must feel a sense of moral obligation to implement evidence about end-of-life care in our practice setting. Nurse leaders can help patients and families orchestrate a beautiful experience that is an alternative to futile, expensive end-of-life care. Preparation is key in helping staff provide the best level of care. A plan built around the best care for patients can integrate with many diverse positions and people. Courageous nurse leaders are well adapted to maneuvering through political traps and advocating for patients and their families. Everyone benefits personally and financially, including our communities and nation, when courageous leaders advocate successfully for effective end-of-life care.     

History and structure of business groups on health

In summary, business groups on health, given the strong financial and political support of key business decision makers, have shown that the competitive model can be used to encourage cost efficiencies in the health care system. It remains yet to be seen whether the growth of such organizations can produce needed change within a time frame that will make other approaches, such as national health insurance, unnecessary.     

澳大利亚居家服务体系研究

从政府职责、服务供给和服务使用三方面阐述澳大利亚居家服务体系,分析该体系目前面临的问题,及其对我国的启示。