私人部门在满足医疗需求方面的作用（上）

本文就私人部门在满足医疗需求方面的作用进行分析,认为如果私人部门能够得到有效监管,并按照社会道德认同的方式进行运转,一国医疗体系就能够受益于私人部门。本部分探讨了医疗体系的基本功能及其目标,介绍了绝对平均主义、两阶层医疗体系和多阶层医疗体系三种分配医疗服务的观点,指出当前用货币价值衡量医疗产出价值是次优选择;而衡量医疗服务分配效率也存在争议。     

基本医疗卫生制度下政府卫生支出及公平性研究

在基本医疗卫生体制中,基本医疗卫生服务的范围是按照基本医疗保险确定的,医疗保险支付是按照居民的基本医疗卫生服务的需求量决定的,高收入者比低收入者享有更高的医疗保险,对基本医疗服务的需求更大,也获得更多的医疗保险补贴。随着政府卫生支出中医疗保障支出比重的增加,医疗服务的公平性却降低了。     

基于信息系统的航天发射场设备健康管理架构研究

有效的设备健康管理需要推进更完整的信息获取、更全面的互联互通、更深入的信息应用。对基于信息系统的航天发射场设备管理的需求进行了分析,主要有:智能化的管理手段、专业化的管理队伍、配套化的管理机制和信息化的管理环境。根据上述需求,分析了航天发射场设备健康管理的总体架构,主要包括资源管理架构、业务逻辑架构、应用表现架构和基础设施架构;设计和描述了航天发射场设备健康管理的层次架构。基于信息系统的航天发射场设备健康管理架构,能够为航天发射场实现科学的设备健康管理奠定基础。     

完善我国重大疾病商业健康保险的若干建议

本文通过对我国社会医疗保险和商业健康保险的比较,揭示重大疾病商业健康保险的必要性和重要性,并基于我国当前商业健康保险的种种缺失提出若干意见和建议。     

肥胖的经济学研究：文献综述

本文从肥胖问题导致的后果、产生的原因及针对的干预三个方面综述了肥胖的相关经济学研究。最近30年肥胖流行症在全球范围内的迅速蔓延已使得如何控制它成为全球最重要的公共健康议题之一。由于肥胖是由社会经济、个体行为、遗传因素及其交互作用所共同决定,单纯的医学研究倍受局限。随着肥胖问题日趋严重,越来越多的学者开始从经济学视角展开探索,这也使人们对肥胖问题有了崭新认识,该领域的研究也已经成为西方应用经济学科研究的重要方向。     

Audit as Leviathan: Constructing Quality Registers in Swedish Health Care

This paper explores the rise of an audit practice: the national quality registers in Swedish health care. Based on actor‐network theory, the study tells the story of an actor‐network formed by physicians in the 1970s who mobilized themselves around a common object; to develop the knowledge‐base of medical professionals. However, over time more actors became persuaded of the potential of the network and associate themselves with it, resulting in reformed registers. The study shows how the network develops into a macro‐actor, a Leviathan in health care, how this macro‐actor comes to affect health care practices and how it contributes towards maintaining a new governance regime.     

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.     

Consumer-Driven Healthcare: Information,Incentives, Enrollment,and Implications for National Health Expenditures

We highlight the importance of information for consumerdriven healthcare (CDHC), describe barriers, display data on adoption rates and product features, and use a new health modeling approach to investigate the potential impact on national healthcare expenditures. We conclude with an assessment of the prospects for CDHC as a revolution of information, competition, and market orientation; and we discuss potential pitfalls, including concern regarding vulnerable populations. While the jury is out on the ultimate effects, enrollment in CDHC programs— while still small—is growing rapidly; utilization and costs for subscribers appear to be moderating; and creative benefit structures emphasize health promotion alongside previously unseen cost consciousness. JEL Classification I11     

An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.     

Relationship between the curriculum system and the understanding of nutritional terms in elementary school children

To clarify the relation between the curriculum system and the understanding of nutrition terms, 944 students aged 8–12 years living in Japan, the USA and the UK, were asked about the recognition, medium for recognition, and understanding of nutrition terms. The effect of nutrition education from an early stage in elementary schools in the UK and the USA was confirmed. These results suggest the possibility of beginning nutrition education earlier in the elementary school in Japan. American students had paid attention to food labels. These results showed that a learning and teaching strategy founded on comprehensively based subjects in the USA had influenced good behaviour for dietary life. On the other hand, there was not a relationship between an understanding of nutrition terms and a developmental stage. Many students in three countries were influenced by television commercials to buy candy or soda. We think that it is important to develop a curriculum that includes practical learning and ensures hours of teaching for the purpose of acquirement of nutritional knowledge. It is also necessary to encourage critical thinking skills to evaluate television commercial messages through school lessons.