Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Do non-profit hospitals provide more charity care when faced with a mandatory minimum standard? Evidence from Texas

Policymakers often question whether not-for-profit (NFP) hospitals provide enough charity care to justify tax advantages. In 1993, Texas enacted legislation requiring NFP hospitals to provide certain community benefits at levels set forth in specific criteria to retain tax-exempt status; this paper focuses on the effect of the legislation’s requirement that NFP hospitals spend a minimum of 4% of net patient revenue on charity care. We also study a modification of the law passed in 1995, which allows the deduction of bad debts expense when calculating net patient revenue. This change effectively lowers required charity care spending, and our study considers whether Texas hospitals responded by reducing charity care spending.     

Changing laundry habits in Norway

Maintenance is often the most energy‐demanding stage during clothes' life cycle. Therefore, a shift towards more sustainable washing habits has great potential to reduce the consumption of energy, water and detergent. This paper discusses the change in laundering practices during the past 10 years in Norway and suggests strategies to help consumers change their laundry habits to more sustainable ones. Quantitative information of consumers' experiences, habits and opinions concerning clothing maintenance was collected through three surveys in Norway in 2002, 2010 and 2011. The 2010 study was supplemented with qualitative in‐depth interviews of a strategic sample of households. The average washing temperature has decreased slightly during the studied time periods. Some products' washing frequencies remained the same, whereas other products such as jeans were used a few more days before washing. The cotton programme is the most used washing programme, but short programmes are gaining popularity. The laundry sorting processes vary greatly and are influenced by several factors such as washing temperature, colours, fibre type and use area. For some consumers, the use of several different sorting categories made it more difficult to collect a sufficient amount of clothing to fill the machine. They were also afraid that overfilling the machine would result in clothes that were not clean enough or had detergent residues. Detergent dosing practices are far from optimal. In 2010, although the majority of respondents only used eye measure and did not know the water hardness of their area, they still tried to vary detergent dosage based on the amount of laundry and the level of soiling. Different design for sustainable behaviour strategies could be used within detergent dosage systems, care labelling, machine programme selection (such as suggesting lower temperature and eco‐programme), machine filling grade indicators, storage systems for slightly used clothing and textile material choice.     

THE AGEING POPULATION: CRUNCH TIME FOR GOVERNMENT REFORMS

Current discussions about reforms to health and long‐term care miss the most important trends that should be influencing debate. With an ageing population that includes a higher proportion of people with manageable illnesses, health and care costs will rise. Reforms must ensure that existing government spending is used more efficiently and that it harnesses – rather than works against – private financing.     

On the efficiency of the negligence rule

The three versions of the negligence rule discussed in the literature differ regarding whether a negligent injurer is liable for the entire loss or only for the incremental loss; or regarding whether negligence is defined as failure to take at least due care or failure to take a cost‐justified precaution. It is shown in the paper that the incremental version with untaken precaution notion of negligence is not efficient; not even for the unilateral case. The paper also establishes, for the bilateral case, the efficiency of the incremental version with the shortfall‐from‐due‐care way of defining negligence.     

Community health service centers in China, not always trusted by the populations they serve?

Based on the idea that healthcare needs to be managed by individuals and that basic health services should be provided by the community, this paper examines the factors that impact urban outpatients' preferences for particular community health service centers (CHSCs) and hospitals. Rational consumption of healthcare is influenced by a patient's beliefs, beyond simple demographics and social structure. Ignorance of basic health issues leads to non-rational patient behavior, which also explains the confusion in Chinese health reform regarding people's mistrust of CHSCs. Health education in the form of self-managed care may increase personal health knowledge and encourage individuals to make use of the basic health services that are supplied by CHSCs.     

论“公正”重于“关护”———对中国就业弱势群体税收支持政策的哲学反思

随着我国就业弱势群体的出现,财政部和国家税务总局陆续出台了一系列促进就业的税收政策,但由于这些税收政策在“公正”与“关护”两个基本原则运用上存在侧重点的偏差,导致这些政策的作用效果并不明显。“公正”与“关护”同属人类伦理学理论资源中的两个基本道德诉求。在就业弱势群体税收支持政策制定中,两者缺一不可、互相关联,但从国家宏观就业指导方针、道德原则的稳定性、持久性以及普遍性的角度看,应该坚持“公正”重于“关护”。     

Treatment effects of selection behavior in managed care plans: evidence from Medicaid

This paper tests whether capitated payments to Medicaid managed care plans induce to plans strategic undercutting of treatment for specific diagnostic groups. I focus on treatment (measured by length of stay and cost) in acute care hospitals in Massachusetts. I use a differences-in-differences-in-differences approach, where the third differences compare treatment patterns between managed care plans that receive capitated payments with those that do not. I find that the first reduce treatment significantly more to mental health patients than to patients in other disease groups, whereas the latter reduce hospital resource use more uniformly across disease groups. These results highlight the importance of using payment mechanisms in public programs that reflect the variability in costs of beneficiaries.Received: September 2002, Accepted: May 2003, JEL Classification: I11I thank Randall Ellis, Kevin Lang and Thomas McGuire and anonymous referees for valuable comments and suggestions. I also thank seminar participants at The Brookings Institution and Harvard/MIT/BU Health Economics Seminar. The Portuguese National Science Foundation (B.D. 5910/95) and NIMH (NIMH R01 MH59254) provided financial support. I am indebted to the Massachusetts Division of Health Care Finance and Policy for kindly providing the data to me for this project. I am responsible for any errors that may remain.     

Attitudes toward Use of Advertising and Various Media Practices by Physicians

Advertising by physicians is a relatively recent phenomenon. The purposes of this study were to determine (a) consumers’ attitudes toward advertising by physicians; (b) whether certain potential consumer demographic variables account for any significant difference in attitudes toward physicians who advertise; and (c) which media consumers feel are appropriate for physicians’ advertising. The intent was to discover information that would be useful to physicians in planning promotional strategies and improving the quality of their advertising. The study seems to confirm the belief of many professionals that advertising and promotion clearly have a place in the future of health care services.     

OSI参考模型在新型农村合作医疗中的应用

本文在介绍新型农村合作医疗概念的基础上,引入了OSI参考模型,同时阐述了OSI参考模型在合作医疗中的优缺点,以及OSI在新型农村合作医疗中的应用。