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.     

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.     

社会统筹养老金供给的两难困境与政策选择

在中国养老保险制度建立与完善过程中,其主要矛盾仍然是如何筹资和如何给付的问题。社会统筹主要通过提高缴费率和扩大覆盖面两条途径来增加基金供给,而现行制度却面临着养老金供给的两难困境。一是提高缴费率增加了基金收入,但不利于经济增长与扩大覆盖面;二是不同群体实行差别费率有利于扩大覆盖面,但加剧了养老金收支的失衡。经数理模型与实证分析,社会统筹缴费率应该保持适度水平,同时应该对不同群体实行差别费率的政策进行调整,以建立养老保障的长效机制。     

Accommodating the elderly poor: almshouses and the mixed economy of welfare in England in the second millennium

This article provides an outline of the development of the English almshouse across the second millennium, and its place within the broader spectrum of social welfare. It discusses the evolution of the almshouse into its modern form, as privately endowed housing dedicated to the elderly poor. It presents the results of new research that provides a firmer quantitative foundation for consideration of the role of the almshouse in welfare history and revisits the issue of the mixed economy of welfare to demonstrate the complex relationship between public and private provision.     

老年人养老方式选择的影响因素研究——基于CHARLS数据的实证分析

本研究在CHARLS调查所获得的微观数据的基础上进行,首先对老年人养老方式选择的结果和老年人人口特质、健康状况、经济状况等方面的6个变量进行关联分析,再通过二项Logistic回归模型,将是否选择机构养老作为被解释变量进行回归分析。结果表明非机构养老方式仍是老年人的主要选择,年龄、婚姻状况、慢性疾病情况、经济状况等因素与老年人养老方式的选择存在显著的关联并对选择结果产生影响。     

非理性就医对医保费用管理的挑战及应对策略

目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。     

优势视角下失独老人的养老困境及相应对策

失去独生子女的父母的养老问题逐渐成为一个日趋急迫的社会问题,也是老龄工作中的新问题。用优势视角基本理念分析失独老人的养老问题,研究他们年老时存在的精神、经济、生活等一系列养老困境及原因。个人、团体、社会应共同帮助他们抚平精神创伤,改变外部环境中的不利因素,使其融入社会,实现个人优势与其生活环境的整合,以逐步帮助他们走出困境,安享晚年。     

Like a member of the family: including and excluding paid caregivers in performances of family

Abstract

We explore the construction of family in contemporary families that employ professional providers of childcare and elder care. We find that families and caregivers at times construct family together, including the caregiver as a family member, while at other times, consumers construct family in ways that exclude the caregiver. Through our exploration of these various ways of constructing family, we offer three theoretical contributions. First, we challenge traditional distinctions between consumers and producers and highlight the fluid, contextualised nature of family by demonstrating that some contemporary constructions of family include paid service providers. Second, we elucidate the ways in which the provision and consumption of a service, everyday care, produces a liminal position for some service providers. Finally, we develop a broader understanding of the ways in which performances of family protect cultural values.     

内蒙古地区普通高校体育保健课开展情况的调查研究

本文通过文献资料、问卷调查法、专家访谈法、分析法及数理统计法对内蒙古39所高校的体育保健课现状进行调查、分析.找出内蒙古地区普通高校在开设体育保健课的开课状况、教学文件、教学内容、教师结构、场地设备及课余体育活动开展等方面存在的问题,提出自己的一些建议,为内蒙古地区各个高校开设体育保健课提供一些理论与实践的参考.