市场、价值取向、政府之于医疗卫生

分析了现代医疗卫生服务的消费品属性并将其划分为3大部分,由此形成的不同供给渠道,决定了医疗卫生服务的市场运作方式的必然性,但必须坚持始终如一的正确的价值取向--社会公众利益最大化的医疗卫生服务的基本目标.强势的政府主导是医疗卫生改革与发展的关键,提出了当前政府主导作用的具体意见和建议.     

政府在基本医疗卫生服务法治化中的职责定位

明确基本医疗卫生服务作为公共产品向全民提供是新医改基本文件核心思想的基础上,辨析基本医疗卫生服务的提供模式,认为政府具体提供方式的差异性与共同性,需要理性看待;在全面依法治国和保障公民健康权的时代背景下,基本医疗卫生服务法治体系的建立,是基本医疗卫生服务提供过程中政府职责规范化的必然要求。提出应明确中央和地方各级政府的行政权力界限与行政违法责任,体现为基层医疗卫生服务机构、基本药物制度、基本医疗保险制度、全科医生制度四方面,从而实现政府行政职责的规范化。     

政府转型与中国医疗服务体系的改革取向

在中国的医疗卫生服务领域,出现了市场失灵和政府失灵并存的现象.市场与政府双失灵造成的恶果是,无论是市场主导的还是政府主导的医疗卫生资源,都涌向城市、涌向经济发达地区;在农村地区,在经济落后地区,在城乡结合部,不仅高层次医疗卫生专业力量不足,设备不足,甚至连机构的数量也不足.针对这些问题,一种流行的解决思路是恢复医疗卫生服务的计划体制,但计划经济时代农村同样是缺医少药.正确而且唯一的改革道路,就是两条腿走路:第一条腿是全面放宽对社会资本进入医疗卫生服务领域的管制,为所有的医疗机构(不论民营还是公立,不论是非营利性还是营利性)创造一个公平竞争的制度环境;第二条腿是政府将新增公共资源更多地投入到市场不足的地方和市场失灵的领域,从而引导整个医疗卫生服务体系健康均衡地发展.     

从失配到适配：农村医疗卫生服务可及性的逻辑转换

医疗卫生服务可及性作为实现供需匹配的重要手段,其实现目标既要有利于实现更高质量的医疗卫生服务均等化,又要有助于增进农民对医疗卫生服务满意度。基于公共管理的视角,可及性是一个评价医疗卫生服务供给与需求的适合度的概念,应包括可获得性、可接近性、可适应性和可承受性等内容。供需失配是农村医疗卫生服务可及性存在的基本症结,而财政失衡与资源错配是形成农村医疗卫生服务供需失配的主要原因。基于问题导向和目标导向,从医疗资源配置、服务供需精准对接、服务质量反馈、医疗卫生支出补偿等方面提升医疗卫生服务可及性,是实现农村医疗卫生服务从失配到适配逻辑转换的根本路径。     

医疗服务公平与效率实现途径的理论探讨

医疗服务的公平与效率是政府对公立医院的集中要求.在市场经济条件下,医疗服务公平与效率之间的特有关系,制约了医疗卫生事业的发展.本文通过对两者主要表现的阐述,从理论上探讨了相关对策,提出通过调整与完善医疗服务管理体系,建立合理的筹资机制等措施来实现医疗服务的公平与效率.     

瓦格纳定律与服务业增长——一个对我国服务业发展水平偏低的解释

医疗卫生、教育和社会保障等公共社会服务领域的公共支出不足是造成我国公共社会服务业发展落后进而制约我国服务业整体发展水平提高的一个主要因素。其原因包括:我国中央财政收入占GDP比重低、政府职能转变步伐慢以及我国地方政府以GDP和财政收入为导向的经济发展动力等。提高我国服务业发展水平应该逐步增加政府支出占GDP的比重、加快政府职能向公共社会服务转变、鼓励地方政府将政府支出更多投向公共社会服务领域。     

新型农村合作医疗制度补偿标准的区域差异化研究——基于江苏省海门市、安徽省金寨县、陕西省户县三地

新型农村合作医疗制度的补偿标准及受益情况是制度的核心所在,直接关系到参合农民的切身利益以及制度本身的发展完善。在东中西部三县新型农村合作医疗制度所设定的补偿标准中,东部海门市最为苛刻;但是在实际发生的受益情况中,东部海门市却又是最为优厚。可以看到,在制度设定的补偿标准与实际发生的受益情况之间出现了逆向发展的区域差异化现象。公共医疗卫生服务供给的非均衡、省际差异化的报销药物目录、区域差异化的筹资结构和财政补贴机制是造成这一特殊现象的重要原因。为此,必须增强中央政府财政转移支付能力,均衡配置医疗卫生资源,强化中西部地区基本公共卫生服务的供给能力,以促进参合农民更为公平地享受基本医疗卫生权益,推动新型农村合作医疗制度的进一步发展与医疗卫生体制改革的逐步深入。     

病人对双向转诊的认识和行为调查分析

发展社区卫生服务是党中央、国务院关于卫生改革和发展的既定方针,病人作为医疗卫生服务的需方,在医疗卫生服务巾占有重要的地位。为进一步完善双向转诊制度,为我国新一轮的社区卫生服务试点改革提供证据,课题组对医疗卫生服务需方——病人对双向转诊的认识和行为情况展开了调研,为卫生管理和医院管理提供决策证据。     

社区卫生服务与其高端医疗资源共享体系创新

从公共管理新视角,重点探讨城市社区卫生服务与其高端医疗资源基于区域健康信息互操作的发展战略,旨在为促进我国医疗卫生体制改革,创新提出"新型和谐的城市卫生服务体系",实现资源共享,适应我国社会经济发展和居民健康需求,为政府管理及其公共政策提供信息支持服务.     

卫生服务公平性--政府职能与作用研究

我国的卫生服务面临许多问题,包括区域规划不合理、资源严重不足但又存在浪费等,突出的是公平性问题.要解决这些问题不能只依靠市场机制,必须发挥政府的职能与作用,通过立法、加强监督管理、增加投入、卫生规划等手段发展医疗卫生事业,逐步实现卫生服务的公平性.     

Monologs,Dialogues, Bodies,Words, Silence,Photographs, Death

ABSTRACT

An examination of a clinical case in which severe demands on the analyst were made to bear silence and trauma unprocessable by the analysand. This discussion draws on the work of Coltart and Ferenczi to consider the demands of such work on the analyst. Intergenerational transmissions of trauma are also considered in the understanding of this case.     

Contrast, induction, facilitation, suppression, and conservation

Ten rats received all of their water in daily 1-hr sessions. Following a baseline phase in which lever and water spout were freely available throughout each session, subjects were trained to press the lever for water on mixed schedules composed of two alternating components. Each component gave access to water for a fixed cumulation of drinking time every time the rat cumulated a fixed amount of lever-pressing time. Changes in one component produced contrast and induction effects, both positive and negative, with respect to both lever pressing and drinking in the unchanged component. All schedules facilitated lever pressing relative to baseline. All schedules suppressed drinking relative to baseline, even though contingency sessions allowed ample time to perform the baseline amount of drinking. The entire pattern of results was predicted in quantitative detail by assuming that the total amount of a dimension apportioned to lever pressing and drinking is conserved between baseline and contingency sessions. Conservation theory was shown to predict several effects produced by simple fixed-ratio schedules, and was compared favorably with probability-differential (Premack, 1971) and response-deprivation (Timberlake and Allison, 1974) theory.     

Philosophy,Logic, Science,History

Analytic philosophy is sometimes said to have particularly close connections to logic and to science, and no particularly interesting or close relation to its own history. It is argued here that although the connections to logic and science have been important in the development of analytic philosophy, these connections do not come close to characterizing the nature of analytic philosophy, either as a body of doctrines or as a philosophical method. We will do better to understand analytic philosophy—and its relationship to continental philosophy—if we see it as a historically constructed collection of texts, which define its key problems and concerns. It is true, however, that analytic philosophy has paid little attention to the history of the subject. This is both its strength—since it allows for a distinctive kind of creativity—and its weakness—since ignoring history can encourage a philosophical variety of “normal science.”     

Eta,disco, odisco,andF

Two coefficients are proposed for measuring the extent of overlap in distributions as a direct function of the variance between the arithmetic means (“disco” and “odisco”). They are designed to answer such questions as: “Given the value of a numerical variablex, to which population should an individual be assigned so that minimum error would be incurred?” This is just the reverse of the question addressed by ANOVA. These coefficients are shown to be analytic inx and they are related to Pearson's eta and Fisher'sF. Extensions of these coefficients (designed for univariate, one-way discrimination) tok-way and multivariate discriminant analysis and measurement of “interaction” are suggested.     

Co-occurrence of Rape Myth Acceptance, Sexism, Racism, Homophobia, Ageism, Classism, and Religious Intolerance

Rape myth acceptance has been extensively studied. Little research is available, however, on the relationship of this variable to other oppressive belief systems. A sample of 492 male and 506 female college students completed the Illinois Rape Myth Acceptance Scale, the Attitudes Toward Women Scale (short form), the Neosexism Scale, the Modern and Old Fashioned Racism Scale, the Modern Homophobia Scale, a modified version of the Economic Belief Scale, the Fraboni Scale of Ageism, and the Marlowe–Crowne Social Desirability Scale (short form). Because there were no existing measures of intolerance toward multiple religions, the Religious Intolerance Scale was developed for this study (using relevant items from the Godfrey Richman Isms Scale). Findings here suggested that greater racism (both modern and old fashioned), sexism (both modern and old fashioned), homophobia (toward both gay men and lesbians), ageism, classism, and religious intolerance were each associated with greater rape myth acceptance. Moreover, each belief system collectively added to the prediction of rape myth acceptance, although sexism has the highest overlap with rape myth acceptance. Although gender did not moderate the relationship between oppressive belief systems and rape myth acceptance, results, across analyses, did indicate that men reported greater rape myth acceptance than women did. Results point to the interrelatedness of rape myth acceptance, racism, sexism, homophobia, classism, ageism, and religious intolerance.     

Narrow-band 1, 2, 3, 4, 8, 16, 24, 32, 48, 64, and 96 cycles/360 degrees angular frequency filters

We measured human frequency response functions for eleven angular frequency filters using a forced-choice procedure in a supra-threshold summation paradigm. Each of the eleven functions of 17 experimental conditions was measured 4-9 times among 12 observers. Results show that, for the arbitrarily selected filter phases, maximum summation effect occurred at test frequency for all filters. These results lead to the conclusion that there are narrow-band angular frequency filters operating in human visual system mostly through summation surrounded by inhibition at the specific test frequency ranges. Our previous suggestion (Simas and Santos, 2002), arguing that summation for the higher angular frequency filters should occur if background angular frequency contrast were set to a maximum of 5 times the test frequency threshold, was supported.