Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks. The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, US Public Health Service, or Department of Health and Human Services. This research was supported by the Intramural Research Program of the NIH Clinical Center.     

Was William James a Patient at McLean Hospital for the Mentally Ill?

Rumors that William James was a patient at McLean Asylum near Boston have persisted for several decades. I focus on the reasons why the question has been so difficult to answer in any definitive way; assess the evidence presented in support of the rumors; note that two different periods in James’s life (late twenties and early sixties) have been judged the most likely; and explore the diagnostic question as well: If he was in fact a patient, for what was he being treated? I also discuss evidence that his younger brother Robertson was a patient at McLean and consider the bearing of this evidence on the question of whether William James was a patient at McLean and on the diagnostic issue.     

Would Socio-Economic Inequalities in Depression Fade Away with Income Transfers?

A number of recent studies have questioned the conventional view regarding the existence of income-related inequalities in depression and have suggested that other factors have a more marked impact, most notably those socio-environmental effects linked to professional status and educational attainment. This paper seeks to measure and decompose the degree of socio-economic inequality in the factors underlying reported depression by drawing on data from Spain (Spanish National Health Survey, 2003), a country in which mental care coverage is somewhat limited, but where a marked social transformation has been apparent in recent decades. Contrary to recent evidence, our findings point towards the existence of significant income-related inequalities in the prevalence of reported (diagnosed) depression. However, the results from our decomposition analysis are more mixed. While a modest proportion of overall inequalities (6–13%) is accounted for by income alone, labour status, demographics and education appear to be more relevant. However, when controlling for potential endogeneity between income and depression by using instrumental variables (IV), income is found to account for more than 50% of overall inequality in reported depression.

Similitudes et différences de perceptions chez des salariés hommes et femmes

This study investigates men and women perceptions in the work, accros the relations between work conditions and job satisfaction. Similarity and difference are questionned about the mean dimensions of the work conditions (factor analysis) as well as the prédictive value of theses dimensions for the job satisfaction (regression analysis). In the same point of view, similarity and difference are analysed about health, importance of life domains and work-family interferences. Men and women seem to organize in the same way work conditions. Three factors are retained (Relations with superiors, Development and autonomy, Work intensity), wich the first two predict job satisfaction, for the men and the women. Nevertheless we note some differences, both about the force of the prediction and about specific item. Results and and futur works are discussed.     

Rabbis and Health: A Half-Century Review of the Mental and Physical Health Care Literature:1950–1999

Electronic searches were conducted on PubMed and the American Psychological Association's database (PsycINFO) for articles that discussed the role of rabbis in relation to some aspect of healthcare. The two searches were conducted in each electronic database using the search-terms: (1) (rabbi OR rabbinical OR synagogue) OR (2) (Judaism OR Jewish) AND (clergy OR chaplain). Articles were classified by the year of their publication, professional discipline, type of journal (either religious or secular), and type of article: either research, or narrative and expositional. Rabbis were discussed most often in psychology, psychiatry, and behavior-related fields, and close to two-thirds of the articles dealt with mental health concerns. A statistically significant increase in articles across decades was found in the secular journals, r=.98, p≤.01, with over 70% of the articles about rabbis in the secular journals being published between 1980 and 1999. Many of the articles addressed collaboration between rabbis, psychiatrists, and other and mental health professionals and discussed previously identified themes related to professional collaboration and referral.     

Estimating state IQ: Measurement challenges and preliminary correlates

The purpose of this study is threefold. First, an estimate of state IQ is derived and its strengths and limitations are considered. To that end, an indicator of downward bias in estimating state IQ is provided. Two preliminary causal models are offered that predict state IQ. These models were found to be highly predictive of state IQ, yielding multiple R's of 0.83 and 0.89. Second, the extent to which state IQ predicts state outcome variables (e.g., gross state product, health, violent crime, and government effectiveness) is estimated. State IQ shows positive correlations with gross state product, health, and government effectiveness and negative correlations with violent crime. These results are consistent with the extent to which IQ predicts outcomes at the level of the individual. Third, a research agenda is provided for improving estimates of state IQ, identifying factors that cause differences in state IQ, and delineating the role of IQ in predicting important variables.     

Work attitudes,career success and health: Evidence from China

Research on the determinants and implications of career success, and in particular on how they are related to health among Chinese workers is scarce. This research explores the impact and relevance of individual attitudes of trust and organizational citizenship behavior on objective and subjective career success, and their relevance to physical and mental health. Further, we explore the moderating role of a career system on the relationships between work attitudes and career success. Using a random sample of 10,372 people in China we used multi-level linear regression methodology to explore a mediation–moderation model based on organizational theories. We found support for the impact of organizational citizenship behaviors and trust, for both objective and subjective career success as mediators of mental and physical health, and for a career system as a moderator, with significant differences emerging between workers employed in the public and private sectors. The results are important as they shed light on the relationship between work and life attitudes on outcomes of high relevance at national level. The original contribution would be of interest to policy makers at both organizational and national level.     

Entre neurosciences et neurophilosophie : la psychologie cognitive et les sciences cognitives

The cognitive sciences are all at once a scientific field with far-reaching epistemological implications and the locus of institutional confrontation between several academic disciplines. In this context, cognitive psychology occupies a key historical and theoretical position. It is therefore essential to clearly situate its contribution to the origin and the development of the cognitive sciences. For some, cognitive psychology may end up being dissolved by cognitive neuroscience, with its brain imaging techniques, which in the long run, should solve the age-old problem of brain-mind dualism. For others, this epistemic wager can only be won by reducing cognition to its most elementary states and processes. Here, the problem of mental representation (of meaning and consciousness) is brought to bear to rule out a view that strictly reduces the mind to the brain. Will the cognitive sciences, then, be nothing more than a mere stage in the integration of cognitive psychology into the cognitive neurosciences? Or on the contrary, will the other disciplines in the cognitive sciences be led to recognize the specificity of cognitive psychology and put it at the centre of their research program? The debate is underway, but the scientific and institutional outcome is uncertain.     

巴西医疗保障体系

从巴西医疗保障体系的建立、资金筹集和使用等方面介绍巴西医疗保障体系,重点关注巴西全民统一医疗制度。鉴于巴西与我国在卫生系统绩效和医疗保障制度改革中所面临的相似挑战,试图通过对巴西医疗保障体系比较详细地介绍及与我国进行简单的对比,总结成功经验、吸取教训为我国建立全民覆盖的医疗保障体系提供借鉴和参考。     

Participatory Organizational Change in Community-Based Health and Human Services: From Tokenism to Political Engagement

Community psychologists have long worked with community-based human service organizations to build participatory processes. These efforts largely aim at building participatory practices within the current individual-wellness paradigm of human services. To address collective wellness, human service organizations need to challenge their current paradigm, attend to the social justice needs of community, and engage community participation in a new way, and in doing so become more openly political. We use qualitative interviews, focus groups, organizational documents, and participant observation to present a comparative case study of two organizations involved in such a process through an action research project aimed at transforming the organizations’ managerial and practice paradigm from one based on first-order, ameliorative change to one that promotes second-order, transformative change via strength-based approaches, primary prevention, empowerment and participation, and focuses on changing community conditions. Four participatory tensions or dialectics are discussed: passive versus active participation, partners versus clients, surplus powerlessness versus collective efficacy, and reflection/learning versus action/doing.