医疗保障制度改革过程中的价值取向问题及其影响

随着社会主义市场经济体制的建立,我国传统的劳保医疗制度和公费医疗制度已越来越不适应社会发展的要求,呈现出诸多弊端,亟待改革。作为一项公共政策,医疗保障制度在改革与完善的过程中应根据科学行政的要求对政策的价值取向进行深入分析,以便顺利实施改革的各项方案。分析医疗保障制度改革中所涉及的各方面的价值观及其对改革的影响,希望唤起政策制定者对不同群体利益的关注,从而保证政策体系的稳定。     

推行职工基本医疗保险制度的现实问题、法律对策与思考

从医疗保险的理论入手,提出了改革是否成功的三条标准,进而推演到 我国城镇基本医疗保险制度的成效和优势。又从实践的角度,概括地列举了推行职工医疗保险制度改革中7个方面的现实问题。并着重论述了社会主义市场经济条件下解决上述问题的对策,其关键在于立法,在于建立健全相应的法律法规体系。从立法的角度阐述了立法规则、 立法监督、立法宣传和咨询,以及保险管理从业人员的专业化问题。对当前正在进行的医疗保险制度的改革有一定的借鉴意义。     

Attribute Framing and Goal Framing Effects in Health Decisions

Levin, Schneider, and Gaeth (LSG, 1998) have distinguished among three types of framing—risky choice, attribute, and goal framing—to reconcile conflicting findings in the literature. In the research reported here, we focus on attribute and goal framing. LSG propose that positive frames should be more effective than negative frames in the context of attribute framing, and negative frames should be more effective than positive frames in the context of goal framing. We test this framework by manipulating frame valence (positive vs negative) and frame type (attribute vs goal) in a unified context with common procedures. We also argue that the nature of effects in a goal-framing context may depend on the extent to which the research topic has “intrinsic self-relevance” to the population. In the context of medical decision making, we operationalize low intrinsic self-relevance by using student subjects and high intrinsic self-relevance by using patients. As expected, we find complete support for the LSG framework under low intrinsic self-relevance and modified support for the LSG framework under high intrinsic self-relevance. Overall, our research appears to confirm and extend the LSG framework.     

How Do People Process Health Information? Applications in an Age of Individualized Communication

Advances in computer technology have made it possible to customize communication, including health-education materials, to the specific needs and interests of any individual. Studies show that individually tailored health-education materials are more effective than generic materials in promoting changes in a variety of health-related behaviors. Theory and research in information processing provide an explanation for why such materials are effective. This article discusses current research on how individuals process tailored health information, and discusses directions for future research in this area.     

Managing Uncertainty: Obesity Discourses and Physical Education in a Risk Society

This paper considers the role of physicaleducation researchers within current publicconcerns about body shape and weight. UsingUlrich Beck's notion of `risk' it examines howcertainty about children, obesity, exercise andhealth is produced in the contexts of `expert'knowledge and recontextualised in the academicand professional physical education literature.It is argued that the unquestioning acceptanceof the obesity discourses in physical educationhelps to construct anxieties about the body,which are detrimental to students and silencesalternative ways of thinking and doing physicaleducation.     

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

Counsellors' experiences of working with suicidal clients: An exploratory study

Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi‐structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self‐doubts about their professional competence. In addition, they identified the threat of litigation for negligent practice and the lack of confidence in appropriate risk assessment approaches as significant causes for concern. The implications for further research, and practice, are discussed.     

Attributional Style and Personality as Predictors of Happiness and Mental Health

This paper contains two studies which set out to examine to what extent attributional style (internal, stable, global) and personality traits predicted happiness and psychiatric symptoms in a normal, non-clinical, population of young people in their early twenties. Two hundred and three participants completed five questionnaires: the Attributional Style Questionnaire (ASQ) (version one & version two), Eysenck Personality Questionnaire, Oxford Happiness Inventory, and Langner 22-Item Measure. Sample 1 (n = 120) completed ASQ version one (in both positive and negative situations) and sample 2 (n = 83) completed ASQ version two (in expanded negative situations). Regressional analysis showed that ASQ (in both versions) was the significant predictor of happiness and mental health accounting for 20% to 38% of variances. The ASQ was significantly associated with extraversion and neuroticism. Further, with happiness and mental health as dependent variables and attributional style, personality traits, and demographic variables as independent variables respectively, extraversion and attributional stability (in positive situations) were the significant predictors of happiness accounting for 59% of the total variance whilst neuroticism and psychoticism were the significant predictors of mental health accounting for 53% of the total variance. The results indicated that optimistic attributional style in positive situations was a stronger predictor of self-reported happiness than mental health and pessimistic attributional style in negative situations was a predictor of both happiness and mental health. Extraverts tended to have optimistic explanatory style for positive outcomes whereas neurotics tended to have pessimistic explanatory style for negative outcomes.