医改的逻辑与利益集团的阳光博弈——兼谈美国医疗保障制度演进中的博弈规则

医疗体制改革本质上是社会公共财富的再分配,伦理上涉及社会公正与正义,经济与管理上涉及各个阶层、利益集团的逐利博弈和理性之间的平衡张力。通过对美国20世纪60年代以来医疗保障立法过程中各个利益集团的交锋和妥协,尤其是代表美国医师利益的美国医学会在历次医疗保障立法程序中的诉求,揭示医疗制度改革的社会化流程,方案的精心设计是最重要的,当要取得社会共识,必须开放利益集团的"公堂博弈""舆论争锋"的空间,以便为后续实施提供良好的社会心理的土壤。     

经验信息与共变信息对判断两原因共同作用的影响

本研究考察了被试在使用经验信息和共变信息进行两原因共同作用因果判断时所具有的特点。研究结果表明:(1)两原因的性质对于被试的选择有着显著影响。当两原因的可信度相等时,更多被试认为两原因都可以引起结果。(2)两原因都不出现时结果出现的概率P(e/~i~j)对于被试的选择没有显著影响。(3)两原因单独出现时结果出现的概率对于被试的选择有着显著的影响,但是这一变量是与两原因的可信程度共同产生影响的。     

From Intent to Enrollment,Attendance, and Participation in Preventive Parenting Groups

Applying the Theory of Planned Behavior (TPB) to the process of engagement in preventive parenting groups, we tested the ability of family and child measures to predict intent to enroll, enrollment, attendance, and quality of participation in PACE (Parenting Our Children to Excellence). PACE is a prevention trial testing the efficacy of a structured program to promote effective parenting and reduce risk of adverse child outcomes. Mothers of preschoolers (N=451) from diverse ethnic and socioeconomic backgrounds participated at two sites. Results showed that mothers who stated their intent to enroll reported relatively few time constraints but high levels of stress, as did mothers who enrolled. The latter also experienced elevated levels of oppositional defiant child behaviors, indicating that the program reached families who stood to benefit from it. Attendance, which was also best predicted by few time constraints, was high (with 49% of mothers who enrolled attending 5 or more of 8 sessions). In turn, attendance predicted quality of participation (at 1 site only), with mothers attending more sessions participating more actively and enthusiastically. Ethnicity and, with a few exceptions, socioeconomic circumstances and site, were not significant predictors of intent, enrollment, or attendance. Results provide qualified support for the TPB and illustrate its relevance to preventive research and interventions.     

Examination of the content of individualism/collectivism scales in cultural comparisons of the USA and Japan

The definitions of individualism/collectivism and the content of scale items used to assess them could explain the lack of cross-cultural differences reported in some research. Specifically, existing scales may not adequately assess expected cultural differences. In study 1 , a new scale was given in Japan and the USA. Three factors were identified in both cultures. Japanese scored higher on the others focus factor but scored lower on the helping others factor than the US Americans. In study 2 , a forced choice version replicated results in study 1 . In studies 3 and 4 , the factor structure and cultural differences were replicated and the convergent and the divergent validities of the scale were examined. Results indicate that Japanese may be more others oriented depending on the item content.     

不同攻击/受欺负类别儿童的同伴交往自我知觉

以474名小学三、四、五、六年级的儿童为被试,考察了不同攻击-受欺负类型儿童自我知觉的社会能力以及自我提名的朋友与双向互选朋友数量、同伴积极提名、消极提名的关系。结果表明,各攻击/受欺负组别在自我提名的朋友数量上无显著差异,但在自我知觉的社会能力、双向互选朋友数及同伴积极提名、消极提名上均存在显著差异。在自我知觉的社会能力方面,单纯攻击组最高,攻击-受欺负组最低。在双向互选朋友以及同伴积极提名方面,未参与组最高,其余依次为单纯攻击组、单纯受欺负组和攻击-受欺负组。     

Marriage and social support in a British–Asian community

People of South Asian origin represent one of the largest ethnic minority populations in Britain. However, research into the marital beliefs and practices of British South Asians has tended to conflate together different South Asian groups of different religious and geographical origins. This study focused on one large religious group originating from one region (Hindus from Gujarat) resident in one large British town, providing analyses drawn from theories of cultural values, acculturation and social identity. Seventy married couples participated in detailed interviews inquiring about the arrangement of their marriage, their attitude towards marriage, gender roles, and the formal and informal support available in times of marital crisis. Our analysis of these interviews suggested that whilst our respondents maintained largely collectivist values in the family, they also saw marriage very much as an expression of individual fulfilment. Marital choice and gender roles in marriage reflected an integrationist strategy combining the traditional cultural practices and identity priorities with the social preferences and economic realities of their new culture. Finally, social support was largely forthcoming from members of the Asian community, reflecting a degree of separation from the majority community particularly when emotional assistance was desired. Copyright © 2000 John Wiley & Sons, Ltd.     

关于特殊群体生育需求的伦理理论与原则分析

随着辅助生殖技术的发展和应用,以及人们婚育思想的改变,一些特殊群体逐渐产生了通过辅助生殖技术的帮助实现生育的需求。然而,其生育愿望能否实现还需进行更全面的思考与讨论。从伦理理论与原则两方面对特殊群体的生育需求进行探讨。在伦理理论中,罗尔斯的正义论、边沁和密尔的效用主义以及女性主义伦理学为支持特殊群体的生育需求提供了理论依据,而社群主义、自然律理论以及儒家伦理家庭观则持不同的态度。此外,也从伦理学的四项基本原则出发,对特殊群体的生育需求进行了具体分析,并提倡在适龄期正常婚育。

     

“医学伦理学再启程”亟待破解的医学伦理课题

面临新境遇的医学伦理学,亟待破解的医学伦理课题有：医疗资本和医疗利益集团追求利润最大化的行为对公立医疗机构公益性造成持续性损害;医学高新技术僭越伦理底线,无限制地对身体进行技术干预;医学技术权力与医学高新技术、医疗资本结盟形成挑战医学伦理的异化力量;确立利益伦理是医学伦理学研究的重要内容;确认患者利益置于首位是现代医学伦理学的首要原则;促进美德伦理与规范伦理结合,推进制度伦理建设与机构伦理建设是医学伦理学落地生根的关键环节。

     

The Psychodynamic Assumptions of the U.S. Constitution

The U.S. Constitution is a blueprint for the design of a government which reflects the consistent application of an understanding of the emotions and interests driving the political activity of individuals and groups. This understanding is articulated in the writings of key proponents of the Constitution, and clarified by its historical and philosophical context. Their theories are congruent with psychoanalytic perspectives on narcissism, leadership, group dynamics, and the role of transitional space in cultural life. The concept of interests, reformulated in psychoanalytic terms, is a useful addition to our understanding of political behavior.