运动员的身份定位与工伤保险赔偿探析

体育行政主管部门下属单位管理的运动员属于事业单位工作人员,这类运动员的工伤问题应按照事业单位工作人员的有关规定执行。规范化的体育职业俱乐部下的运动员具有劳动者的地位,这类运动员必须参加统筹地区的工伤保险。运动员工伤保险赔偿和第三人侵权赔偿竞合时不能重复赔偿;运动员工伤保险赔偿与伤残互助保险赔偿、商业保险赔偿竞合时可以重复赔偿。     

男、女戒毒劳教人员精神卫生状况的对照研究

目的采用目前较为成熟的人格、心理测量量表,研究戒毒劳教人员的人格特征、心理卫生状况。方法对16～61岁的508名戒毒劳教人员(其中男性258人,女性250人)进行MMPI、SCL-90的测试。结果MMPI测试显示男性戒毒劳教人员Hs、Pd、Pa、Pt、Sc、Ma均高于临界值,以Hs和Pa为最高;女性Hs、Pd、Pt、Sc均高于临界值,以Hs和Pd为最高。SCL-90测试显示戒毒劳教人员在各因子分上均高于中国常模,女性甚于男性。结论戒毒劳教人员普遍存在个性特征异常和心理卫生问题,男性者个性特征异常更为突出,女性者心理卫生状况尤其值得关注。     

Work and mental health: learning from return-to-work rehabilitation programs designed for workers with musculoskeletal disorders

Despite the high costs associated with mental health problems in the workplace, few studies have yet been published on the design and evaluation of return-to-work rehabilitation programs for workers with mental health problems. In fact, the best-documented return-to-work rehabilitation programs concern workers with musculoskeletal disorders (MSKD). For this clientele, a disability paradigm has been adopted which explains the multicausality of work disability. Long-term work disability is no longer seen simply as the consequence of impairment, but rather as the result of interactions between the worker and three main systems: the health care, work environment and financial compensation systems. A return to work is thus influenced by a complex set of interrelated factors that must be taken into account in any intervention. Parallels can inevitably be drawn in the field of mental health in the workplace, where individual and organizational factors are involved and must be taken into account in the return-to-work process. This paper presents the first results of an exploratory study aimed at determining the possible links between work rehabilitation programs for workers with MSKD and those for workers with mental health problems. To this end, the components of a work rehabilitation program for workers with MSKD, the Therapeutic Return to Work (TRW) program which addresses psychological factors, work environmental factors and factors related to the involvement of the various stakeholders in the rehabilitation process, are described through a multiple-case analysis and mapping of interventions. The results support the relevance of adopting the disability paradigm and considering the return-to-work clinical activities conducted with workers with MSKD (and their mechanisms of action) in the design of work rehabilitation programs for workers with mental health problems.     

Massachusetts Youth Screening Instrument for mental health needs of youths in residential welfare/justice institutions: identifying gender differences across countries and settings

This study examines the use of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) for mental health needs among 1643 youngsters in residential welfare/justice institutions in Europe and the USA, identifying gender differences across countries and settings. Overall, the MAYSI-2 appeared to be a reliable instrument among these youngsters, with only some scales falling (slightly) below the threshold of acceptable internal consistency. Girls (vs. boys) in Belgian/USA justice institutions and Swiss mixed welfare/justice institutions displayed higher scores for the angry–irritable, depressed–anxious, somatic complaints, suicide ideation scales. Also, detained girls from Belgium and Switzerland reported higher scores for traumatic experiences. No gender differences were revealed among adolescents in German welfare institutions. Our findings suggest that the MAYSI-2 may serve as a useful mental health screening instrument among youngsters in welfare/justice institutions and that girls in justice institutions and mixed welfare/justice institutions form a particularly vulnerable population with regard to mental health problems.     

论我国生态损害责任保险制度的构建

生态损害责任险在我国既缺乏立法支撑又缺乏实践经验,我国生态损害责任险的构建将会面临诸多问题,包括生态损害风险的可保性、投保模式、保险费率、保险限额、保险机构及索赔机制等.我国应当尽快构建生态损害责任保险制度,逐步提升生态损害风险的评估技术水平以解决可保性问题,并在风险预防及有效填补损害原则的指导下构建我国生态损害责任保险制度.     

Health care and the labor market: learning from the German experience

Many observers have begun to question the U.S. reliance on an employment-based private health insurance system. In thinking about the future of this system, it is instructive to examine the German experience. The German health insurance system is almost entirely organized and financed around the labor market. In recent years, the German labor market has changed in several ways. Among other changes, more German women now work, the proportion of retirees in the population has increased, the share of manufacturing in employment has declined, and the economy has become more open. These labor market changes have made it more difficult to organize health insurance around employment in Germany. Recent changes in the German health insurance system have, to some extent, decoupled health insurance from employment. This decoupling is likely to continue as the labor market changes further. We explore the implications of this experience for the United States.     

新冠疾病对法医精神病鉴定的挑战与思考

新冠疾病(COVID-19)传染性强,潜伏期长,已在全球快速蔓延,给司法鉴定带来新的挑战.本文对COVID-19疫情下法医精神病鉴定的日常工作相关环节如何避免感染,COVID-19导致的器质性与功能性精神损伤特点及其损伤/伤残评定,COVID-19与精神卫生医疗机构医疗纠纷的防范及法医学鉴定思路等方面进行了探讨,并提出...     

Report from Germany: current conditions and controversies in the health care system

This paper presents a structured survey of the West German health care and health insurance system, and analyzes major developments of current German health policy. In order to make the analysis more accessible to a largely American audience, brief historical remarks, comparisons with U.S. experience, and considerable data and tabular information are provided. The German statutory health insurance scheme is known as a very comprehensive and generous one. However, under the pressure from rapidly expanding health care expenditures and a severe economic recession, the German governments under Helmut Schmidt and his successor Helmut Kohl imposed a number of cost-containment measures, namely a change in the mode of remuneration for physician services, certain regulations of the drug market, and increased cost-sharing. Cost-sharing is especially favored by the new conservative-liberal government. The article concludes with a summary of striking similarities between the American and German health care schemes, and an outlook on proposals for reform which are currently under investigation by the German government.     

Victim Compensation and Offender Restitution in the Federal Republic of Germany—a Western-European Comparative Perspective

In the Federal Republic of Germany, as well as in most other Western European countries, the growing emphasis in victimology during the last 15 years has led to several legal schemes for victim compensation. The German Victim Compensation Act of 1976 provides compensation for violent acts within the framework of a social security system with periodic payments, while most of the other West-European countries grant lump sums from a special compensation fund. The German legislation, however, has given the victim a relatively weak position. The problems are aggravated because of the restrictive, and concerning the Federal states—different, application of the law. Victim compensation as a restitutional sanction within the penal law doesn't play an important role. Furthermore, the financial situation of most offenders is so bad, that the civil claims of the victim for damages cannot be compensated. In Germany, however, remarkable efforts are made by the debt relief programs for offenders, which allow victim compensation on the one hand and offender rehabilitation on the other. This balancing of victim-offender interests seems very important for criminal policy in general. An extension of the legal provisions for victim compensation is considered necessary as is the wider application of restitutional sanctions whether instead of or combined with penal sanctions. Furthermore, help for victims should include social and psychological assistance programs, which are not yet developed in Europe to any great extent.     

Financial Compensation for Victims of Catastrophes: A Law and Economics Perspective

This article examines the various approaches legislators may use to compensate victims of catastrophes. Traditional law and economics of insurance literature, with respect to government relief and insurance solutions towards financial compensation, is used to analyze (highly diverging) approaches in Europe and the United States. First, the importance of liability (insurance) is discussed in cases where a liable injurer can be identified; second, the possibilities of first-party insurance are examined, whereby various regulatory solutions (particularly the French model of providing mandatory coverage for catastrophes) is critically discussed. The (first-party) insurance solution is compared with public intervention, and a distinction is made between ad hoc government relief on an ex-post basis and structural compensation funds. The solutions applied and discussed in many countries are critically analyzed for their ability to provide adequate compensation at low costs and their effects on incentives for prevention and for developing private (insurance) solutions.     

Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

Environment, Damages, and Compensation

This article, the first part of a larger study devoted to the compensation of damages caused by pollution, reviews the existing sources of compensation in the United States: the common law of torts, federal and state statutes, and various forms of commercial insurance coverages. It shows how the rules of nuisance law have remained flexible in response to changing customs and public policies, how for a long time prevailing attitudes favored industrial development and economic growth over physical comfort, and how increasing concerns about the long-term health effects of environmental pollution have created a trend in the opposite direction. The author also points out that the existing system of liability and compensation, which relies on individual actions and case-by-case adjudication, is not ideally suited for dealing with the effects of large-scale pollution or for the —primarily political—task of evaluating and balancing all of the interests and values, present and future, economic and noneconomic, that need to be considered before decisions can be made that are bound to affect the health and economic well-being of a large part of the population beyond the immediate parties to a lawsuit. This indicates a need for a comprehensive approach that would not only coordinate the rules concerning liability and those concerning insurance and other sources of compensation but would also make the compensation of pollution damages an integral part of a thoroughly rational and consistent environmental policy. The various possibilities of constructing such a comprehensive compensation system will be discussed in the second part of the study, to be published in a forth-coming issue of the American Bar Foundation Research Journal.     

National vaccine injury compensation program: calculation of average cost of a health insurance policy. Final rule

Subtitle 2 of Title XXI of the Public Health Service Act, as enacted by the National Childhood Vaccine Injury Act of 1986, as amended (the Act), governs the National Vaccine Injury Compensation Program (VICP). The VICP, administered by the Secretary of Health and Human Services (the Secretary), provides that a proceeding for compensation for a vaccine-related injury or death shall be initiated by service upon the Secretary, and the filing of a petition with the United States Court of Federal Claims (the Court). In some cases, the injured individual may receive compensation for future lost earnings, less appropriate taxes and the "average cost of a health insurance policy, as determined by the Secretary." The final rule establishes the new method of calculating the average cost of a health insurance policy and determines the amount of the average cost of a health insurance policy to be deducted from the compensation award.     

Workers describe the effect of the workers' compensation process on their health: a Québec study

This article reports on a Canadian qualitative study designed to examine the workers' experience of the workers' compensation process and to look at the effects of the process on the physical and mental health of claimants. Eighty five in depth individual interviews of injured workers in Québec and six group interviews with workers and worker advocates from Québec, Ontario and British Columbia were analysed to determine the positive and negative impact on claimant health of various steps of the workers' compensation process and of behaviours of significant actors in that process. While superior access to health care and access to economic support both contributed to claimant well-being, various facets of the process undermined the mental health of workers, and in some cases, also had a negative impact on physical health. Primary characteristics of the process that influenced outcomes included stigmatization of injured workers and the significant power imbalance between the claimants and the other actors in the system; the effect of both these mechanisms was tempered by social support. The article describes how caseworkers, physicians, appeal tribunals, employers and compensation boards contribute to the positive or negative impacts on worker health and concludes with recommendations designed to promote the therapeutic aspects of workers' compensation and to curtail those facets that are harmful to worker health. It also has implications for researchers who wish to consider the role of lawyers or compensation in the development or prevention of disability.     

Blending reform of tort liability and health insurance: a necessary mix

The thesis of this Article is that making more health insurance benefits available to more people, far from lessening injury victims' proclivity to sue in tort (as conventional wisdom argues), will increase such suits. Thus, it is necessary to accompany any increases in health care coverage with the type of tort reform proposed herein. This reform would allow parties to opt out of the cumbersome and expensive tort claim process with its compensation of noneconomic losses by substituting quicker and surer compensation of any unmet economic losses.     

精神损害赔偿之利益衡量视域——以我国侵权责任法的制度设计为视角

我国《侵权责任法》已经吸纳了精神损害赔偿制度。于制度设计的视野审视，精神损害赔偿之规范安排应当坚持利益衡量的制度进路，在对受害人实施法律救济与保障行为人的行动自由之间，寻求和给定规范路径，在利益冲突的格局中实现各个利益主体之间的利益平衡，实现个案中的实质正义。同时，精神利益的保护是精神损害赔偿的立法着眼点，对精神利益的界定与衡量是精神损害赔偿制度设计的基本价值取向之一。于利益衡量的视域中，即将实施的《侵权责任法》在精神损害赔偿的制度安排上尚存需要完善的空间，需要从利益衡量的角度给予讨论。     

Why we must end insurance discrimination against mental health care

In this Policy Essay, Representative Patrick Kennedy argues that insurance discrimination against those suffering from mental illness constitutes a serious and often overlooked deficiency of the modern American health care system. While the Mental Health Parity Act of 1996 was an important step toward resolutions of this issue, many loopholes remain that allow insurance companies to deny much-needed coverage to those suffering from such illnesses. This Essay details how improving access to health insurance for the mentally ill is not only socially beneficial, but also economically sound; the cost of instituting mental health parity is far outweighed by the costs that employers bear because of the reduced productivity of untreated mental illness sufferers. Representative Kennedy recommends that these problems may be addressed by additional mental health policy legislation--specifically, the proposed Paul Wellstone Act.     

Compensation for industrial accidents and incentives for prevention: a theoretical and empirical perspective

This paper examines the compensation systems for industrial accidents in Belgium, Germany and Great Britain, thereby taking into account some recent empirical data on industrial accident rates and (although hardly available) amounts of compensation paid out to employee victims. The key question of this paper, derived from past research in law and economics, is whether these particular compensation systems include elements that may contribute to the prevention of industrial accidents. While the three countries examined here all have at least some incentive-based elements, notably in the way those systems are financed, there appears to be room for improvement both in Belgium and Great Britain. The German case study leads to the proposition that giving an organisation the responsibility for both compensation and prevention may have a beneficial effect on the accident rate.     

The need for a regulatory response to diagnosis fraud in mesothelioma cases

Australian courts and tribunals allow claimants with pleural plaques to "piggy back" compensation claims for mental health problems. This article contends that Australia is open to an era of diagnosis fraud by psychologists similar to that which has been experienced in the United States with radiologists. The courts will continue to reflect Australia's "compensation culture" unless legislation squarely addresses the compensability of pleural plaques and clarifies when, if at all, the courts should allow mental health claims for asymptomatic "marker" conditions such as pleural plaques.     

Explaining health care system change: problem pressure and the emergence of "hybrid" health care systems

In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care systems.