关于美国变性人歧视问题介绍

变性人在就业、教育、医疗保险等很多领域遭受歧视,本文分析变性人在这些领域遭受的歧视。对于如何解决歧视问题,需要各种政策和措施,尤其需要政府予以立法来保护变性人的权利。     

South European Healthcare Systems under Harsh Austerity: A Progress–Regression Mix?

This article addresses the question of whether the economic crisis provides a politically opportune time to drastically curtail public healthcare in South Europe or whether, instead, there are signs of longer-term reform strategies for potentially balancing fiscal targets with the quest for enhanced value and health outcomes, when eventually growth resumes. After a brief examination of the profile of healthcare systems in Greece, Italy, Portugal and Spain prior to the crisis, we comparatively assess the mix of retrenchment, restructuring and recalibration strategies. The effects of the austerity-driven reforms on current (and expected) health outcomes are also briefly analysed. We conclude with reflections on the future of public healthcare in South Europe.     

Economic inequality in satisfaction with healthcare in the Baltic countries during and after the economic crisis (2008–2014)

ABSTRACT

Public satisfaction with healthcare systems is an important dimension of healthcare legitimacy. The paper analyzes how satisfaction with healthcare systems depended upon the economic situation of our respondents during and after the economic recession in the Baltic states. The results show that there were no differences in public satisfaction with healthcare between better and worse off people in Estonia (except in 2009). In Lithuania, however, satisfaction among the economically better off was higher compared to other groups between 2008 and 2014. In Latvia, inequality in satisfaction between groups in different economic situations became significant from 2010.     

医疗侵权构成要件举证责任分配的流变

我国对医疗侵权诉讼的举证责任分配方式进行了几次重要的修改,从而出现了医疗侵权构成要件举证责任分配的流变,大体分成了三个阶段,每个阶段的医疗举证责任都有很大的改变,笔者就每个阶段的医疗举证责任特点进行详细的阐述并分析其中转变的原因。同时,笔者就《侵权责任法》对医疗举证责任的修改进行了评析并给出自己的司法解释建议。     

Linking Organizational Climate to Work Engagement: A Study in the Healthcare Sector

Using a two-level structural equation approach, this article investigates the links between organizational climate and work engagement in a sample of public hospitals in Italy. Drawing from the Job Demands-Resources model, the model posits a positive association between work engagement and a climate promoting worker’s autonomy, empowerment, and well-being, whereas it suggests that a climate based on efficiency and goal attainment is not favorable for engagement. Results support the hypotheses and suggest that performance based models implemented in recent years as part of public sector reforms are not conducive to engaged workers. Implications for research on work engagement in the public sector and for public management are drawn.     

医疗保险干预能否缓解三级医院的“虹吸效应”?——基于某大城市的实证研究

【问题】患者普遍偏好在三级医院就诊,而三级医院对患者的“虹吸效应”直接影响了医疗服务体系的运行效率。差异化报销的医保政策干预成为各地推行“分级诊疗”的普遍手段。虽然三级医院的“虹吸效应”已经得到学界的普遍关注,成为医改领域的热点研究问题,但现有相关研究还主要停留在理论探讨层面。而且,医保政策干预作为分级诊疗推动措施究竟能够发挥多大作用,在实证方面还缺乏足够的文献支持。【方法】文章基于A市的医疗保险数据,使用固定效应等研究方法,对三级医院的“虹吸效应”和医保政策干预效果进行了分析。【发现】三级医院对使用社会医疗保险患者的门诊就医选择有“虹吸效应”,每10万人配备的三级医院数量每增加1家,赴三级医院门诊就医的患者比例就提高5.8%。“虹吸”的主要对象来自二级医院而非一级及以下医疗机构的患者群体。“虹吸效应”存在异质性:无慢性病群体、高收入者、儿童更容易被三级医院“虹吸”。医保政策干预能够缓解“虹吸效应”,且对“小病、常见病”的影响程度更大,可以有效引导把价格敏感的患者向基层医院分流。【贡献】文章从实证上检验了三级医院对需求方的“虹吸效应”及其程度,首次揭示了中国二级医院的“夹心层”困境;通过检验医保政策干预对“虹吸效应”的效果,为医保补偿政策推动分级诊疗提供了新的经验证据。文章对于推动分级诊疗、优化医疗资源配置具有重要的现实意义。     

关于加强基层医疗卫生服务建设的建议——兼论推进疫情防控关口前移

加强基层卫生服务,推进疫情关口前移,是落实习近平总书记关于疫情防控重要指示精神的重要举措。本文在总结当前基层疫情防控现状的基础上,分析国外家庭医生制度特点及对我国的借鉴意义,探讨我国基层卫生服务建设的重点、难点与不足以及在重大疫情防控中的作用,并在此基础上提出建议:加强基层卫生服务体系建设,培养全科医生公共卫生应急技能,强化基层疫情应急服务,加强医防融合和全民健康教育,推进疫情防控关口前移,构建重大传染病的社会屏障。     

Retired EU migrants,healthcare rights and European social citizenship

Drawing on a set of 210 qualitative interviews conducted in six European countries, this paper investigates the citizenship status and experiences of retired EU migrants at both national and European levels. The paper focuses upon the experiences of two types of respondents: 'Retired Migrants' (retired nationals of one EU country who moved on retirement and reside in another EU host state) and 'Returnees', that is, those migrants who have chosen to return to their country of origin after a period of residence abroad. In particular, this paper will attempt to explore three issues: (a) The extent to which retired migrants have access to, and make use of, the public healthcare systems of the countries in which they reside. (b) Retired migrants' perceptions and experiences of those systems. (c)Whether or not a lack of access to and/or the quality of public healthcare is an important determinant of return migration decisions, i.e. moves back to the country of origin. By focusing on healthcare the paper combines an analysis of the formal welfare rights available to EU citizens who migrate on retirement (both in terms of their EU rights and their status in the receiving and exporting countries) with qualitative evidence that documents the substantive reality of such rights.     

Racial Differences in Battered Women’s Experiences and Preferences for Treatment from Physicians

The present study evaluated racial differences in battered women’s experiences and preferences for treatment from physicians when seeking help for abuse-related issues. Prior research revealed unexpected findings that African American women rated certain physician behaviors related to victim blaming and expression of sympathy for the male partner less negatively than White women. The present study found that when potential confounders, such as source of care, education level, and income were controlled, racial differences in approval ratings of physician behaviors almost disappeared. Only one physician behavior—blaming the patient for the abuse—differentiated the two groups. However, despite racial differences, both groups rated the behavior negatively. Other findings were that, overall, African American women are more likely than White women to seek abuse-related health care from emergency and urgent care settings and have fewer preferences for the race of their physician provider. Both White and African American women preferred to see a female physician. Implications of these findings for future research are discussed.     

我国就医选择权的现状及其对策

我国的医疗机构和医师的数量、质量无法满足需求,并且分布不均衡、可及性较差;医疗信息公开的方式和内容无法满足公众需求,更换医疗机构和医师的成本高,因此我国公众不享有真正意义上的就医选择权。政府垄断是导致该问题的主要成因,必须破除政府对医疗行业的垄断,构建分层次、多元化、竞争式的医疗卫生服务供给体系,并加强医疗信息公开工作,保障公众的就医选择权。