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Regulation of research with children: the evolution from exclusion to inclusion. 儿童研究的规范:从排斥到包容的演变。
Pub Date : 2002-01-01
Duane Alexander
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引用次数: 0
Extended Care Career Ladder Initiative (Eccli): Baseline Evaluation Report of a Massachusetts Nursing Home Initiative 扩展护理职业阶梯倡议(Eccli):马萨诸塞州养老院倡议的基线评估报告
Pub Date : 2001-09-01 DOI: 10.2139/SSRN.292944
S. Eaton, C. Green, T. Osypuk, Randall Wilson
The Commonwealth of Massachusetts initiated the Extended Care Career Ladder Initiative (ECCLI) as part of a broader Nursing Home Quality Initiative, adopted by the Legislature in 2000. This legislation is a response to high turnover and vacancies among paraprofessionals in long-term care, creating instability that threatens quality and access to health care. Basic to these initiatives is the equation of good care for consumers with good jobs and opportunities for frontline caregivers. Thus it asks long-term care providers to partner with other organizations (including community based groups, unions, work force development agencies, community colleges, and other long-term care providers) to mount demonstration projects that offer insight into new care-giving and workplace practices that improve the quality of care and the quality of jobs. These projects should also demonstrate how the accomplishment of care giving and workforce quality goals can be mutually reinforcing. Sponsors hope that such projects will offer clear and replicable models for both the long term care industry, and the workforce development community that supports the industry and its potential and existing labor force. ECCLI'S overall program goal is to promote systemic change and build capacity within the long-term care and work force development communities in support of the following goals and objectives: (1)Improve quality of care; (2) Promote skill development; (3) Create and institutionalize career ladders and other workplace practices that support and develop workers; and (4) Improve employee retention. The attached baseline evaluation report is presented as a working paper for the information of researchers and practitioners in the field of nursing home quality and workforce development. It covers the period from March 2001 to June 2001 when the ECCLI program was getting underway, and was submitted to the Commonwealth Corporation of Massachusetts, the quasi--public agency that is administering the funds from the Nursing Home Quality Initiative. Future reports will analyze data collected by the researchers after this baseline and planning period. Major findings include insight into the process of forming consortia across unfamiliar realms of human services (health care and workforce development and education), and challenges for the participants as they consider and implement organizational change as well as training programs for frontline workers as well as supervisors.
马萨诸塞州联邦发起了延长护理职业阶梯倡议(ECCLI),作为2000年立法机构通过的更广泛的养老院质量倡议的一部分。这项立法是针对长期护理的辅助专业人员的高流动率和空缺,造成不稳定,威胁到保健的质量和获得。这些举措的基础是为消费者提供良好的护理,为一线护理人员提供良好的工作和机会。因此,它要求长期护理提供者与其他组织(包括社区团体、工会、劳动力发展机构、社区学院和其他长期护理提供者)合作,开展示范项目,为新的护理和工作场所实践提供见解,以提高护理质量和工作质量。这些项目还应证明,实现护理和劳动力质量目标是如何相互促进的。发起人希望这些项目能够为长期护理行业和支持该行业及其潜在和现有劳动力的劳动力发展社区提供清晰和可复制的模式。ECCLI的总体计划目标是促进长期护理和劳动力发展社区的系统性变革和能力建设,以支持以下目标和宗旨:(1)提高护理质量;(2)促进技能发展;(3)建立职业阶梯和其他支持和发展工人的工作场所实践并使之制度化;(4)提高员工保留率。所附的基线评估报告是一份工作文件,供养老院质量和劳动力发展领域的研究人员和从业人员参考。它涵盖了从2001年3月到2001年6月ECCLI项目开始实施的时期,并被提交给马萨诸塞州联邦公司,这是一个准公共机构,负责管理养老院质量倡议的资金。未来的报告将分析研究人员在基线和规划期之后收集的数据。主要发现包括洞察在不熟悉的人类服务领域(卫生保健和劳动力发展和教育)形成联盟的过程,以及参与者在考虑和实施组织变革以及一线工人和主管培训计划时面临的挑战。
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引用次数: 2
Measurement of Inequity in the Delivery of Public Health Care: Evidence from Spain (1997) 衡量公共保健服务不公平:来自西班牙的证据(1997年)
Pub Date : 2001-09-01 DOI: 10.2139/ssrn.286593
Rosa Urbanos Garrido
This paper assesses horizontal equity in the delivery of public health care in Spain, and tries to identify those health care levels and population groups where inequality is concentrated. Different kinds of health care are analysed for 1997, both at disaggregate and aggregate level. The results show that the socio-economic population groups affected by inequity vary according to the specific health care level studied although, in global terms, there is not a clearly significant degree of inequity. The Spanish results are also compared to those obtained for other European countries.
本文评估了西班牙提供公共卫生保健的横向公平性,并试图确定不平等集中的卫生保健水平和人口群体。对1997年不同种类的保健服务进行了分类和综合分析。结果表明,受不平等影响的社会经济人口群体根据所研究的具体保健水平而有所不同,尽管就全球而言,不平等的程度并不明显显著。西班牙的结果也与其他欧洲国家的结果进行了比较。
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引用次数: 21
Income Redistribution and the Political Economy of Social Health Insurance: Comparing Germany and Switzerland 收入再分配与社会医疗保险的政治经济学:比较德国与瑞士
Pub Date : 2001-05-01 DOI: 10.2139/ssrn.296083
F. Breyer
In many countries, collectively financed health insurance systems or health services delivery systems (such as the NHS) exist. Typically, these institutions are financed via general taxes or specific contributions levied on earnings. As benefits are not dependent upon income, this implies a redistribution from high to low earners. An exception can be found in Switzerland, where equal per-capita contributions are used. From a public-choice perspective it is natural to ask whether the combination of health insurance and income redistribution leads to an expansion or a contraction of the size of a public health care system, a question that is particularly relevant in view of the projected rapid increase of health care costs in the next decades due to population ageing and medical progress. Building upon the work of Gouveia (1997) and an earlier paper by the author (Breyer 1995) I use a simple model of direct democracy to analyze under what circumstances income redistribution tends to expand the size of a public health insurance system. The predictions of the model are confronted with existing evidence from Germany and Switzerland and are used to develop hypotheses on the future development of the systems.
在许多国家,存在集体供资的医疗保险系统或卫生服务提供系统(如国民保健服务体系)。通常,这些机构的资金来自一般税收或对收入征收的特定捐款。由于福利不依赖于收入,这意味着从高收入者到低收入者的再分配。瑞士是一个例外,它使用人均等额捐款。从公共选择的角度来看,很自然地要问,健康保险和收入再分配的结合是否会导致公共卫生保健系统的规模扩大或缩小,鉴于预计在未来几十年由于人口老龄化和医疗进步,卫生保健费用将迅速增加,这个问题尤其相关。在Gouveia(1997)的工作和作者早期的一篇论文(Breyer 1995)的基础上,我使用了一个简单的直接民主模型来分析在什么情况下收入再分配倾向于扩大公共医疗保险系统的规模。该模型的预测与来自德国和瑞士的现有证据相对照,并用于对系统的未来发展提出假设。
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引用次数: 9
What Can the Take-Up of Other Programs Teach Us About How to Improve Take-Up of Health Insurance Programs? 关于如何提高健康保险计划的使用率,其他计划的采用能教给我们什么?
Pub Date : 2001-03-01 DOI: 10.3386/W8185
D. Remler, Jason E. Rachlin, S. Glied
Many uninsured Americans are already eligible for free or low-cost public coverage through Medicaid or CHIP but do not take up that coverage. Several other programs, such as food stamps and unemployment insurance, also have less than complete take-up rates and take-up rates vary considerably among programs. This paper examines the take-up literature across a variety of programs to learn what effects non-financial features, such as administrative complexity, have on take-up. We find that making benefit receipt automatic is the most effective means of ensuring high take-up, while there is little evidence that stigma is important. Overall, surprisingly little is known about the quantitative impact, of non-financial characteristics of programs on take-up. New research that could be used to draw measurable causal inferences about how features as administrative complexity, renewal rules, and organizational structure affect participation, would be extremely valuable.
许多没有保险的美国人已经有资格通过医疗补助计划或CHIP获得免费或低成本的公共保险,但他们没有接受这种保险。其他一些项目,如食品券和失业保险,也没有完全的接受率,而且不同项目的接受率差别很大。本文考察了各种项目的招生文献,以了解非财务特征(如行政复杂性)对招生的影响。我们发现,使福利自动接收是确保高接受的最有效手段,而很少有证据表明耻辱是重要的。总的来说,令人惊讶的是,我们对课程的非财务特征对学生入学的定量影响知之甚少。新的研究可以用来得出关于行政复杂性、更新规则和组织结构等特征如何影响参与的可衡量的因果推论,这将是非常有价值的。
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引用次数: 65
Does Managed Care Change the Mission of Nonprofit Hospitals? Evidence from the Managerial Labor Market 管理式医疗改变了非营利性医院的使命吗?来自管理劳动力市场的证据
Pub Date : 2000-09-01 DOI: 10.3386/W7924
R. Arnould, Marianne Bertrand, Kevin F. Hallock
This paper examines how the managerial labor market in nonprofit hospitals has adjusted to the negative income pressures created by HMO penetration. Using a panel of about 1500 nonprofit hospitals over the period 1992 to 1996, we find that top executive turnover increases following an increase in HMO penetration. Moreover, the increase in turnover is concentrated among the hospitals that have low levels of economic profitability and are more financially leveraged. While the link between top executive pay and for-profit performance measures is on average very weak, HMO penetration substantially tightens that link: as HMO penetration increases, top executives are compensated more for improving the profitability of their hospitals. These results are consistent with the view that HMO penetration increases the importance of for-profit performance objectives among not-for-profit hospitals. Boards appear to fire the managers that are least able to compete in the new competitive environment and reward incumbent managers more for achieving for-profit goals. Consistent with donors' belief that these changes represent a weakening of the nonprofit mission and not simply an attempt by altruistic boards to protect intergenerational equity, we find that public donations fall as HMO market share increases.
本文考察了非营利性医院的管理劳动力市场如何适应HMO渗透带来的负收入压力。通过对1992年至1996年间约1500家非营利性医院的调查,我们发现,随着HMO普及率的提高,高层管理人员的流失率也在增加。此外,营业额的增加主要集中在经济盈利水平较低、财务杠杆较高的医院。虽然高管薪酬与营利性绩效指标之间的联系平均而言非常微弱,但HMO的普及大大加强了这种联系:随着HMO普及率的提高,高管们因提高医院的盈利能力而获得了更多的报酬。这些结果与以下观点一致:在非营利性医院中,HMO的普及增加了营利性绩效目标的重要性。董事会似乎会解雇那些在新的竞争环境中最没有竞争力的经理,而更多地奖励那些实现盈利目标的在职经理。捐赠者认为,这些变化代表了非营利使命的削弱,而不仅仅是无私的董事会试图保护代际公平,我们发现,随着HMO市场份额的增加,公共捐赠减少了。
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引用次数: 27
Sharing the Pain of Social Security and Medicare Reform 分担社会保障和医疗改革的痛苦
Pub Date : 2000-08-01 DOI: 10.2139/ssrn.256588
L. Thompson
In combination with current trends in health costs, adjustments now scheduled for Social Security, Medicare and the income tax are likely to offset virtually all of the increase in Social Security cash benefits that future economic growth would otherwise produce. Current law will reduce future Social Security benefits in two ways, through the increase in the normal retirement and the expansion of the fraction of benefits included in the personal income tax base. Medicare projections suggest that beneficiaries also will have to devote an increasing fraction of their remaining benefit income to paying out-of-pocket health expenses and Medicare premiums and deductibles. Under current projections, the net earnings of future workers (their earnings after paying income and payroll taxes) will grow much more rapidly than the net benefits (Social Security benefits net of health costs) of retirees. The gap between the prospects of future workers and the prospects of future retirees is large enough that the current Medicare and Social Security financing problems could be addressed entirely through increases in taxes on future workers, without disadvantaging future workers relative to future beneficiaries. Indeed, the gap appears large enough also to allow the addition of a modest prescription drug benefit to Medicare. Restoring fiscal balance to Social Security and Medicare through higher taxes on future workers also does not appear to create intergenerational equity problems. The intergenerational transfers that current children can expect to receive from their parents within the confines of a typical family would still exceed the burden of the payroll tax payments flowing from these children back to their parents over the balance of their work careers.
结合目前的医疗成本趋势,目前计划对社会保障、医疗保险和所得税进行的调整可能会抵消未来经济增长可能产生的社会保障现金福利的几乎所有增长。现行法律将以两种方式减少未来的社会保障福利,一是增加正常退休年龄,二是扩大个人所得税基数中福利的比例。医疗保险计划表明,受益人还将不得不把越来越多的剩余福利收入用于支付自付医疗费用、医疗保险保费和免赔额。根据目前的预测,未来工人的净收入(他们在缴纳所得税和工资税后的收入)将比退休人员的净福利(扣除医疗费用的社会保障福利)增长得快得多。未来工人的前景和未来退休人员的前景之间的差距足够大,目前的医疗保险和社会保障融资问题可以完全通过增加对未来工人的税收来解决,而不会使未来工人相对于未来受益者处于不利地位。事实上,这一差距似乎也大到足以允许在医疗保险中增加一个适度的处方药福利。通过对未来工人增税来恢复社会保障和医疗保险的财政平衡,似乎也不会造成代际公平问题。在一个典型的家庭范围内,现在的孩子可以期望从父母那里得到的代际转移,仍然会超过这些孩子在工作生涯的平衡中流向父母的工资税负担。
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引用次数: 0
The Demand for Medical Care in Urban China 中国城市居民对医疗服务的需求
Pub Date : 2000-04-01 DOI: 10.2139/ssrn.223289
N. Mocan, E. Tekin, J. Zax
This is the first paper to investigate the determinants of the demand for medical care in the People's Republic of China. It uses a data set that consists of detailed characteristics of 6407 urban households, a continuous measure of health care spending, and price. A two-part model and a discrete factor model are used in the estimation. Household characteristics and work conditions impact the demand for medical care. Income elasticity is around 0.3, indicating medical care is a necessity. Medical care demand is price inelastic, and price elasticity is larger in absolute value for poorer households.
这是第一篇研究中华人民共和国医疗保健需求决定因素的论文。它使用的数据集包含6407个城市家庭的详细特征,是对医疗保健支出和价格的连续衡量。估计采用了两部分模型和离散因子模型。家庭特点和工作条件影响对医疗保健的需求。收入弹性约为0.3,表明医疗保健是必要的。医疗需求具有价格非弹性,贫困家庭的价格弹性绝对值更大。
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引用次数: 92
Tort Claims Against Gun Manufacturers for Crime-Related Injuries: Defining a Suitable Role for the Tort System in Regulating the Firearms Industry 针对枪支制造商的犯罪伤害侵权索赔:界定侵权制度在规范枪支行业中的适当角色
Pub Date : 2000-03-14 DOI: 10.2139/ssrn.201729
Timothy D. Lytton
Gun violence is a serious problem in the U.S. For many years, in order to decrease gun violence, the sale and possession of firearms has been regulated by statute. This article argues that tort claims against gun manufacturers can complement legislative regulation, providing gun sellers and manufacturers with incentives to take reasonable measures to prevent gun sales to criminals. The article does not, however, endorse all tort claims against the gun industry. It argues in favor only of narrowly tailored claims that identify specific marketing and sales practices that increase the risk that guns will be used to commit crimes. The likely effect of such claims would be to make the firearms industry more responsible and to reduce gun violence. This article advocates an essential, albeit secondary, role for the tort system in regulating the gun industry. Legislatures ought to decide whether and under what circumstances the sale of guns should be legal. The tort system, by means of liability exposure, ought to discourage attempts by manufacturers to legally circumvent the aims of the regulatory system. On one hand, this article advocates a greater role for the tort system than those who view tort claims against the gun industry as illegitimate attempts to achieve more stringent regulation of the gun industry through the court system, following failure to do so in state legislatures and Congress. On the other hand, this article advocates a more modest role for the tort system than those who view the tort system as a primary source for industry reform, free of the corrupting political influences that distort legislative policy making.
枪支暴力在美国是一个严重的问题。多年来,为了减少枪支暴力,枪支的销售和持有一直受到法律的管制。本文认为,针对枪支制造商的侵权索赔可以补充立法监管,为枪支销售者和制造商提供激励,以采取合理措施防止枪支出售给犯罪分子。然而,这篇文章并不支持所有针对枪支行业的侵权索赔。它只支持狭义的索赔,即确定特定的营销和销售行为会增加枪支被用于犯罪的风险。这种说法的可能效果是使枪支行业更负责任,减少枪支暴力。本文主张侵权制度在规范枪支行业方面发挥重要作用,尽管是次要的作用。立法机关应该决定是否以及在什么情况下出售枪支应该合法。侵权制度,通过责任暴露,应该阻止制造商合法规避监管制度目标的企图。一方面,本文主张侵权制度发挥更大的作用,而不是认为针对枪支行业的侵权索赔是在州立法机构和国会失败后,通过法院系统实现对枪支行业更严格监管的非法尝试。另一方面,与那些将侵权制度视为行业改革的主要来源的人相比,本文主张侵权制度发挥更适度的作用,不受扭曲立法决策的腐败政治影响。
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引用次数: 4
The definition of disability: perspective of the disability community. 残疾的定义:残疾群体的视角。
Pub Date : 2000-01-01
D Kaplan
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引用次数: 0
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Journal of health care law & policy
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