Research on Restricting Factors and Countermeasures of Balanced Development between Fairness and Efficiency of Basic Medical and Health Service in China / 中国医学伦理学

This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.

Ethical Controversy and Reflection on Gene Enhancement / 中国医学伦理学

Gene enhancement is one of the research hotspots at home and abroad in recent years. Gene enhancement is expected to treat human genetic diseases and improve human abilities and traits, but it also raises a series of ethical problems. From the perspective of ethics, those who support gene enhancement, starting from the open and unfinished state of human nature, advocate that gene enhancement is an effective alternative to promote human nature for kindness and social equity, and believe that gene enhancement does not necessarily lead to inequality, on the contrary, it contributes to moral improvement. Opponents, starting from the integrity of human nature, hold that gene enhancement challenges human dignity, causes a crisis of human identity, has a serious impact on social fairness and justice, and is also a violation of the natural order. By sorting out and analyzing the ethical viewpoints that support and oppose gene enhancement, this paper found that the social fairness and justice issues caused by gene enhancement can be reasonably solved through exercising the roles of the government and the market, while the human nature problems caused by gene enhancement are more complex, and the setting of natural standards lacks a basis. At the same time, gene enhancement also makes people further reflect on the relationship between human and technology.

Mediating role of innovation self-efficacy in the relationship between sense of organizational fairness and innovation behavior in nurses / 中国职业医学

Objective To study the relationship among the sense of organizational fairness, innovative self-efficacy (ISE) and innovative behavior in nurses. Methods A total of 392 nurses from a grade A tertiary hospital were selected as the research subjects using convenience sampling method. The Organizational Fairness Scale, Innovation Self-efficacy Scale, and Innovation Behavior Scale were used to evaluate the sense of organizational fairness, ISE, and innovation behavior, respectively. The mediate equation model was constructed, and Bootstrap analysis was applied for validation. Results The scores for organizational fairness, ISE, and innovative behavior among the nurses were (67.8±15.2), (23.9±3.5), and (30.5±6.7) points, respectively. Organizational fairness score was positively correlated with both innovative behavior and ISE scores ［correlation coefficients (r) were 0.38 and 0.36, respectively, both P<0.01］. ISE score was positively correlated with innovative behavior total score (r=0.51, P<0.01). The results of the mediation analysis indicated that the total effect of organizational fairness on innovation behavior was 0.34 (P<0.01),with a direct effect of 0.17 (P<0.01). ISE plays a mediating role between organizational fairness and innovation behavior among nurses(P<0.01) with standardized mediation effect of 0.17, accounting for 50.0% of the total effect. Conclusion Organizational fairness can influence the ability of innovative behavior directly or through the mediating role of ISE.

Effect of transcranial direct current stimulation of the bilateral dorsolateral prefrontal cortex on fairness-related decision-making behavior of normal adults / 中华行为医学与脑科学杂志

Objective:To investigate the effect of a single-trial transcranial direct current stimulation(tDCS) of the dorsolateral prefrontal cortex (DLPFC) on fairness-related decision-making behavior.Methods:From September 2018 to February 2019, a total of 60 healthy participants between the ages of 18 and 45 were enrolled.Then, the participants were randomly divided into 3 groups with 20 in each group to receive left anode stimulation/right cathode stimulation (left anode /right cathode group), left cathode/right anode stimulation (left cathode /right anode group) or bilateral control electrodes (sham stimulation group) on the bilateral dorsolateral prefrontal cortices (DLPFC), respectively.After tDCS, the participants immediately completed the ultimatum game (UG) task as responders and a fairness questionnaire in turn.SPSS 22.0 statistical software was used to analyze the data with repeated measurement ANOVA and nonparametric test.Results:In the UG task, there was no significant difference in the acceptance rate among the three groups of participants as responders (all P>0.05). When analyzing the acceptance rate facing different proposers (" computer" and " human" ) under different fairness levels in the three stimulus types through the paired samples Wilcoxon test, it was found that the acceptance rate of the sham stimulation group to the extremely unfair proposals proposed by the human opponent was lower than that proposed by the computer(0.28 (0, 0.67), 0.44 (0.33, 0.89), Z=-2.14, P=0.032), while there was no difference in acceptance rates (both P>0.05) in the face of fair or unfair proposals proposed by computer and human opponents.The acceptance rate of the left cathode /right anode group to the unfair(0.90 (0.50, 1.00), 1.00 (0.70, 1.00), Z=-1.90, P=0.046)or extremely unfair(0.44 (0, 1.00), 0.89 (0.50, 1.00), Z=-2.73, P=0.006) proposals proposed by human opponents was significantly lower than the proposals proposed by computer opponent, and there was no differences in acceptance rate when facing fair proposals proposed by computer and human opponents ( P> 0.05). There were no significant differences in acceptance rates in the left anode /right cathode group when faced with fair, unfair, and extremely unfair schemes proposed by computer and human opponents (all P>0.05). For fairness questionnaire scores, a repeated measurements ANOVA showed that the interaction effect between group and proposer types was not significant ( F(2, 54)=2.037, P=0.140), and the group main effect was not significant ( F(1, 54)=0.165, P=0.848), but the proposer type main effect was significant ( F(1, 54)=6.363, P=0.015), indicating that the fairness questionnaire score in the face of the human opponents was lower than when facing the computer opponents( P<0.05). Conclusion:Although a single-trial tDCS on bilateral DLPFC has no significant effect on the overall acceptance rate of fairness-related decision-making, it affects the decision-making of unfair distribution scheme proposed by human or computer.

Thinking on Integrating Health Ethics into Health Education and Prospect of Its Practice Path / 中国医学伦理学

Since the reform and opening-up, China’s health care has made great progress, and the level of national health literacy has steadily improved. However, there is still a disconnect between the health literacy and healthy behavior of Chinese residents, and traditional health education has little effect on behavior change. Based on the limitations of current traditional health education on improving health level of the whole people, this paper explored more effective education methods, deeply discussed how to integrate health ethics into health education to achieve the purpose of effectively promoting individual health behaviors. At the same time, this paper systematically expounded how the theory of behavioral economics provides theoretical support for the rationality and feasibility of health ethics education to promote healthy behavior, further explained the internal psychological mechanism of health ethics education affecting people’s healthy behavior, and provided feasible solutions for how to integrate health ethics into the new model of health education in practical application. To sum up, the integration of health ethics into health education is conducive to disseminating health concepts, improving health literacy, as well as promoting health behaviors, and then promoting the effective implementation of individual health and Healthy China.

The allocation and equity of personnel and facilities of radiotherapy in the county hospitals of Chinese mainland in 2019 / 中华放射肿瘤学杂志

Objective:To examine the status of personnel and facilities of radiotherapy in county hospital of Chinese mainland and to evaluate the equity of allocation.Methods:All the county level radiotherapy units were chosen for study, and the data were extracted from the 9 th national survey on radiation oncology departments conducted by Chinese Society of Radiation Oncology of Chinese Medical Association from April 10, 2019 to September 20, 2019. Descriptive statistics and statistical analysis were performed. For the further analysis on the equity, the Gini coefficient, Theil index and agglomeration degree were calculated. Results:The number of county level radiotherapy units was 191 in the eastern region, 172 in the central region and only 59 in the western region, and there was no radiotherapy unit in the county area of some provinces in the western region. For the counties with larger population (population over 500 thousand) in Chinese mainland, 23.4% of the counties in the western region had radiotherapy units, lower compared to the eastern region (48.9%) and central region (41.8%). The Gini coefficients of all kinds of radiotherapy health resources according to population allocation were in alert states, and in highly unfair states according to geographical allocation. The intra-regional gap in radiotherapy resource allocation was larger than the inter-regional gap, and the intra-regional gap mainly came from the western region. HRADi,HRADi/ PADi in the eastern and central regions were all greater than 1, while those in the western region were all less than 1. Conclusions:The overall configuration of county level radiotherapy units in Chinese mainland is insufficient, and there is a regional difference. The fairness of geographical allocation of radiotherapy resources is generally poor. Radiotherapy resources should be scientifically configured to improve the fairness of radiotherapy resource distribution.

Fairness of blood bank resources allocation in China / 中国输血杂志

【Objective】 To study the fairness of blood bank resources allocation in China, aimed at providing references for reasonable allocation of blood bank resources. 【Methods】 A questionnaire survey was conducted among 32 provincial blood centers and 321 regional central blood banks across China in August 1~25, 2018. Resource allocation of blood banks in China was analyzed using descriptive methods, and the fairness of resource allocation were analyzed using Lorenz curve, Gini coefficient and Theil index. 【Results】 Blood bank resources and services showed an overall upward trend from 2013 to 2017. The fairness of institutional coverage was optimal in 2017 according to the Lorenz curve and Gini coefficient, suggesting the allocation of blood bank resources according to the population was better than geographic area. The fairness of health technicians staffing was the worst from the perspective of geographic area. The total Theil index was 0.448 5~0.526 7, and the differences was contributed more by intra group comparison than that of inter group. 【Conclusion】 The unbalanced development underlying in the provincial and regional blood centers has been observed, and the service capacity needs to be further improved. The resource allocation varies greatly among regions, and it is recommended to optimize the regional planning of blood bank resources.

Inventarios e índices de diversidad agrícola en fincas campesinas de dos municipios del Valle del Cauca, Colombia / Inventories and indices of agricultural diversity in peasant farms in two municipalities of Valle del Cauca, Colombia / Inventários e índices de diversidade agrícola em fazendas camponesas em dois municípios de Valle del Cauca, Colombia

Resumen Con el objetivo de conocer la diversidad de especies y variedades manejadas a nivel de finca por los agricultores de 2 municipios del Valle del Cauca, Colombia y el uso que las familias le dan a estas, se realizaron inventarios de agrobiodiversidad y se estimaron índices de riqueza y abundancia de dichas especies. Se evaluaron siete fincas de las veredas El Diamante, Alto del Oso y San Pablo en el Municipio de Restrepo y dos fincas en los corregimientos Fenicia y Puerto Fenicia, en el Municipio de Riofrío. Los inventarios e índices evaluados en los dos municipios muestran que existe gran riqueza y abundancia específica, y que no hay especies dominantes. Los inventarios de agrobiodiversidad y la aplicación de índices se deben constituir como herramientas indispensables para el diseño de la estructura de los sistemas sostenibles como clara estrategias para la mitigación al cambio climático basados en el uso y manejo de la agrobiodiversidad local y la generación de medios de vida para los agricultores, y como aporte para la seguridad y soberanía alimentaria.

Abstract With the objective of knowing the diversity of species and varieties managed at the farm level by the farmers of 2 municipalities of Valle del Cauca, Colombia and the use that families give them, agrobiodiversity inventories were carried out and wealth indices were estimated and abundance of these species. Seven farms of the El Diamante, Alto del Oso and San Pablo villages in the Municipality of Restrepo and two farms in the Fenicia and Puerto Fenicia districts, in the Municipality of Riofrío were evaluated. The inventories and indices evaluated in the two municipalities show that there is great wealth and specific abundance, and that there are no dominant species. Agrobiodiversity inventories and the application of indexes should be constituted as indispensable tools for the design of the structure of sustainable systems as clear strategies for climate change mitigation based on the use and management of local agrobiodiversity and the generation of means of life for farmers, and as a contribution to food security and sovereignty

Resumo Com o objetivo de conhecer a diversidade de espécies e variedades manejadas no nível da fazenda pelos agricultores de 2 municípios de Valle del Cauca, Colômbia e o uso que as familias lhes dão, foram realizados inventários de agrobiodiversidade e estimados índices de riqueza e abundância dessas espécies. Foram avaliadas sete fazendas das aldeias El Diamante, Alto del Oso e San Pablo no município de Restrepo e duas fazendas nos distritos de Fenicia e Puerto Fenicia, no município de Riofrío. Os inventários e índices avaliados nos dois municípios mostram que há grande riqueza e abundância específica e que não existem espécies dominantes. Os inventários de agrobiodiversidade e a aplicação de índices devem ser constituídos como ferramentas indispensáveis para o desenho da estrutura de sistemas sustentáveis, como estratégias claras para a mitigação das mudanças climáticas, baseadas no uso e gestão da agrobiodi-versidade local e na geração de meios de vida para os agricultores e como uma contribuição para a segurança e soberania alimentar.

Mediating Effect of Voice Behavior on Relationships between Empathy, Fairness and Intention in Helping Behavior of Nursing Students in Assumed Bullying Situations / 간호행정학회지

PURPOSE: The study was done to investigate the mediating effects of voice behavior on the relationships between empathy and fairness and intention in helping behavior of nursing students. METHODS: A structured self-report questionnaire was used to measure empathy, fairness, voice behavior and intention in helping behavior. During November 2018, data were collected from 128 nursing students in D and G cities. Data were analyzed using hierarchical multiple linear regression with the SPSS/WIN 24.0 program. RESULTS: Empathy, fairness and voice behavior were positively correlated with intention in helping behavior of participants and voice behavior was positively correlated with empathy, fairness and intention in helping behavior of participants respectively. Also, voice behavior had a partial mediating effect on the relationship between empathy, fairness and intention in helping behavior. CONCLUSION: Findings indicate that empathy and fairness are important factors related to the intention in helping behavior of nursing students. It is also expected that voice behavior can further promote the intention in helping behavior of nursing students.

Analysis of the Impacts of the Full Coverage Policy for Essential Medicines on the Fairness of Medicine Expenditure Affor- dability of Diabetic Patients in Taizhou City / 中国药房

OBJECTIVE： To provide the empirical basis for improving full coverage policy of essential medicines in China and promoting the fairness and accessibility of medicine. METHODS： Taking Taizhou diabetes essential medicines full coverage policy as an example， the electronic health records of diabetic patients in Taizhou city from 2011 to 2017 were collected， and the cost burden of patients was evaluated by whether catastrophic expenditure of family drugs had occurred. The concentration index was used to analyze the fairness of catastrophic expenditure on household medicines， and the effects of various influencing factors on the fairness of local medicine expenditure affordability were evaluated by year-by-year comparing the relevant indexes from baseline year to the third year of policy implementation. RESULTS & CONCLUSIONS： The concentration index of catastrophic expenditure on household medicines is negative from baseline year to the third year of policy implementation， which indicates that catastrophic expenditure on household medicines for diabetic patients in Taizhou mainly occurs in low-income groups. From the result of decomposition of concentration index， among the factors that affect the fairness of catastrophic expenditure on drugs in diabetic families， the contribution rate of  “taking free essential medicines” keeps at top five places year by year， and the contribution value is positive， which shows that the implementation of policies is conductive to reducing the unfairness of catastrophic expenditure on household medicines in low-income families. Full coverage policy of essential medicines effectively improves the fairness of medicine expenditure affordability. In addition， scientific and reasonable essential medicines selection mechanism， the guarantee level of the policy， collaboration with multiple factors should be promoted so as to improve the fairness and accessibility of essential medicines.

Ethics Struggle of Protection and Sharing in the Construction of Biobank / 中国医学伦理学

At present, the development of biobank in China is still at the initial stage, and there are many problems, such as lack of scientific management and sharing mechanism, insufficient application of transformation and weak sustainable development. Through constructing the ethical challenge of biobank, the author draw out the rights protection claims of biological sample sources, such as the informed consent of samples source and the privacy protection of samples management. In order to achieve the balance between the protection and sharing of biobank construction, we should improve the awareness of privacy protection, take effective means of privacy protection and fully consider and foresee ethical issues after rapid development of technology. Finally, it is pointed out that the principle of public welfare, the principle of fairness in the distribution of results and the predictive principle should be reflected in the transformation of results.

Discussion on Fairness of Performance Reform of Public Hospital Based on RBRVS and DRGs / 现代医院

A large size tertiary comprehensive hospital designed the performance reform program not only based on RBRVS and DRGs but also combined with cost control and medical quality and safety. The hospital have implemented performance reform at 2016, with achieving the public welfare and fairness by "combination" and exploring a set of performance management methods which suit the hospital's actual condition and boost its development.

Introduction to the Four Principles of Biomedical Ethics in Confucius / 中国医学伦理学

It is not only the problem of the real life,but also the challenge of the biomedical ethics for how to get the balance and compromise between the principlism and situationism.The fairness in Confucian is constructed on the basis of the external nature,and also is a standard and content-full ethical principle,which is different from the political one in the western culture.The Confucian basis is the principlism but does not refuse the situationism.In the four principles of Confucian,both fairness and respect for autonomy belong to the principlism,while the other two of knowing where to stop and no harm or the principle of benefit of utilitarianism are the basis of the situationism.The principle of knowing where to stop is the internal core spirit of the Confucian moral virtue and ethical principles,but fairness is the first principle of its all external principles.

Importance and Challenge of Non-Affiliated Scientific Member in Ethics Review Committee / 中国医学伦理学

After discussing the reason for insufficiency of committee member in current ethical review , and considering the requirement for improving the function of Ethics Review Committee , this paper proposes that Ethics Review Committee should appoint more non -affiliated scientific members to ensure the independence of ethical re-view , thus protecting the rights and beneficence of subjects , and to secure the justice in ethical review of protocols , the paper also discussed the resolutions to address the challenge brought by appointing non -affiliated members .

Fairness of Urban and Rural Basic Medical Insurance Reform---Based on the Investigation of Hunan Province / 中国医学伦理学

Based on the Hunan province research site, from the egalitarian concrete analysis of the province since the new reform of basic medical insurance of urban and rural reform and the fairness of the situation, think the current reform of insurance of primary medical treatment to a certain extent, promote the economy of the basic medical service accessibility and equity, but rural population and urban population in the benefit of insurance of primary medical treatment is still a gap, should be by advancing the basic medical insurance system of urban and rural integration manage-ment, gradually promote the fairness of health care among different populations.

Increasing insurance protection efforts and improving the fairness of health care services: A-nalysis on the convergence mechanism between New Rural Cooperative Medical Scheme and Healthcare Financial Assistance Program / 中国卫生政策研究

The goal of China's health care insurance system is to improve the fairness and accessibility of health care services for low-income people. In the past 10 years of practice, the insurance has made remarkable a-chievements and gained popularity among broad masses of people. With the support of World Bank and UK Depart-ment for International Development, China Rural Health Development Project ( hereinafter referred as Health XI Project) have used the advantages of unique funding, management and human resources to launched a series of pro-ject activities, with the main goal of achieving effective convergence between the New Rural Cooperative Medical Scheme (NRCMS) and Healthcare Financial Assistance Program (HCFAP) in order to explore the assistance system of catastrophic diseases. Some areas have achieved seamless convergence between NRCMS and HCFAP to explore the assis-tance program for catastrophic diseases in the context of confirming and optimizing the management of services covered by the project, especially conducting a series of exploration and practice activities in the aspects of increasing new funding channels to establish theCatastrophic Disease Assistance Fund, strengthening the related supporting regulations, etc. The results show that the utilization of services covered by HCFAP in the project has significantly improved, the protection level of health insurance has greatly improved, and the people satisfaction has significantly increased.

INVESTIGATION OF EQUITY PRIMARY HEALTH CARE INSTITUTIONS PAY FOR PER-FORMANCE IN ZHEJIANG / 现代医院

Objective To understand the basic medical and health personnel's perception of fairness for pay for performance program .Methods This study used document analysis , expert consultation , pre-survey method to de-sign the questionnaire , and then was conducted on 367 medical and health personnel at the basic level in Zhejiang Prov-ince, analysis of variance , correlation analysis were used for statistical analysis .Results Only 0.13% of the basic medical and health personnel think pay for performance program is very fair;23.16%of people think pay for perform-ance program is fair;29.43%of people do not know whether pay for performance program is fair;34.06%of people think pay for performance program is not fair;11.99% of people think pay for performance program is very unfair . There were no significant differences between age , educational levels, working time, professional qualifications and po-sition(p>0.05).Staff in different areas of the perception of pay -for-performance fairness exists obvious difference (p<0.05).Conclusion Only a small portion of basic medical and health personnel think pay for performance pro -gram is fair, and it may directly affect the enthusiasm of staff , reduce the work quality and efficiency of basic medical and health personnel .It suggests that relevant departments should improve the pay for performance program .

A ideia da estrutura básica como objeto primário da justiça em uma teoria da justiça de John Rawls / The idea of the basic structure as the primary object of justice in a theory of justice of John Rawls

O objetivo deste artigo é estabelecer uma reflexão sobre a estrutura básica da sociedade (basic structure of society) proposta por John Rawls em sua teoria da justiça como equidade, baseando-se principalmente nas obras Political Liberalism (Lecture VII) e A theory of justice (Part Two. Institutions). Nossa intenção é demonstrar ao longo do texto, que uma sociedade sustentada em princípios e com espírito de cooperação, tem maior possibilidade de atingir estabilidade e legitimidade politica ao longo do tempo.

The main purpose of this article is to provide a reflection on the basic structure of society proposed by John Rawls in his theory of justice as fairness, mainly based on the following books, Political Liberalism (Lecture VII) and A theory of justice (Part Two. Institutions). The intention is to demonstrate throughout the text, that a society which is based on principles and spirit of cooperation, is more likely to achieve political legitimacy and stability over time.

Fair Benchmarks of Evaluation Framework for Health Resource Allocation and Its Reference for China / 中国医学伦理学

This paper introduced the fair benchmarks of evaluation framework for health system constructed by Daniels, et al, and its developmental application in evaluation of health resource allocation fairness .After introdu-cing the resources rational allocation of public health fair benchmarking fixed framework , this paper assessed the al-location of health resources according to the fixed framework .China has achieved good results in public health serv-ice interventions .But public sector governance , macro economic and social policy environment , factors such as ac-countability may restrict the improvement of the health care system .China's health expenditure allocations have un-fairness between provinces , urban and rural areas and different classes .China can use the new benchmark in the field of public health to promote the reform of health resource allocation fairness , make effective social health strate-gies.

Analyzing Fairness Degree of Health Resources Distribution in China Based on Theil Index / 中国卫生经济

Objective: To analyze the fairness of health resource distribution in various cities and provinces in China, to provide policy recommendations for the state to formulate relevant policies. Methods: Using Theil index method to measure the provincial disparity of health resources allocation and analyze the relevant data about regional health resources in 31 provinces from 2003 to 2011 in China. Results: Chinese medical and health technical personnel are seriously uneven distributed; the number of health technical personnel in big cities such as Beijing is denser than that in western areas like Guizhou. At the same time, the medical treatment level between urban and rural residents also exist serious inequality, urban residents have higher spending levels than rural residents. Conclusion:The state is recommended to adopt measures to encourage more medical technical talents to work in western underdeveloped region. At the same time, the state should improve the medical level of rural residents by improving the rural medical insurance reimbursement ratio and other measures.