The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study.

BACKGROUND: Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. METHODS: Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. RESULTS: For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from - 0.0636 (95 % CL: -0.0846, - 0.0430) before the policy to - 0.0457 (95 % CL: -0.0684, - 0.0229) after it. In addition, the horizontal inequity index decreased from - 0.0284 before the implementation of the policy to - 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from - 0.0532 (95 % CL: -0.0868, - 0.0196) before the policy was implemented to - 0.1105 (95 % CL: -0.1333, - 0.0876) afterwards; the horizontal inequity index of IHSU increased from - 0.0066 before policy implementation to - 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. CONCLUSIONS: The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy's original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage.

Addressing the health advocate role in medical education.

The health advocate role is an essential and underappreciated component of the CanMEDs competency framework. It is tied to the concept of social accountability and its application to medical schools for preparing future physicians who will work to ensure an equitable healthcare system. Student involvement in health advocacy throughout medical school can inspire a long-term commitment to address health disparities. The Social Medicine Network (SMN) provides an online platform for medical trainees to seek opportunities to address health disparities, with the goal of bridging the gap between the social determinants of health and clinical medicine. This online platform provides a list of health advocacy related opportunities for addressing issues that impede health equity, whether through research, community engagement, or clinical care.First implemented at the University of British Columbia, the SMN has since expanded to other medical schools across Canada. At the University of Ottawa, the SMN is being used to augment didactic teachings of health advocacy and social accountability. This article reports on the development and application of the SMN as a resource for medical trainees seeking meaningful and actionable opportunities to enact their role as health advocates.

Codifying explicit and tacit practitioner knowledge in community social pediatrics organizations: Evaluation of the first step of a knowledge transfer strategy.

In this article, we the present the evaluation of the first phase of a KT initiative, the codification of the tacit and explicit knowledge of community social pediatrics (CSP) practitioners. As increasing numbers of professionals began working in the CSP field, it became necessary to capture the know-how to make it better understood. This first phase of the initiative took advantage of one of the KM stages, the codifying process that is absent from KT models. The evaluation aim to answer the question: "What is the CSPs practitioners level of familiarity with the codification document, as well as their perceptions of its utility and its contribution to the understanding of the CSP model". The results, show that most respondents had consulted the codification document and were able to describe in detail parts of it. The results also show that they considered it to be a useful and necessary tool to guide practices and helpful in understanding the model. The results of this evaluation is paving the way for the next steps of the KT initiative.

Protección de la salud en el trabajo: de lo indemnizatorio mercantil al real cuidado de la salud / Protection of health at the workplace: from monetary compensation to true health care

Este artículo cuestiona los mecanismos de protección de la salud en el trabajo desarrollados internacionalmente hasta ahora por el campo de la seguridad y la salud en el trabajo. Su objetivo fue hacer un análisis de los enfoques de la salud ocupacional y el aseguramiento que han estructurado la praxis hegemónica de la protección de la salud en el trabajo y contrastarlos con el enfoque de la salud de los trabajadores proveniente del campo de la medicina social­ salud colectiva. La metodología usada para el desarrollo del artículo fue la de una investigación documental, conjugada con la experiencia en formación, investigación y organización en el campo de la salud de los trabajadores del autor del artículo. Las reflexiones epistémicas, ontológicas, metodológicas, políticas y prácticas, sobre la base de lo revisado documentalmente, permitieron sostener que a pesar de algunos beneficios de los mecanismos tradicionales de protección de la salud en el trabajo, los enfoques de la salud ocupacional y el aseguramiento no transforman las condiciones de trabajo que históricamente han generado efectos negativos sobre la salud y la vida de los trabajadores, mientras que el enfoque de salud del trabajador proporciona elementos que aportan a configurar una protección integral del cuidado de la salud en trabajo, con un sentido de autonomía y emancipación de los trabajadores y una apuesta real por la transformación tanto de las condiciones de trabajo, como de las del modo de producción(AU)

This paper questions the mechanisms of protection of health at the workplace currently applied globally in occupational safety and health. The author performed an analysis of occupational health and insurance approaches that have driven the hegemonic practice of occupational health protection, and contrasted them with an approach centered on workers' health coming from the field of social medicine/collective health. The methodology used for the development of the paper was that of a documentary investigation, combined with the author's experience in training, research and organization in occupational health. The epistemic, ontological, methodological, political and practical reflections, on the basis of the documentary review, allows the author to postulate that, despite some benefits of the traditional mechanisms of occupational health protection, these approaches do not transform the working conditions that have historically generated negative effects on the health and life of workers. In contrast, the workers' health-centered approach provides elements that contribute to configuring an integral protection of health care in the workplace, with a sense of autonomy and emancipation of workers and true commitment to the transformation of both working conditions and those of the means of production(AU)

La pediatría social se debe ejercer siempre que nos encontremos con niños que tienen problemas que afecten la salud cuyo origen y causalidad deriven de problemas en la sociedad. [Editorial] / Social pediatrics should be exercised whenever we we meet children who have problems that affect their health whose origin and causality derive from problems in society. [Editorial]

La pediatría social se debe ejercer siempre que nos encontremos con niños que tienen problemas que afecten la salud cuyo origen y causalidad deriven de problemas en la sociedad

Can Health Surveillance be emancipatory? An alternative way of thinking about alternatives in times of crisis. / Pode a Vigilância em Saúde ser emancipatória? Um pensamento alternativo de alternativas em tempos de crise.

This article in essay form is an invitation to reflect upon the emancipatory character of health surveillance, a debate that was interrupted in the 1990s. In these times of grave political and institutional crisis in Brazil and in the year of the first National Conference on Health Surveillance (1ª CNVS, acronym in Portuguese), it is particularly appropriate to revive the critical theoretical and epistemological discussions that have grounded the trajectory of Latin American social medicine and public health over the last 40 years. To this end, I draw on aspects of critical thinking on modernity devised by the Portuguese sociologist Boaventura de Sousa Santos, who postulates three pillars of domination: capitalism, colonialism (or coloniality), and patriarchy. In the current context of a crisis of civilization, rethinking emancipation requires us to refresh our understanding of the meaning of social struggles in terms of their relationship with the knowledges and epistemologies undermined by modern civilization and still present in the Global South, whether in spaces occupied by indigenous peoples and poor farmers or in urban peripheries.

Resumo Este artigo, na forma de ensaio, é um convite à reflexão sobre o caráter emancipatório da vigilância em/da saúde, um debate interrompido na década de 1990. Em tempos de grave crise política e institucional no Brasil e no ano da 1ª Conferência Nacional de Vigilância em Saúde (1ª CNVS), é estratégico renovar as discussões teóricas e epistemológicas críticas que fundamentaram a trajetória da medicina social latino-americana e da saúde coletiva nos últimos 40 anos. Para isso, baseamo-nos nos pensamentos críticos da modernidade que articulam o capitalismo, o colonialismo (ou a colonialidade) e o patriarcalismo como os três pilares da dominação, segundo o sociólogo português Boaventura de Sousa Santos. Em um contexto de crise civilizatória, repensar a emancipação significa atualizar o significado das lutas sociais em seu relacionamento com o conhecimento e as epistemologias desprezadas pela civilização moderna e ainda presentes no Sul Global, seja nos espaços indígenas e camponeses ou nas periferias urbanas.

Pode a Vigilância em Saúde ser emancipatória? Um pensamento alternativo de alternativas em tempos de crise / Can Health Surveillance be emancipatory? An alternative way of thinking about alternatives in times of crisis

Resumo Este artigo, na forma de ensaio, é um convite à reflexão sobre o caráter emancipatório da vigilância em/da saúde, um debate interrompido na década de 1990. Em tempos de grave crise política e institucional no Brasil e no ano da 1ª Conferência Nacional de Vigilância em Saúde (1ª CNVS), é estratégico renovar as discussões teóricas e epistemológicas críticas que fundamentaram a trajetória da medicina social latino-americana e da saúde coletiva nos últimos 40 anos. Para isso, baseamo-nos nos pensamentos críticos da modernidade que articulam o capitalismo, o colonialismo (ou a colonialidade) e o patriarcalismo como os três pilares da dominação, segundo o sociólogo português Boaventura de Sousa Santos. Em um contexto de crise civilizatória, repensar a emancipação significa atualizar o significado das lutas sociais em seu relacionamento com o conhecimento e as epistemologias desprezadas pela civilização moderna e ainda presentes no Sul Global, seja nos espaços indígenas e camponeses ou nas periferias urbanas.

Abstract This article in essay form is an invitation to reflect upon the emancipatory character of health surveillance, a debate that was interrupted in the 1990s. In these times of grave political and institutional crisis in Brazil and in the year of the first National Conference on Health Surveillance (1ª CNVS, acronym in Portuguese), it is particularly appropriate to revive the critical theoretical and epistemological discussions that have grounded the trajectory of Latin American social medicine and public health over the last 40 years. To this end, I draw on aspects of critical thinking on modernity devised by the Portuguese sociologist Boaventura de Sousa Santos, who postulates three pillars of domination: capitalism, colonialism (or coloniality), and patriarchy. In the current context of a crisis of civilization, rethinking emancipation requires us to refresh our understanding of the meaning of social struggles in terms of their relationship with the knowledges and epistemologies undermined by modern civilization and still present in the Global South, whether in spaces occupied by indigenous peoples and poor farmers or in urban peripheries.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea.

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.

[Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency]. / Teilhabe als Ziel von Sozialmedizin und Pflege: ­ Definition von Pflegebedürftigkeit ­ Prävention von Pflegebedürftigkeit.

Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their successful cooperation.

[Social support after traumatism]. / Soziale Unterstützung nach Traumatisierung.

The classical concept of social support has recently become of relevance again, particularly in the context of traumatized patient groups, which include refugees and migrants. This article summarizes the evidence from social support research, e. g. different types of positive effects as well as context, gender and cultural aspects. These aspects are highlighted by means of studies stemming from applied healthcare research and thus describe a wide range of health effects, e.g. increased well-being and reduced depressive symptoms, improved functional abilities, better immune status and longevity. Two new trauma-specific differentiations of the social support concept are introduced: societal acknowledgement as a trauma survivor and disclosure of traumatic experiences. Against this background several implications for working with refugees arise: promotion of self-efficacy and posttraumatic maturation as well as the treatment of mental disorders show considerable benefits from focusing on social support. Finally, possibilities emerging from digital communication media are discussed, which are particularly relevant in this context.

Fundamental Interventions: How Clinicians Can Address the Fundamental Causes of Disease.

In order to enhance the "structural competency" of medicine-the capability of clinicians to address social and institutional determinants of their patients' health-physicians need a theoretical lens to see how social conditions influence health and how they might address them. We consider one such theoretical lens, fundamental cause theory, and propose how it might contribute to a more structurally competent medical profession. We first describe fundamental cause theory and how it makes the social causes of disease and health visible. We then outline the sorts of "fundamental interventions" that physicians might make in order to address the fundamental causes.

[Why Strive after Clinical Social Medicine? From Epidemiological Association to Personalized Social Medicine: a Case of Breast Cancer Care]. / Klinische Sozialmedizin - Warum? Von der epidemiologischen Assoziation zur personalisierten Sozialmedizin am Beispiel der Versorgung bei Mammakarzinom.

Advances in biomedicine, especially molecular biology and genetics, gave rise to the concept of personalized medicine targeting the patient's individual characteristics and needs to ensure the best possible therapy and healthcare. This concept, however, can be successfully implemented only if due consideration is given to (psycho-)social factors, as is shown for instance by considerably reduced post-therapy survival rates among cancer patients in regions with lower socioeconomic status, How breast cancer patients, for instance, find their way back to daily life and work after initial treatment at a breast center is substantially determined by multiple factors going beyond pure medical care. These factors critically affect health status and therapy outcomes, but are missing in current research agenda. A profound expertise in social medicine is required to respond in ways tailored to the individual's healthcare needs that go beyond just medical therapy. This expertise comprises, in particular, knowledge of inequality of access to healthcare due to varying health competence that in turn, results in inequality of health outcome and care. Competence in social medicine both in the clinic and outpatient care can help to individually target negative factors that originate from the social environment as well as from deficits in communication and coordination in the healthcare system and have an effect on the health status of patients..This, however, requires institutionalization of (clinical) social medicine and in particular, better opportunities for advanced training in social medicine in clinical departments and outpatient units.

[Development of Social Medicine and Public Health in Germany]. / Entwicklungslinien der Sozialmedizin und Öffentlichen Gesundheit in Deutschland.

Social medicine in Germany has multiple lines of tradition, which are marked by the presence of 2 German states and their re-unification and by the (re-)establishment of multidisciplinary public health by the end of the twentieth century. At the same time, a differentiation within the applied fields of social medicine into several thematic topics can be observed. These can be grouped in a first step into the domains of clinical social medicine, of social medicine for social insurance purposes and of a population-oriented social medicine. For social medicine as a scientific discipline within the broad context of medicine, the requirement of a context-adequate development, which encompasses the special methods of multidisciplinary public health, poses big challenges. For successfully meeting these challenges and going beyond population-oriented public health and for bridging the gap between the individual and the social medical institutions of the health system, it is indispensable for social medicine to be independent of other disciplines within the array of medical specialties. The present study argues for strengthening social medicine within the medical faculties. Chairs for social medicine and public health are not only in the interest of the applied fields of social medicine, but represent also an indispensable scientific discipline which can relate and contribute to all specialties of medicine.

[DGSMP - Interdisciplinarity to Advance Social Medicine and Prevention of Illness]. / DGSMP - Interdisziplinarität zur Förderung von Sozialmedizin und Prävention.

The German Society for Social Medicine and Prevention (DGSMP) refers back to a tradition of over more than 100 years, nevertheless having a critical look at it. As a scientific medical society the DGSMP promotes cross-sectoral configuration of contemporary social medicine to the benefit of both, general welfare and individual health in form of prevention, rehabilitation, re-integration, palliation and long-term care. Human medicine is the lead discipline in the interdisciplinary approach by the DGSMP in order to create - facing the dynamics in the health care system - professional prerequisites to maintain and update solidarity and equity in medical services on a scientific basis.