Family Writing of Mainland China Women's Fictions in the 1990s

九○年代大陸女性作家的家族書寫在八○年代末的新寫實小說思潮、新歷史小說思潮以及西方女性主義文學思潮的相互激盪之下，延續新時期文學對「革命現實主義」的反叛姿態，在「追求自我」、「認識自我」的性別覺醒意識中重新審視女性的歷史，從而在「父子相繼」的傳統家族譜系之外，想像並打造「母女相連」的女性主體譜系，揭露「政治權力結構」和「性別權力結構」所暗含的偏斜與不公。對「政治權力結構」的批判是指文化大革命的「國家集體話語」對「個人自由」的限制與傷害，這部分藉由作者的敘事聲音、小說人物際遇以及承載特殊歷史意涵的意象來表現，對「性別權力結構」的反省主要在突顯父權秩序對女性的強制收編，因此塑造有別於血緣母親的代理母親、刻畫女性身體的各種造型，以及利用象徵性符號進而凝聚、團結女性們的精神力量。 本文所界定的女性家族書寫是指女性作家站在女性立場所書寫以女性為核心的家族故事，不僅積極嘗試改變、顛覆女性在父權歷史建構中的地位，並且能夠將「女性意識」、「家族敘事」和「歷史建構」融為一體，呈現女性歷史的發展過程和女性文化的演進形態，依此定義，本文選擇《玫瑰門》、《櫟樹的囚徒》和《羽蛇》作為研究分析對象，並且建立分析架構，分析架構包括「敘事面向的敘事時間、空間、視角、聲音分析」、「身體面向的女性人物主體性分析」、「文學面向的特殊意象分析」以及「史觀面向的陰性書寫策略分析」。《玫瑰門》展示的「演出型敘事模式」，用演員的登臺亮相、家具意象所潛藏的歷史象徵意義，以及「氣味」、「圖象」的感官陰性史觀，隱喻歷史的表演性質；《櫟樹的囚徒》呈現的「接力式敘事模式」，將歷史的詮釋權分配給不同世代的女性，隱喻歷史的傳承過程充滿著多元言說主體以及敘述的裂痕，因此「樹木」、「河流」、「眼睛」意象的源遠流長特質以及女性生死循環的陰性史觀，成為組織家族歷史最強而有力的書寫方式；《羽蛇》營造的「夢遊體敘事模式」，透過「羽蛇」這個實體人物和象徵符號在現實、夢境、幻境和家族歷史的自由轉換過程，「巨蚌」、「水晶燈」、「無字碑」等意象中無所不在的女性身體，以及「鮮血」和「白雪」相互抗衡的陰性史觀，投射出穿越時空的女性集體精神壓迫。 本文的研究侷限是對小說文本中的「男性人物」缺乏深刻關注，以及對小說文本的選取集中在五○年代出生作家群。研究展望是希望未來能進行「比較性研究」，交叉比較家族書寫作者和敘述內容所呈現的不同性別立場，展現更為多元的女性主體性，多向度比較家族書寫作者的社會身份以及文本中構成女性身份的各種因素，為社會學層面和心理學層面的女性研究提出貢獻，並且比較大陸和臺灣的女性作家家族書寫在不同的政治、社會環境下，開展出何種相異與相似的書寫面貌，讓女性作家的家族書寫版圖更加遼闊

Process evaluation of health system costing - Experience from CHSI study in India.

BACKGROUND:A national study, 'Costing of healthcare services in India' (CHSI) aimed at generating reliable healthcare cost estimates for health technology assessment and price-setting is being undertaken in India. CHSI sampled 52 public and 40 private hospitals in 13 states and used a mixed micro-costing approach. This paper aims to outline the process, challenges and critical lessons of cost data collection to feed methodological and quality improvement of data collection. METHODS:An exploratory survey with 3 components-an online semi-structured questionnaire, group discussion and review of monitoring data, was conducted amongst CHSI data collection teams. There were qualitative and quantitative components. Difficulty in obtaining individual data was rated on a Likert scale. RESULTS:Mean time taken to complete cost data collection in one department/speciality was 7.86(±0.51) months, majority of which was spent on data entry and data issues resolution. Data collection was most difficult for determination of equipment usage (mean difficulty score 6.59±0.52), consumables prices (6.09±0.58), equipment price(6.05±0.72), and furniture price(5.64±0.68). Human resources, drugs & consumables contributed to 78% of total cost and 31% of data collection time. However, furniture, overheads and equipment consumed 51% of time contributing only 9% of total cost. Seeking multiple permissions, absence of electronic records, multiple sources of data were key challenges causing delays. CONCLUSIONS:Micro-costing is time and resource intensive. Addressing key issues prior to data collection would ease the process of data collection, improve quality of estimates and aid priority setting. Electronic health records and availability of national cost data base would facilitate conducting costing studies

Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study

Objective: Expose the weak loops in the Chinese medical insurance coverage and uncover hospitals' role of over-pricing hospitalized insured patients compared with those non-insured. Methods: A multi-linear regression method was used to analyze hospitalization expense for insured and uninsured patients with uncomplicated acute appendicitis, cholecystitis, benign uterine tumors, and normal delivery. Results: Hospitalization cost is higher among insured than uninsured patients due to longer hospitalization lengths of stay, type of disease (highest among cholecystitis patients), type of gender - females, old-aged people, and type of marital status - singles, as well as drugs expenses, surgical expenses, and other medical acts. Conclusion: Require a better government's supervision system over medical insurance expenses such as reforming methods of payments, building up new cost compensation mechanism, and unifying and stabilizing prices for each category of medicines. Copyright © 2008 John Wiley & Sons, Ltd.