Health, Health Care and Social Welfare

This paper reviews the conceptualisation of social welfare in the health economics literature, and the contribution of health and health care to social welfare.     

Environmental Health Risks and Tradable Health Risk Permits

Health risk permits are suggested as an instrument for the systematic management of all health-relevant pollutants. These permits are denominated in statistical deaths due to pollution and have to be acquired by firms which emit pollutants inimical to health. They have two advantages: First, they guarantee that a clear decision about the acceptable number of statistical deaths due to pollution is made. Second, health risk permits are able to realize any level of health risk thus chosen in an efficient way. However, in practice some compromises have to be made: The health risk function relating emissions to health risk must employ some simplifying assumptions and complementary regulation is needed to make health risk permits feasible and acceptable. Furthermore, there are other aims of environmental policy besides the preservation of human health, such as climate control and conservation, for which health risk permits are of no use.     

基于卫生资源利用效率视角下的健康公平实现研究

面对卫生资源利用效率低下导致健康不公平的现实,从医疗资源利用效率角度运用数据包络分析方法,对我国31个省级行政区的卫生资源利用效率进行了比较分析。由各省份在技术效率、投入冗余和产出不足三个方面参差不齐的表现,提出了DEA非有效省份与DEA有效省份健康差距的缩小主要依赖于控制卫生机构规模、缩减不必要的资源配置、使卫生产出与需求保持平衡,并根据实际情况探索提高效率的途径,促进健康公平。     

The Role of the Health System in Health Biotechnology in Developing Countries

This paper examines the role of local health systems in developing countries in health biotechnology innovation. The heath systems encompass the final users of health biotechnology products and services. In innovation studies in general, users have been identified as playing vital roles as sources for innovation and in shaping the innovation process. It is therefore of interest to cast light upon the role of users in the health biotechnology innovation in developing countries. This paper briefly reviews literature on science and technology based health innovation in both industrialised and developing countries. It then examines to what extent the focus of developing countries is on their local health problems and explores the linkages between the organisations involved in research and development of health biotechnology products and services with the local health system, and thereby identifies the main roles of their own health systems in the innovation process. The paper bases this analysis on research on publication patterns and case studies on leading developing countries in health biotechnology and focuses particularly on health biotechnology development in Brazil, Cuba and India.     

健康性别不平等与政府卫生预算的社会性别分析

从社会性别的角度分析了我国不同性别之间的健康需求、预算配置和服务受益情况。(1)我国女性人口卫生服务需求高于男性,且经济欠发达地区女性卫生服务利用受到一定程度抑制;(2)性别问题并非当前预算体制下卫生预算分配的主要关注点,但目前已有促进两性平等利用卫生服务的实际行动和措施;(3)在当前公共卫生投入政策下,两性公共卫生服务受益差异不明显。(4)现有统计信息系统大多不归集分性别资料,尤其是预算数据,因此尚无法对政府卫生预算开展深入的性别分析。要推进性别预算观念和分性别统计工作,逐步建立和完善我国的性别预算框架和操作规范,将社会性别纳入健康政策主流,使健康政策和政府卫生预算增加社会性别公平。     

Housing and Health

Deprived housing is recognized as a source of poor health, but there is still little evidence of a causal relationship between housing and health. While existing literature identifies neighborhood effects and the individual dwelling as factors which affect health, it does not offer a joint examination of these factors. Moreover, endogeneity is a concern in analyses of both problems. Thus far, studies addressing endogeneity have done so through experimental design or instrumental variables. The first approach suffers from problems of external validity and the latter from the lack of reliable instruments. We therefore adopt an alternative strategy which considers both sources of endogeneity in order to identify the effects of housing on health by estimating fixed‐effect models. We reveal how housing problems affect health depending on living conditions and socioeconomic status. Our results therefore indicate that living in poor housing is an important short‐term socioeconomic determinant that directly affects health.     

生态系统健康评价

生态系统健康是人类赖以生成和发展的必要条件,生态系统健康科学深深植根于生物学,生态学,并与保护生物学,生态监测和景观生态学等领域密切相关,这些领域也与可持续发展有关,生态系统健康评价指标包括物理化学指标,生态学指标和社会经济指标,较小尺度徨态系统的评价更多采用生态学指标,大尺度生态系统健康的评价则注重整体性评价,最后,提出了生态系统健康恢复和维持的措施。     

积极组织行为学与组织健康

组织健康研究截至目前经历了3个阶段。受传统组织行为学的影响,对组织健康的研究多从消极取向开展,存在诸多弊端。积极心理学和积极组织行为学的兴起为组织健康研究提供了一种新的研究视角。本文将组织健康研究置于积极组织行为学的视野下,提出了组织健康研究的综合模型。     

Can Health Savings Accounts Reduce Health Spending? Evidence from China

Health care costs are high and continue to rise in most major economies, and the health savings account (HSA) is often viewed as an appealing way to contain health care costs because it can potentially solve the moral hazard spending caused by traditional health insurance. This study uses data from the China Household Finance Survey (CHFS) to empirically examine the effectiveness of HSAs in containing medical expenses and reducing moral hazard. The findings show that HSAs that restrict the use of funds may lead enrollees to discount the value and thus spend more on health care. In addition, the positive effect of HSAs on medical expenses is larger for the relatively healthier group, which may suggest that moral hazard exists regarding the use of HSA funds. The empirical estimates of the HSA effect on medical expenses are robust when a set of covariates are controlled, and HSA balances are instrumented using housing savings account balances.     

中国城乡老年健康及照料状况研究

人口老龄化背景下我国城乡的老年健康及老年照料问题日益严重。利用中国城乡老年人状况调查数据、全国残疾人抽样调查数据以及国家卫生服务利用调查数据,从两周患病率、慢性病患病率、残疾水平、自评健康以及健康预期寿命等方面分析了我国城乡老年人的健康状况,探讨了目前我国城乡老年人的照料提供来源。提出了人口老龄化趋势下提高老年健康水平,应对老年人口照料危机的政策建议。     

生态系统健康与农业可持续发展

生态系统健康已成为生态学一个热点研究领域,目前关于生态系统健康的概念很多,许多学者分别从不同的角度对生态系统健康概念进行了阐述。农业可持续发展和农业生态系统健康是同一层面的意思,一个健康的农业生态系统或者说一个可持续发展的农业体系应具有良好的生态环境、健康的农业生物、合理的时空结构、清洁的生产方式,以及具有适度的生物多样性和持续的农业生产力。文章论述了生态系统健康和农业可持续发展的内涵,提出了相应的评价指标体系,并指出研究生态系统健康和农业可持续发展还应该重视农业生态学的研究和应用。     

Health, Wealth, and Fairness

How much health should we have and how should it be distributed? This paper studies how to define social objectives for the allocation of health and income in a setting where individuals may differ in their preferences about health and consumption, earning ability, and health disposition. It is shown, on the basis of three simple ethical principles, that a reasonable social objective is to apply the maximin criterion to “full‐health equivalent” incomes. An application to the choice of the optimal health policy illustrates how this social objective may be used.     

Health subsidies,prevention and welfare

People value healthy ageing but may underinvest in health-improving preventive care. This arises when they ignore the beneficial effects of healthy ageing on public health expenditures and hence on the tax burden of future generations. This health externality justifies public intervention. We build an overlapping generations model with a government subsidizing investment in health by the young generation and paying the health care costs of the old generation. We find that the welfare-maximizing subsidy rate depends positively on the health externality and the size of health care costs, and negatively on the discount factor. The subsidy rate should therefore be high when prevention is cost-effective and when the population is careless about the future. Moreover, the welfare-maximizing subsidy rate is lower than the health-maximizing rate but higher than the capital-maximizing rate. This underlines the trade-off for a policy maker between health and economy.     

Health Policy and Equity of Health Care Financing in Australia: 1973–2010

Using data from Australian Taxation Statistics and Household Expenditure Surveys we analyze the distribution of health care financing in Australia over almost four decades. We compute Kakwani Progressivity indices for four sources of health care financing: general taxation, Medicare Levy payments, Medicare Levy Surcharge payments, and direct consumer payments, and estimate the effects of major policy changes on them. The results demonstrate that the first three of these sources of health care financing are progressive in Australia, while the distribution of direct payments is regressive. Surprisingly, we find that neither the introduction of Medicare in Australia in 1984 nor the Extended Medicare Safety Net in 2004 had significant effects on the progressivity of health care financing in Australia. By contrast, the Lifetime Cover scheme—introduced in 2000 to encourage people to buy and hold private health insurance—had a progressive effect on health care financing.     

维护公共健康期待公民的责任自觉

公共健康是一个群体性的健康问题。传染病、生活方式和环境卫生都是影响公共健康的重要因素。防止传染病的扩散和生活方式病的产生以及环境卫生的优化都需要公民的责任自觉。依靠公民的责任自觉可以尽量地减少人为因素造成的公共健康问题,这不仅可以提高所有公民的生活质量,而且无形中为政府节省大批的公共健康治理成本。从健康利益与责任的公平分配来看,公民的责任自觉是实现健康公平的一个重要途径。     

中国农村的收入差距与健康

随着收入差距的扩大,收入分配对健康和健康不平等的影响日益受到关注。本文利用中国健康营养调查(CHNS)1997年和2000年农村的面板数据回答两个问题:收入差距对健康的影响以及影响健康的方式;收入差距的扩大是否会导致健康不平等的加剧,尤其是低收入人群的健康是否受到更为不利的影响。研究发现,首先收入差距对健康的影响存在滞后效应;其次,收入差距对健康的影响呈现“倒U”型,在收入差距较高时,收入差距对健康的影响主要为负向的,一个可能的原因是收入差距影响到公共卫生设施的供给。再次,收入差距的扩大会加强收入效应,其含义是如果低收入人群的收入更容易受到负向冲击,那么收入差距对低收入人群的健康更为不利。     

Health insurance and lifestyles

This article contributes to the discussion surrounding the existence of ex ante moral hazard and propitious selection in a voluntary private health insurance scenario. Moreover, it provides an estimation of the determinants of lifestyle choices and of private health insurance demand. A multivariate probit is estimated for health insurance demand and lifestyle decisions to take into account the potential endogeneity of these decisions. The results indicate that there is evidence of ex ante moral hazard in deciding to do sports and eating healthy snacks. Hence, no propitious selection has been found for these decisions. Another relevant result shows that there is no individual heterogeneity for the lifestyle choices, except for smoking, and private health insurance choice. Evidence from the results also supports the idea that there are nonobservable variables playing a role in the lifestyle decisions. These results provide some directions for policymakers, such as the promotion of precautionary behaviours and the use of implicit lifestyle drivers to promote healthy choices by people.     

欧洲卫生技术评估网络发展概况

面对医疗技术更新、民众医疗服务需求提升和医疗投入有限等多重卫生系统压力,欧洲国家力图在其卫生政策制定、管理、报销或监管过程中利用卫生技术评估（Health Technology Assessment,HTA）方法,在充分进行医疗组织、经济、社会和伦理等方面论证的基础上,综合透明、科学和可靠的证据,确定卫生政策优先领域,推动卫生体系的健康可持续发展。欧洲在卫生技术评估方面的有益经验,对我国强化卫生技术评估理念和做法,支持卫生政策制定,具有积极的借鉴意义。     

全球健康外交:公共卫生全球化和现代外交发展的结合

全球健康外交是公共卫生全球化趋势和现代外交发展的结合点,是实现良好的全球健康治理的重要手段和渠道之一。介绍了全球健康外交的定义和发展进程,从发展、贸易、安全和外交四个方面分析了外交政策与健康的关系,健康已经成为外交政策的重要组成部分,国家对外交利益的重视可能会影响全球健康目标的实现。中国在SARS后更加积极地参与全球健康安全机制的建构,在全球、地区、双边层面参与健康外交。研究机构也积极参与全球合作,北京大学参加的国际研究型大学联盟加强了学术合作对政策形成的推动作用。要达到理想的全球健康外交目标还需要健康和外交政策的进一步融合。     

生态环境、经济收入与公众健康的关系——基于我国29个省市区面板数据的经验研究

公众的健康水平受到其所处自然和社会环境的共同影响,文章利用我国29个省市区的面板数据,构建了同时包含生态环境与经济收入因素的公众健康影响模型,检验了生态环境污染、治理状况以及经济收入、收入不均对人口健康的影响。研究结果表明,环境污染已经威胁到人们的健康,而污染治理投入能缓解污染的危害,同时收入公平性比绝对收入水平对健康影响更大。最后,在此基础上指出走人与自然协调、社会公平发展道路的重要意义。