借鉴“管理式医疗”机制,破解医疗体制改革困局

美国的"管理式医疗"机制在全球医疗保障领域独树一帜。"管理式医疗"的实质,在于医保机构从游离于医患关系之外的被动赔付者转变为介入医患关系之间的"第三方",通过一体化医疗服务网络、预期付费制度、医疗服务管理、健康管理等契约安排或管理手段,克服医患关系中的市场失灵,解决医疗费用和质量问题。要破解医疗体制改革的困局,从根本上缓解"看病贵、看病难"问题,我国需要在明确医保部门、卫生部门和医疗机构的分工定位,加强人才、软件、硬件三个方面的基础设施建设的基础上,借鉴"管理式医疗"的先进经验,完善医疗保障运行机制。     

我国医疗服务监管体制漏洞及对策分析

目前医疗改革的步伐与日益增长的多元化医疗服务需求之间仍然存在很大差距,广大人民群众“看病难、看病贵”的问题十分突出,医患之间的矛盾与冲突也日益加剧.我国医疗系统存在的诸多问题,与我国医疗服务监管体制不完善有直接关系.本文分析了医疗服务监管的必要性,并结合中国的具体国情,提出了几点改进意见.     

我国医疗服务价格改革的倒逼机制研究

医疗服务价格改革是我国医疗体制改革的核心,也是解决“看病贵,看病难”问题的切入点和突破口.本文通过梳理中国医疗服务价格现状,发现由医疗信息不对称,医改政策扭曲以及支付制度落后等问题形成的倒逼机制是医疗服务价格改革裹足不前的症结所在.因此,为了推动医疗服务价格市场化,必须进一步建立医药分开的药品流通渠道,引入第三方进行监管,促进医疗信息公开透明,才能从源头上拜托摆脱倒逼机制带来的医疗服务价格改革困境.     

“看病难和看病贵”经济学分析及对策

目前我国城乡居民仍然存在看病难和看病贵的问题,产生这个问题的经济学原因主要有:医疗资源总量供给不足,而且资源的配置极不合理;医疗需求和供给缺乏弹性;医患之间的信息不对称等。在分析原因的基础上提出了相关的政策建议。     

医院单病种结算中存在的问题及解决建议

"看病难、看病贵"是一直以来困扰广大人民群众的一大难题。随着医疗保险制度在社会的全面铺开,更多的人享受到了国家给予的优惠政策。电话预约、网上预约等措施有效解决了看病难的问题。看病难解决了,但如何解决看病贵的问题就成为医患之间新的矛盾焦点。为了控制日益增长的医疗费用,寻求一种合理的控制办法,单病种付费方式成为医院的首选。     

论医院开展成本核算的重要性

"看病贵,看病难"已成为当今社会普遍关注的热门话题,也成为引发医患纠纷的主要原因之一.医院要缓解医患之间的这一矛盾,除了要不断提高自身医疗技术水平,更重要的是医院要认识到成本核算的重要性,从成本核算着手,通过控制医疗成本降低病人医疗费用.本文从成本核算的现状与问题入手,阐述了医院开展成本核算的重要性,并对完善医院成本核算的基本措施提出了几点建议.     

高科技企业的资本构成及其治理结构：一个基于资产专用性理论的分析框架

在不同的企业合约关系中,人力资本与非人力资本之间存在着多元化的组合,这直接造成两者在企业合约中谈判力的不同,从而影响企业中控制权和剩余索取权的分布。与传统企业相比,高科技企业具有不同的人力资本和非人力资本组合模式和治理结构演进路径,这可以解释为什么高科技企业可以在很大程度上克服了传统企业经营要面对的道德风险与逆向选择问题。     

不对称信息下医患间的博弈经济学研究

近年来,随着医疗卫生服务领域的改革,以医疗服务为核心的相关利益集团之间正发生着深刻的变化.尽管改革的总体趋势是朝着好的方向发展,但有些问题却需要引起足够的重视.譬如"医疗纠纷的数量不断增多"、"患者对医生的不信任感愈来愈强"等现象,正在严重破坏医生的形象和医患之间的关系.文章将主要围绕医生与患者之间的利益关系,运用博弈论和信息经济学的理论和方法对就医过程进行分析,主要论述信息不对称条件下相关信号在医生向患者传递过程中的作用.     

刍议“看病难、看病贵”

缓解"看病难、看病贵",实现病有所医,是构建和谐社会的重大课题之一。思考"看病难、看病贵"的形成原因和解决对策,是为了逐步解决"看病难、看病贵"问题。形成"看病难、看病贵"既有医德、医价、药价和不当的检查费用等直接原因,也有医疗卫生管理中政府社会职能的缺失等间接原因。因此,只有从医疗环境、政府职能和观念制度等方面实行系统治理,保障公民健康权,才能从根本上缓解"看病难、看病贵"。今鉴于此,为了有针对性地破解"看病难、看病贵"难题,对"看病难、看病贵"的主要影响因素进行了分析。     

医疗体制改革应防止过度市场化

中国医疗服务体制改革走过了艰难而曲折的道路,目前到了攻坚阶段。由于医疗服务具有外部经济性、信息不对称性、垄断性和需求刚性等经济学特征,所以医疗服务体制改革不能完全以市场化为导向,而是要防止过度市场化。要以政府为主导,充分利用市场机制的积极作用,通过投资主体多元化的途径,加强医疗服务供给体系建设,以打破垄断为重点,加强医疗服务监管体系建设,构建新的医护人员激励机制,促进医疗服务水平的提高,以提升医疗服务的可及性,从根本上解决"看病难,看病贵"的问题。     

新医改背景下我国药品流通产业集中度提升的路径探讨

当前新医改已进入关键攻坚时期,整顿药品流通秩序、规范经营主体行为、降低药品价格是新医改的重要内容。但我国药品流通产业集中度偏低的局面依然严重影响着市场流通秩序、行业利润和药品价格。依据"推-拉理论",我国政府应该在宏观层面和中观层面实施积极的经济政策,形成一种推力促进行业的快速整合;大型流通企业应该通过技术、规模、资金、品牌等优势形成一种拉力来加快兼并收购或结成战略联盟,进而来提升药品流通产业的集中度。提升药品流通产业集中度对促进医改有促进作用。     

Price Indexes for US Medical Care Spending, 1980–2006

We construct price indexes for medical care spending in the US economy for the period 1980–2006. Our indexes show slower price growth than the official deflator from 1987–2001, consistent with the fact that indexes that improve on the official statistics typically find slower price growth than the official indexes. However, the result is reversed for the 2001–2006 time period. We develop a decomposition that parses out the numerical differences in these indexes into three factors that are held constant in the official price indexes but are not in our indexes: changes in the type of provider supplying care, changes in the type of insurance plan used by the patients, and changes in the bundle of procedures used to treat patients. Our results suggest that using the official price measures may provide misleading conclusions about spending trends and productivity growth in this important sector over this time period.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

Price dispersion in the private health insurance industry: The case of Catalonia

This paper presents a vertical and horizontal product differentiation model that explains price dispersion among different kinds of health care insurance firms. Our model shows large insurance firms engaging in price competition with small mutual organizations that serve only a local area and charge lower premiums. We found that, although the market allows the entry of an excessive number of firms, the presence of local insurance companies increases social welfare by increasing the range of products available to consumers. Our conclusions are applicable to OECD countries in general although we rely on Catalonia's data.     

医疗卫生产业化改革研究综述

看病难、看病贵在全国范围内是一个普遍存在的问题,深化医疗卫生体制改革是解决该问题的重要途径之一。然而,医改是世界难题。2005年,国务院作出了中国医改基本不成功的结论。学术界和实业界有关人士把前一阶段医改的失败归因于＂过度市场化＂,新医改方案也特别强调政府的作用。而由于一直以来,理论界对于＂市场化＂和＂产业化＂均没有形成统一的概念和认识,二者经常被混淆,因此目前医疗卫生产业化的提法显得相当谨慎。该研究系统分析了市场与产业的区别,在此基础上明确市场化与产业化的本质差别;对医疗卫生产业化的内涵进行了综述和界定,对医疗卫生是否应该产业化的正反两方观点进行总结和评析,提出在当前国情下,医疗卫生应该继续走产业化改革和发展之路,并着重讨论了医疗卫生产业化发展的背景和意义、遇到的困难障碍及应对思路。     

中国医疗服务市场中的信息不对称程度测算

本文构建了一个医疗服务市场上信息不对称程度的测度模型,并基于"中国健康与营养调查"(CHNS)中微观个体调查数据,对医疗服务市场上医患双方的信息程度及其对最终的医疗服务价格的影响效应进行了实证测度。研究结果表明:(1)医患双方所掌握的信息因素对最终医疗服务价格的形成具有重要影响,同时医生相对于患者掌握着更多的信息并具有更强的议价能力;(2)几乎所有的患者都将被迫接受一个高于公正基准价格的价格,平均而言达成的医疗服务价格相对于公正的基准价格要高出26.61%;(3)年度效应分析发现,1989—2006年,各年度的医疗服务市场价格大致都高于公正基准价格26%左右,换言之,改革开放以来中国的医疗服务体制改革,并未有效起到解决"看病难、看病贵"的作用;(4)患者在城乡因素、医疗保险、工作状况、年龄以及受教育程度等因素上的异质性,对医患双方最终价格的作用是有限的。本文的政策含义是:强调通过引进竞争,强化市场机制在医疗服务市场中调节作用的改革思路,是否适合中国值得反思。解决现实中普遍存在的医疗服务价格虚高问题,回归医疗服务的公益性,需要政府更多地参与其中,并有效发挥价格规制、市场监管以及外部性矫正等功能。     

货币供应与通货膨胀的动态关系研究

本文通过实证研究发现,货币供应量的冲击无法有效解释我国通货膨胀现象,超额的货币供应并不是影响我国通胀的重要原因,而居民对物价水平的预期却能解释未来通货膨胀的变化。因此,从通货膨胀治理的角度来说,调整货币供应抑制通货膨胀的作用非常有限,而通货膨胀预期管理也许更能起到平抑通货膨胀的作用。     

Price and quantity in international comparisons of health care expenditure

An important omission from earlier cross-national comparisons of health care expenditure has been the failure to distinguish between price and quantity. Using recent data on purchasing power parities, the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 OECD countries. The article concludes that, contrary to what has been suggested in some recent articles, the relative price of health care is not correlated to the aggregate per capita income. The fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity. The relative price of health care has a rationing effect on the quantity of health care that is offered, with a price alasticity close to minus one. The latter finding means that the health care expenditure is not greater in countries with higherprices. Furthermore, the differences in health care expenditure or quantity between countries persist after correction for the relative price and the income level. Part of these differences can be explained by differences in the definition of health care in the various countries.     

Effects of the Reform of the Social Medical Insurance System in Japan

We estimate outpatient medical care demand functions and examine the effects of the 1997 reform of the medical insurance system. We focus on the issue of which persons have been most affected by the reform and on the extent to which price elasticities have changed since the reform. The estimation results show that the reform affected mainly dependants' demand for medical care, which implies that all members of the household shared the increase in the medical costs of the head of the household. Price elasticities ranged from −0.18 to −0.26 before the reform, and from −0.08 to −0.11 after the reform.
JEL Classification Numbers: C35, I10, I18.