Making competition in health care work

Health care reform in the United States is on a collision course with economic reality. Most proposals focus on measures that will produce one-time cost savings by eliminating waste and inefficiency. But the right question to ask is how to achieve dramatic and sustained cost reductions over time. What will it take to foster entirely new approaches to disease prevention and treatment, whole new ways to deliver services, and more cost-effective facilities? The answer lies in the powerful lessons business has learned over the past two decades about the imperatives of competition. In industry after industry, the underlying dynamic is the same: competition compels companies to deliver constantly increasing value to customers. The fundamental driver of this continuous quality improvement and cost reduction is innovation. Without incentives to sustain innovation in health care, short-term cost savings will soon be overwhelmed by the desire to widen access, the growing health needs of an aging population, and the unwillingness of Americans to settle for anything less than the best treatments available. The misguided assumption underlying much of the debate about health care is that technology is the enemy. By assuming that technology drives up costs, reformers neglect the central importance of innovation or, worse yet, attempt to slow its pace. In fact, innovation, driven by rigorous competition, is the key to successful reform.     

论美国专利与竞争政策平衡的措施

美国政府追求专利与竞争政策的平衡是从20世纪80年代开始的。通过对"经贸危机"进行深刻反思,美国政府认识到之所以国内技术研发死气沉沉,是当时的专利和竞争政策对发明人保护不力使然,于是改革了专利政策、反垄断政策及税收政策,使得合作研发热情空前高涨,专利数量大幅上升,应用技术发展突飞猛进,美国综合国力快速增强。但是,美国政府所做的政策改革,在若干年后却导致了"专利灌木丛"现象的出现,其结果同样是造成了不公平竞争,对经济发展造成阻碍。     

Global trade and the future of national health care reform

As a result of economic globalization, health care reform is no longer strictly a matter of domestic health policy and politics. This paper argues that international trade agreements impose institutional constraints on governments’ abilities to implement health care reform, and, if left unchallenged, could frustrate social reforms. The thesis is developed through three case studies that examine the implications of various trade agreements for health care reform in the United States, Canada, and Australia. The findings are discussed in the context of theoretical debates concerning the impact of globalization on the autonomy of nation states and the relevance of national politics.     

Consumer-centered vs. job-centered health insurance

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.     

对法国和中国会计新制度的比较分析

本文通过对法国和中国会计制度的比较分析 ,论证了会计制度的形成受制于特定的社会经济条件。基本经济条件的变化会引起制度创新的必要。中国的发展中大国的特点决定了其会计制度改革必须立足于本国的条件 ,过于偏离这些条件可能会额外地增加改革的成本。在吸取先进国家经验方面 ,现阶段应更多地借鉴“欧洲大陆模式”而不是“英美模式” ,因为中国的社会经济条件与前者更为接近     

Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.     

Perspectives Articles: Exploring Stakeholder Perspectives on What Is Affordable Health Care

Health care expenditures have accounted for increasing proportions of the U.S. gross domestic product, and the rate of growth of health care expenditures has increased over the past two decades. These two measures of assessing whether the level of health care expenditures is affordable may be appropriate in the aggregate for the United States but are not appropriate to assess whether individual stakeholder groups can afford their particular level of spending on health care. Health care is an economic good that differs from other economic goods, as it involves life and death issues, and invokes a call for a moral authority. This article explores definitions of what is affordable health care from the perspective of different stakeholders and suggests that other measures are needed to assess whether or not health care is affordable for stakeholders as one definition is not appropriate for all stakeholders.     

Health care fraud: a primer on the schemes and the tools to fight health care fraud

As the national debate over health care reform moves forward, one issue with which policy makers must grapple is the percentage of health care dollars lost to fraud and abuse. The General Accounting Office estimates that as much as ten percent of total health care dollars are lost to the inappropriate, and in some cases criminal, practices of health care providers. This article discusses the characteristics of the health care industry that make it particularly susceptible to abuse and then reviews the efforts by the Office of Inspector General, Department of Health and Human Services, to deter and punish those who defraud the federal health care programs.     

中美所得税改革取向的差异

本文认为,中国、美国截然相反的消费和储蓄经济结构,决定了两国所得税改革的政策取向不同。美国实行消费型的联邦所得税改革符合其低储蓄、高消费的经济现状,而我国高储蓄、高投资、低消费的经济结构,决定了我国应实行储蓄型或投资型税制改革,我国所得税的改革应更多地鼓励消费而不是储蓄或投资。     

Potential “Savings” of Medicare: The Analysis of Medicare Advantage and Accountable Care Organizations

Medicare faces significant financial challenges because of rising health care costs. In response, Medicare reform efforts have been testing various payment and service delivery models, including accountable care organizations (ACOs), aiming to reduce expenditures while preserving or enhancing the coordination of quality care. The idea behind ACOs is to form an organizational network to coordinate all care for Medicare beneficiaries and in so doing, at least theoretically, improve quality of care and hopefully reduce medical costs. The purpose of this research is to apply Data Envelopment Analysis (DEA) to assess the potential savings of Medicare obtainable through optimally efficient implementation of ACOs and Medicare Advantage plans. DEA comparisons across plans achieve this purpose by identifying which Medicare plans operate relatively more efficiently and which are inefficient, and additionally, for inefficient plans, the DEA analysis generates target levels of “inputs” and “outputs” required to bring the plan into efficient operation. Knowing sources of inefficiency can also provide insights into Medicare reform, such as Medicare privatization and innovation models. Our results show that Medicare Advantage plans are more efficient in reducing health expenditures but incur higher administrative costs. Health expenditure savings can also be achievable by promoting government-sponsored managed Medicare such as ACOs. Finally, compared to the profit efficiency of Medicaid managed care plans, Medicare Advantage should have the potential for more Medicare market penetration from the supply (insurer) side.     

"特朗普税改政策"的溢出效应及中国的应对策略

特朗普税改使美国成为税收洼地,各国为争夺国际资本竞相效仿降税,加剧了全球税收竞争,为世界经济复苏增加了更多的不确定性.因此,有必要通过构建利润转移视角的税收竞争模型,揭示特朗普税改对全球经济产生溢出效应的作用机制及赤字约束问题,并运用一般均衡模型(CGE)模拟特朗普税改对世界经济溢出效应的长短期影响.特朗普税改是以邻为壑的经济政策,但长期内对中国等世界主要经济体的负面影响不断减弱,并会对出口产生一定的正面影响.因此,我国应构建国际税务交互管理体制,强化企业税收激励的法制保障,完善税改冲击的应急运行机制.     

Formal and Informal Regulation of Industrial Pollution: Comparative Evidence from Indonesia and the United States

Economic theory and recent empirical work suggest that whenformal regulation of pollution is absent or less than 100 percenteffective, affected communities are often able to negotiateabatement from plants in their vicinity through "informal regulation."Using a model of equilibrium pollution, this article confirmsthe existence of significant informal regulation for unregulatedpollutants in both Indonesia and the United States as well asfor regulated pollutants in the United States. Combining plant-leveldata with community data in both countries, regressions revealthat even after controlling for traditional economic variablessuch as output levels and input prices as well as for plantcharacteristics such as industrial sector and age, the per capitaincome of affected communities significantly affects pollutionintensities. Higher-income communities win significantly loweremissions in both countries and for both unregulated and regulatedpollutants in the United States, presumably because income affectsboth preferences for environmental quality and the ability tobring pressure on polluting factories.     

当前美国经济综合风险分析

当前,美国经济正面临三大风险的威胁,这三大风险分别是巨额的"双赤字"及持续增长的债务、能源价格的大幅波动、愈演愈烈的次级债务危机。这些风险将会给美国经济带来很大的负面影响。更为严重的是,这三大风险相互交织在一起,相互作用、相互加强,将对美国经济造成系统性的冲击。2008年美国经济很可能出现相当程度的经济衰退,较长时间的调整是不可避免的。     

发达国家科技型中小企业技术创新的经验与启示

创新是一个民族进步的灵魂,科技型中小企业技术创新能力的提高对增强市场竞争力和国民经济可持续发展都具有十分重要的作用。美国、日本、德国科技型中小企业发展的历史较长,积累了较为丰富的技术创新经验,学习和借鉴对我国科技型中小企业技术创新具有较高的指导意义。文章总结分析了美国、日本、德国科技型中小企业技术创新的经验,并得出健全法律法规体系、加强财政金融支持、完善社会服务体系、构建技术人才激励模式的启示。     

Fledgling firms offer hope on health costs

Julia Adler-Milstein and Ashish Jha Regional health information organizations--RHIOs--are springing up in the United States to meet a vital need: to connect the nation's disparate patient-health information systems. If RHIOs can find a viable business model, they stand to improve the quality and decrease the cost of U.S. health care dramatically.     

美国金融业专利战略研究及启示

美国1998年State Street Bank案的判决对商业方法软件专利保护态度的转变,使得商业方法软件专利成为金融业参与市场竞争和促进金融创新的重要武器。本文在分析了美国金融专利背景及现状的基础上,通过案例分析,剖析了一些与金融商业方法软件专利密切相关的专利战略模式,以期为我国金融企业运用专利战略增强竞争能力提供借鉴。     

Health care spending accounts: a flexible solution for Canadian employers

Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.     

国家数字化战略的国际比较及启示

本文探讨了国家数字化战略对于驱动创新、促进改革和管理风险的意义。通过借 鉴美国、德国和英国的数字化战略的政策与实践,提出了我国推动数字化战略的四点启示：一 是加强基础设施与平台建设;二是发展数字技术和数字产业;三是加强人才培养和数字教育; 四是保护数据安全和个人隐私。     

FINANCING SATELLITE OUTPATIENT CARE IN RURAL HOSPITALS

Providing health care to low income or elderly residents of rural areas remains a serious national health care problem in the United States. This case study evaluates an intervention for primary outpatient care to a particular class of patients – veterans – and shows how it can benefit them. Locating the outpatient clinic in a struggling rural hospital makes an outreach by the urban veterans hospital financially feasible and is profitable for the rural hospital.