Funding and Providing Aged Care: Lessons from the Last Decade

This article examines the future funding of aged care in the context of the Intergenerational Report. Noting the predicted substantial increases in aged‐care costs, it argues that the current funding of aged care, which imposes high and likely rising co‐contributions on care recipients, should be replaced with comprehensive aged‐care insurance. It also recommends improving the transparency of the Intergenerational Report and the sophistication of its sensitivity testing.     

The Challenge of Obtaining Quality Care: Limited Consumer Sovereignty in Human Services

Abstract

This paper offers a conceptual analysis of the problem of quality in human services: in elementary school, psychiatric care, and the health and social care of children, the elderly, and the intellectually disabled. Geriatric nursing home patients are used as a case. These care recipients cannot enforce their legal right to quality service; their quality-effective demand is low. Formal economic analyses often characterize the weak position of the care recipient as an information asymmetry problem. An additional obstacle, however, is the recipient's inability to safeguard her personal interest due to physical, mental, or social incapacities; that is, “limited consumer sovereignty.” Incapacitated individuals cannot enforce quality even when quality information is available. This creates a fundamental incentive problem in the monitoring of quality. They also depend on services that are complex and non-verifiable, making external monitoring difficult. This paper presents a typology of measures to increase the quality pressure facing providers.     

Crossing the Great Divide: Ostrom’s Coproduction and the Economics of Aged Care

As the first woman to win the Nobel Prize in economics, Elinor Ostrom has attracted the interest of many feminist economists. Best known for her work on common pool resources, Ostrom made numerous theoretical and methodological contributions to economics, many of which are useful for feminist economists. This paper explores Ostrom’s work on coproduction: the active participation of individuals who receive a good or service in the production process. A particular focus is on how Ostrom’s model of coproduction might be applied and extended to capture the characteristics and circumstances of aged care. Data from interviews with women employed in Australia’s aged-care sector are used to inform a discussion of coproduction in aged care and the institutional supports necessary for successful outcomes. Key issues include the skills and resourcing of aged-care workers, and their authority to negotiate care practice with care recipients under current governance arrangements.     

管理医疗模式的影响差异——来自加州医疗救助的经验证据

国际上越来越多的健康保险(医疗保险)采用了管理医疗的方式,目的在于保证健康服务质量并节约成本。尽管该方式在控制成本方面的效果有目共睹,但对于其保证健康服务质量方面的评价则颇为困难。本文使用独特的大样本数据,利用美国加利福尼亚州医疗救助项目(美国最大的公共健康保险之一)从传统按次偿付方式到多种管理医疗模式的转变,来识别不同管理医疗模式对健康服务的使用及服务质量的影响。这对于我国公共健康保险制度(如新型农村合作医疗)的探讨具有一定的借鉴意义。     

NEW FORMS OF PROVIDER IN THE ENGLISH NATIONAL HEALTH SERVICE

ABSTRACT 1 : A wide ranging set of reforms is being introduced into the English National Health Service (NHS). They are designed to increase the market‐like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services. This paper is concerned with one aspect of those reforms: namely the policy to increase the diversity of types of providers of care to NHS patients. In this context, increasing diversity means that providers will not all be standard publicly owned NHS organizations. They can be publicly owned but autonomous, or independent (both in for‐profit and not for profit). The paper discusses the wide range of organizational forms available, analyzing their governance structures It then discusses the small amount of evidence currently available about the performance of diverse providers of health care.     

Delivering Public Health Care Services: Substitutes,Complements, or Both?

In this article we investigate how the availability of public health care providers increases (complement) or decreases (substitute) the likelihood of having public or private health insurance. The probability of each of three insurance alternatives (uninsured, Medicaid, private insurance) is modeled as a function of the availability of public programs in the respondents'community along with individual characteristics including family income, health status, and family structure. Using population-based estimates, public hospitals are associated with a crowd-out rate of 3.5 percent to 8.6 percent. Federally qualified health centers were associated with a net complementary effect (additional public insurance take-up) of 7.1 percent. (JEL I11 , I18 , I38 )     

医疗服务递送机制中主体利益关系及扭曲矫正——基于政府职能的视角

医疗服务递送机制中涉及到医疗服务机构、医生、药企和患者四方利益主体。当前我国这些利益主体之间种种不合理的利益"合作"与"冲突",均与医疗服务递送机制中政府职能的缺位和错位存在着直接关系。在进一步深化医改的过程中,我国政府应当正确地履行好理应承担的公共职能,即加强对卫生资源的合理规划与配置;加大对公立医院的财政投入并优化对其补偿机制;加强对医疗服务机构与药品行业的监管;加强医药信息披露机制建设;鼓励医药卫生服务市场公平竞争,并放弃不适当的医药价格管制。     

The Use and Cost of Child Care in Australia

The use and cost of child care have become important policy issues with rising labour force participation for women responsible for young children. In this article it is shown that for children aged less than 2 informal care is much more important than formal care. For children aged 3 to 5 by far the most important, and cheapest, form of formal care is preschool. The category of formal care which has expanded most rapidly is child care centre places. However the recent expansion of female employment has been effected with no rise in the share of formal care in the total. Publicly supplied child care centre places are over 40 per cent more expensive to produce than private ones. It is argued that for those who do not receive a fee relief subsidy public care is more expensive than private care. The inference is drawn that people are willing to pay more for public than private care because public care is of higher quality. However those buying this higher quality care pay (at most) only 80 per cent of the cost of producing the care. The shortage of care in the public sector is not solved by private sector expansion because users of care are not willing to pay the price of producing high quality care.     

Ex Post Welfare under Alternative Health Care Systems

The implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.     

ARE TELEVISION AND VIDEO GAMES REALLY HARMFUL FOR KIDS?

Are watching television (TV) and playing video games really harmful for children's development? By using a unique longitudinal dataset with detailed information on children's development and health, we examined the causal effect of hours of TV watched or of video games played on school‐aged children's problem behavior, orientation to school, and obesity. The results suggested that the answer to the question is yes, but the magnitude of the effect is sufficiently small to be considered as negligible. The results were robust to within‐twin‐fixed effects. (JEL I10, I20)     

山西农村老年照料的个案研究

利用"社会照料"的理论,通过对永济市农村老年照料模式的个案研究,从三个维度分析了农村老年照料传统模式的特点,指出了传统模式的优势和面临的挑战。     

中国老人医疗保障与医疗服务需求的实证分析

本文采用2005年中国老年健康长寿调查数据库(CLHLS)22省调查数据,建立了中国65岁以上老年人群的医疗服务需求模型,实证分析了医疗保障对老人医疗服务需求的影响。本文的主要结果如下:第一,医保制度对老人医疗服务的影响主要表现在提高就医程度,而非就医选择行为的改变,同时医保制度又明显地促进了老人及时就医率。第二,医保制度对减轻老人家庭医疗负担具有显著作用。第三,城镇医保和公费医疗所发挥的作用明显高于其他保险形式。本文的基本判断是,国家医保政策在改善中国老人医疗服务利用和减轻老人家庭医疗负担方面确实发挥了良好的积极作用,并且更多惠及了就医必要性更大的老年人群,从资源配置角度看是提高效率的。因此,进一步推进全民基本医疗保障制度的建设不仅是国家惠及全民的医改重任,也是中国医疗卫生应对老龄化挑战的有效选择。     

Bequests,gifts, and education: links between intergenerational transfers

We study the channels parents use to make transfers to their children. First, we focus on the relationship between investments in education and property transfers. Second, we turn to how property transfers are divided between inter vivos gifts and bequests. We use a Swedish dataset that is superior to previously used data as it contains information on both gifts and inheritances received from parents. We estimate models for the probabilities of having university education, receiving gifts, and receiving inheritances. In addition, we estimate models for gift and inheritance amounts. We find that the more resources parents have, the higher the likelihood of transfers, and that the correlation between receiving inter vivos gifts and inheritances is very high. Finally, women are more likely to have university education and to receive gifts, and daughters receive gifts of larger amounts than sons, although there are no differences in terms of inheritance.     

Who Dares to Care? (In the World of Finance)

This study argues that gendered barriers to care are limiting the progress of socially responsible investment (SRI). Anchored within the world of finance – an industry predicated on mathematical theorizing, neoclassical economic thought, and omission of relational values – the inclusion of environmental, social, and governance (ESG) reporting, a commonly used term for nonfinancial information in SRI, in investment decision making confronts several barriers. One such barrier concerns care: who cares for what, and where. In an environment where an atomistic-individualistic ontology dominates, and a relational-values ontology is omitted, the study investigates the possibilities for ESG to have a wider uptake. It considers the changes required to align the inherently relational aspect of care within a culture of economic reasoning reliant on the exclusion of care. It concludes with suggestions for how a relational caring perspective can be incorporated to accommodate and encourage SRI in the world of financial management.     

Informational lobbying and political contributions

Interest groups can potentially influence political decision-makers by offering contributions and by providing relevant information that sways the decision in the group's favor. What mix of these two instruments should an interest group choose, and how does the use of one instrument affect the effectiveness of the other? In this paper we identify an information externality that raises the cost of offering contributions and show that this indirect search cost reduces the group's incentive to gather information when contributions are allowed. Furthermore, we analyze how competition among lobby groups as providers of information and contributions affect the choice and effectiveness of the instruments. We show that the information externality rewards the group that can abstain from information search and focus its influence on contributions.     

Language,culture and institutions: Evidence from a new linguistic dataset

Kashima and Kashima's (1998) linguistic dataset has played a prominent role in the economics of culture, providing the instrumental variables used in two seminal works to identify the causal effect of culture on institutional quality. However, for economists, this dataset has a number of weaknesses, including poor overlap with a key cultural dataset and reliance on sources of linguistic information of uneven quality. We address these issues by constructing a new linguistic dataset based on an authoritative source of linguistic information, the World Atlas of Language Structures. The resulting dataset has greater overlap with key sources of cultural information, is arguably less subject to selection bias, and provides more refined information regarding key dimensions of linguistic variation. We show that the variables in this dataset are significantly correlated with commonly used measures of individualism and egalitarianism. In addition, we reexamine the key results from the literature on culture and institutions, showing the causal relationship between culture and institutions is robust to the use of the new linguistic instruments.     

Availability of Long‐term Care Facilities and Middle‐aged People's Labor Supply in Japan

This paper estimates the effect of the availability of long‐term care facilities in the prefecture or medical district where middle‐aged men and women reside on their labor supply. Prefecture‐ and medical district‐ level panel datasets of the capacity of long‐term care facilities are merged with individual level employment data, and each individual's employment status is regressed on the capacities of long‐term care facilities. I find no evidence for a positive impact of the long‐term care availability on labor supply, although the estimates are unstable in sign and not estimated precisely enough to draw any strong conclusions.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

Taxing Sin Goods and Subsidizing Health Care*

We study the taxation of sin goods in a two‐period, three‐good model. Individuals can buy health care to compensate for the damages caused by their earlier sin‐good consumption. Individuals are myopic and underestimate the effect of the sinful consumption on health; in their second period, they may acknowledge their mistake or persist in their error. We characterize and compare the first‐best and the (linear) second‐best taxes in these different settings. In particular, we examine how the results are affected by the way sin‐good consumption and health care interact in health production technology.