声誉能解决医疗保险的“双刃剑”难题吗？——来自实验的证据

医疗保险虽然有利于提高医疗卫生服务的可及性和公平性，但也滋生了严重的道德风险问题。文章基于医疗服务的信任品属性，利用实验方法刻画了商业保险和社会保险两种保险形式，并通过对比私人信息和公开信息探究了加强声誉建设对解决医疗保险“双刃剑”难题的作用。实验结果表明，首先，商业保险和社会保险均会导致医患双方的道德风险问题，且商业保险更严重。其次，声誉加强有利于缓解保险的道德风险，其作用机制在不同保险条件下有所不同。在商业保险条件下，声誉通过弥补患者的信息劣势，加大了对医生欺骗行为的约束；而在社会保险条件下，声誉在提振患者对市场的初始信心的同时，降低了患者因保险依赖而盲目交易的可能性。最后，综合医疗市场的经济效益和社会效益来看，公开信息商业保险和公开信息社会保险是两种相对高效的政策组合。     

新农合道德风险与逆选择及其规避研究

道德风险和逆选择并不是医疗保险中特有的现象,它们在任何商业保险和社会保险中都存在,但在医疗保险中更为严重。在新农合中,由于农民有自愿投保的选择权而保险机构却没有拒保权,面对的又是处于艰难生存环境的农村卫生机构,其道德风险和逆选择现象要严重得多,如果不能处理好新农合中道德风险和逆选择问题,将可能导致新农合的市场萎缩与效率的下降。本文就是在研究新农合中逆选择与道德风险生成机理的基础上,提出一些规避措施,为新农合的长期可持续发展奠定微观制度基础。     

Health-Specific Moral Hazard Effects

In this paper I examine the effect of insurance on the demand for health care among consumers of similar health, which I call the health-specific moral hazard effect. Using the 2000 Medical Expenditure Panel Survey, I analyze the variation in the moral hazard effect across health subpopulations in the demand for inpatient and outpatient services. The endogeneity of insurance, the change of insurance regime, and the discreteness and the nonnegativity of the use of health care motivate the use of an endogenous switching model for count data. The econometric results indicate that the moral hazard effect for physician visits is higher at relatively higher levels of health, whereas the effect for both hospital nights and hospital admissions is lower at relatively higher levels of health. The evidence suggests that both efficient and inefficient moral hazard may exist, and this may depend on the type of health care service used.     

社会医疗保险中的道德风险及对策分析

文章分析了社会医疗保险中道德风险问题的表现形式:来自参保人员的道德风险,来自医疗机构的道德风险,包括医患合谋、信息不对称、医疗消费的特殊性,我国目前社会医疗保险制度的漏洞等问题,并提出了防范社会医疗保险中道德风险问题产生的对策。     

Tax Deductions for Losses and Equilibrium in Competitive Insurance Markets

This paper examines how tax deductions related to uninsured personal losses may be Pareto-improving if there are inefficiencies in insurance markets in the context of adverse selection by including individuals with different risk types. In the absence of moral hazard, we provide a positive view of loss deduction policies by showing that they more easily reach a separating equilibrium than does the free market in the Rothschild and Stiglitz equilibrium concept.     

社会医疗保险中的道德风险及对策分析

文章分析了社会医疗保险中道德风险问题的表现形式:来自参保人员的道德风险,来自医疗机构的道德风险,包括医患合谋、信息不对称、医疗消费的特殊性,我国目前社会医疗保险制度的漏洞等问题,并提出了防范社会医疗保险中道德风险问题产生的对策。     

我国保险公司偿付能力影响因素研究

保险公司的偿付能力是理论界、监管机构和保险业内关注的问题,该研究使用2007-2012年975家保险公司的数据,对我国保险公司的偿付能力及影响因素进行了理论分析和实证分析,并利用各种影响因素来解释保险公司偿付能力差别的原因。研究发现,保费增长率、赔付比率同企业偿付能力负相关,保费收入比重、资产净利率和准备金提取率同偿付能力正相关。论文拓展了对偿付能力的研究,并在改变保险公司发展模式和提高保险公司的产品结构,提高保险公司偿付能力等方面提出了相应的政策建议。     

隐性存款保险向显性存款保险转变对银行道德风险的影响

目前我国没有建立显性的存款保险制度，但存在着对存款人的隐陛保护。本文通过严格的模型证明了当银行特许权价值低、显性存款保险制度的可信性高，被保险存款占负债总额的比例高时，从隐性存款保险向显性存款保险转变有助于降低银行的道德风险。在此基础上．结合我国国情论证了合理的显性存款保险制度有助于降低银行的道德风险。     

医疗保险的福利效应

本文考察在完全信息的市场经济条件下,医疗保险的进入对于社会总福利的影响。分析表明,保险公司的进入可能使得消费者为医疗服务付出更高的代价,但是会提高医院的利润,总的来说保险公司的进入会提升社会总福利。本文还发现,由于保险公司未考虑其合约设计对医院利润的影响,市场均衡的医疗保险水平仍低于社会最优水平。这些结论有助于澄清相关文献对医疗保险的一些负面看法。     

基于存款保险制度视角下的道德风险问题研究

众所周知,现代银行作为一个企业,具有与一般意义上的企业同样的因经营不善或其它原因而导致的破产倒闭的可能性,尤其是在金融危机频发的当代。那么,当银行破产倒闭时,储户或者说存款人的存款由谁来负责赔偿就成为一个问题。如果这个问题解决不好,极有可能引发社会的不稳定。基于上述考虑,存款保险制度应运而生,在一定程度上,存款保险制度不仅保护了存款人的利益,而且维护了金融体系乃至整个社会的稳定。但任何制度在实际运行中都无一例外地表现出两重性。存款保险制度也不例外。从实际运行情况来看,其存在着很大的缺陷,其中尤以各方的道德风险行为最为突出。基于此,本文着眼于存款保险制度下的道德风险问题,主要分三部分,第一部分是一个简单的引言;第二部分分别从存款人和投保银行的角度对其进行分析;第三部分在分析的基础上,提出防范道德风险的几个措施,以供参考;最后,对全文进行简要总结。     

The impact of safety regulations on externalities

Empirical analyses of product safety regulations have indicated that such regulations induce compensating behavior (also known as offsetting behavior) by the users of products that pose risks to their health. Many of these analyses conclude that such compensating behavior causes externalities to rise. In such cases, regulations reduce the loss suffered by the user of the good when a harmful event occurs, encouraging a moral hazard response which creates externalities for others. Other studies find that although compensating behavior mitigates the beneficial impact of safety regulations, such externalities do not rise. This paper presents a model suggesting that although compensating behavior always occurs in response to product safety regulations, a dichotomy exists wherein regulations engineered to reduce the typical loss suffered by individuals per accident (or loss event) will increase externalities, while regulations engineered to reduce the number of accidents (or loss events) will reduce externalities.     

信息不对称与债券担保——基于中国债券市场的检验

担保是解决债券市场上信息不对称的有效机制。逆向选择理论强调担保能够缓解事前信息不对称;道德风险理论则强调担保有助于解决事后信息不对称。两种理论对于债务人风险程度与采取担保的可能性、担保与债务利率之间的关系给出不同的预测。文章以2008-2015年间中国债券市场的实际数据为样本对以上两类理论进行实证检验。在解决可能存在的内生性问题后,研究发现,债券发行人风险越高,越有可能采取担保;在控制其它因素的情况下,相较于同一债券信用评级的无担保债券,担保债券具有较高的发行利差。研究结果表明道德风险理论能够很好地解释我国债券发行人的担保行为。     

On the Cutting Edge between Policy and Academia: Challenges for Public Economists

In surveying the literature on privatization and social insurance, this paper identifies two major trade-offs. The first trade-off, which applies mainly to the choice between private and public governance, is flexibility versus commitment. The other trade-off, which bedevils the design of social insurance, is that of moral hazard versus adverse selection. After stressing the relevance of bounded rationality for understanding actual public policymaking, the paper turns to the importance of non-government, non-commercial institutions in facilitating social coordination. Finally, the paper addresses the role of economists in formulating public policy.     

农村住院医疗保险制度分析——以江阴为例

With the introduction of the household contract responsibility system, the traditionat rurat cooperative medical service has declined rapidly in terms of its coverage, reaching the lowest level at present. The operation of the medical service with funds raised by the city government and commercial insurance in Jiangyin has provided a new line of thought. This model has not only better solved the difficult problems of fund raising and service equity in the rural medical insurance, but also helped to alleviate serious problems of adverse selection and moral hazards -widely present in commercial medical insurance. It is also that extending such a model to other regions without regard to local conditions is dangerous.     

A Political Economy Model of Health Insurance Policy

This paper aims to explain the divergent path of U.S. health policy from other high-income countries. The paper develops a general framework of interest group politics to study how the organization of industry can shape health insurance coverage and greater public involvement in health insurance. Large firms face a higher degree of unionization and provide more health coverage for employees than small firms. Consequently, large firms favor the adoption of a policy of universal health care coverage as a means of divesting health care costs to the public sector. Public aversion to higher taxation counterbalances this effect.     

Gatekeeper incentives and demand inducement: An empirical analysis of care managers in the Japanese long-term care insurance program

This study analyzes the incentives and supplier-induced demand of care managers, who are intermediaries between consumers and service providers in the Japanese social insurance program for long-term care. Care managers can be considered as pure gatekeepers, in that their function is limited to referral people to specialists and they themselves do not provide care. Care managers are rewarded by capitation, which is considered as a cost-effective payment mechanism for insurers. However, many care managers actually work for firms that also operate as service providers. Service providers are rewarded by a fee-for-service payment and can have a motivation to induce excess consumer demand. The violation of the neutrality of care managers might result in a financial burden on social insurance. In this study, we empirically test whether there is a positive correlation between care manager density and care costs, which might imply the existence of supplier-induced demand. Our results show a positive correlation, particularly in the case of care managers who work for firms that jointly operate in service provision sectors. Based on these results, we conduct a quantitative analysis, and show that the demand induced by care managers might produce a considerable financial burden on social insurance.     

How is Fintech reshaping the traditional financial markets? New evidence from InsurTech and insurance sectors in China

We examine the effect of Fintech on the market structure of traditional financial markets, and focus particularly on InsurTech and the insurance sector. We find that InsurTech has significantly reduced the non-life insurance sector's market concentration but plays a limited role in the life insurance sector's market structure. The results are not driven by potential reverse causality and remain unchanged when we employ an instrumental variables approach and use an alternative supply-side InsurTech index. We further explore the underlying mechanisms and find that, instead of competing directly with insurance companies, Fintech companies provide insurance technologies to traditional insurers and help them lower entry barriers and reduce operating costs. Our paper sheds light on how InsurTech is reshaping traditional insurance sectors, and the results are generalizable to Fintech and financial markets.     

A crumbling legacy: The decline of African American insurance companies in contemporary America

African American insurance companies, since the 1960s, have experienced a significant decline in their profitability and stature. Because of recent racial desegregation, which in an economic sense consists of white-controlled businesses and black consumers increasing their interaction with each other, black insurers are waging an increasingly difficult struggle to survive. It appears the only way African American insurance companies can counteract this disturbing trend is to voluntarily merge into one “mega” company. Such a maneuver would empower consolidated black insurers to better serve African American consumers and to make definitive inroads in cultivating the burgeoning African consumer market.     

An economic evaluation of area yield insurance for small-scale cane growers

In the past, crop insurance schemes have based indemnity payments on individual producers' yields. Insurance of individual yields does not cope efficiently with systemic risk and therefore fails in areas where crop yields are correlated across space. Area yield insurance provides an alternative and eliminates the problems of moral hazard and adverse selection associated with individual yield insurance. Area yield insurance therefore effectively copes with systemic risk. In this study, principles of area yield insurance were applied to yield data on small-scale cane growers in KwaZulu-Natal and used to calculate pure premium rates. The viability of a government-subsidised area yield insurance scheme for small-scale cane farmers was assessed in terms of affordability to the government, the farmers and private insurance companies. The empirical results obtained from this study indicate that such a scheme may pose great expense to the government and, as a result, may not be viable in South Africa. This topic needs further study, while other risk management strategies should also be considered.     

Health insurance reform and economic growth: Simulation analysis in Japan

This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations. Our simulation produced the following results: first, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior following the increase in co-payment rates, however, reduces economic growth. Third, Japan's trend of increasing the future public health insurance benefits can mainly be explained by its aging population, and increasing the co-payment rate does little to reduce future payments of public health insurance benefits. Fourth, the effect on future economic burdens of reducing medical costs through efficiencies in public health insurance, emphasis on preventive medical care, or technological progress in the medical field is small. Finally, a policy of maintaining public health insurance at a fixed percentage of GDP will require reducing public health insurance benefits, perhaps up to 45% by 2050. Such a policy also reduces economic growth until approximately 2035. Our simulation indicates that the reform does not significantly reduce future public health insurance benefits, but it can enhance economic growth and welfare by encouraging private saving.