经济地位、社会保障待遇与老年健康关联研究——基于中国居民收入调查数据的分析

社会经济地位分化引发的健康不平等一直受到关注。文章基于中国家庭跟踪调查数据,以经济贫困、教育水平、社会保障待遇作为社会经济地位的代理变量,以老年自理能力(ADL丧失率)作为老年健康的代理变量,实证检验结果显示:经济贫困、教育水平与老年ADL丧失率呈显著正相关;社会保障待遇中医疗、养老保险与老年ADL丧失率呈显著负相关,低保或社会救济与老年ADL丧失率呈显著正相关,其中养老保险的OR值最大。利用自评健康作为老年健康代理变量的检验结果显示与ADL丧失率的检验结果一致,回归结果具有稳健性。经济贫困、教育水平很难在短期内改变老年人健康水平,但通过提高社会保障待遇可以为老年人口健康带来适宜有效的改善。     

卫生融资体系中基本医保与商业健康保险的关系 ——基于2003~2012年我国城镇地区的省级面板数据研究

随着国民对健康和医疗服务需求的快速增长,我国医疗卫生费用融资体系面临着新挑战,而新医改政策的逐步实施,使得影响居民卫生费用融资结构的因素需要进一步探究。本文利用省级面板数据回归,结果显示：与之前预期的“挤出效应”不同,中国的基本医疗保险对商业健康保险是正向的促进作用;“新医改”、医疗服务供给能力和可及性的提高促进了商业健康保险的发展;医疗卫生消费与医疗保险的互补性特征对低收入群体更为明显;而我国老龄化背景下的医疗保障需求还没有得到很好满足。     

北京优质医疗资源扩容提质

国家发展改革委等部门印发的《"十四五"优质高效医疗卫生服务体系建设实施方案》中提出"推动优质医疗资源扩容和区域均衡布局,提高全方位全周期健康服务与保障能力"."十三五"时期,北京持续向郊区扩容优质医疗资源,促进了全市医疗资源布局相对均衡.在新形势下,要将"扩容优质医疗资源,提升医疗服务质量"同时发力,加强北京医疗服务能...     

论独立审计师健康护理认证——基于委托代理理论的现实思考

本文主要讨论为保证和谐医患关系,审计师作为独立第三方介入医患双方关系,并开展健康护理认证业务的有关问题.文章首先从医患双方的本质和特征入手,揭示了医患关系实际上是一种存在严重信息不对称的委托代理关系;然后,探讨了审计师开展健康护理认证业务的必要性、可能性和必然性,以及审计师开展健康护理认证业务对认证对象具体评价的维度和审计师执业过程中应该遵循的原则.我们认为,独立审计师开展健康护理认证服务确实是可行并值得推广的.最后,预测了审计师对医疗服务质量开展认证所能达到的效果,并说明本文研究的不足之处.     

医疗健康问题对居民资产配置的影响

健康状态的维持需要医疗健康成本的投入。该成本在政府和个人两者间分担,个人承担份额的多少会影响可供其他消费和投资的财富量,从而影响投资者资产配置决策;另外,医疗健康问题还会通过多个渠道影响其投资决策。本文从医疗健康成本角度分析了成本分担方式,构造了两期资产配置模型并进行求解,在分析了医疗健康问题影响渠道后建立了考虑医疗健康问题的长期资产配置模型。本文的研究表明:随着个人支付成本占工资收入比例的降低,投资者用于医疗健康以外的其他消费相应增加,两者之间为非线性数量关系;政府对医疗体系的稳定投入有助于减少收入波动风险,降低人们的风险对冲需求,从而可能促进投资者对风险资产的投资。本文主要的创新之处在于构造出考虑医疗健康成本因素的资产配置模型,分析了医疗健康成本与个人消费、投资之间的数量关系,并在量化研究基础上提出了稳定增加对医疗卫生体系投入的政策建议。     

借鉴国际经验,深化北京市卫生管理体制改革

医疗卫生是服务领域中一个重要而且突出的行业,关系国民健康、社会稳定和经济发展的全局。中共十六届三中全会通过的《中共中央关于完善社会主义市场经济体制若干问题的决定》提出,深化公共卫生体制改革,强化政府公共卫生职能,建立与社会主义市场经济体制相适应的卫生医疗体系,为当前和今后一个时期我国卫生事业改革和发展指明了方向,不仅有很强的现实意义,也具有长远的指导意义。     

商业健康保险是否促进了居民健康——基于微观数据的实证研究

党的十九大报告明确提出全面实施"健康中国"战略,强调商业健康保险参与多层次医疗保障体系建设,服务广大人民群众健康保障的重要作用。明确商业健康保险如何从微观层面提高居民健康是有效发挥其助力"健康中国"作用的前提与基础。本文基于中国健康和营养调查(CHNS)2000～2015年面板数据,利用面板工具变量法解决内生性,考察商业健康保险对居民健康水平的影响,同时对不同收入阶层和年龄阶段进行异质性分析,并进行机制探讨。研究表明,商业健康保险能够显著提高居民的健康水平,而且这一正向影响对高收入阶层和中年人群的正向影响更为明显。此外,机制分析表明商业健康保险能够提高居民的医疗服务利用,改善居民健康行为,从而提高健康水平。     

探究如何提高医疗行业财务管理水平

随着我国经济的不断发展及科技的进步,医疗卫生行业也得到了迅速的发展,国民基础医疗建设也逐渐完善。医疗卫生行业的进步水平是人们身体健康的直接影响因素,医疗卫生行业发展水平在整个社会发展中发挥着重要的作用。医疗行业是集生产、销售、服务为一体的行业,在我国逐渐健全的市场经济体制背景下,市场竞争力也得到了提高,因此,重点研究医疗行业的财务管理工作将在医疗企业取得进一步发展的关键所在。     

现阶段医院物价管理存在的问题及解决措施

目前我国处于改革开放的深入阶段,改革进入了深水区。医疗改革是改革的重点领域。我国的医院长期是"以药养医",医院物价管理工作关系到医院和患者的切身利益,现在很多的医患矛盾都是医院的不合理收费形成的。随着医药卫生体制改革的逐步深入,加强医院物价管理,完善价格监督机制,是目前我国医疗改革的重点。一个合理的医院物价水平是为病人提供优质服务的前提,从另一方面也可以提高医院的社会效益和经济效益。近几年来,国家为促进医疗卫生事业的健康发展,为缓解"看病难、看病贵"等矛盾下了很大的功夫。各级相关部门也在深化医疗服务价格改革,不断探索和规范医疗价格体系,取得了一定的成效。但目前,仍存在很多的问题没有解决。文章通过探讨医疗价格改革中出现的相关问题,提出相应的解决方案,最终希望为国家的医疗事业改革提供一定的借鉴。     

构建和谐医患关系的探讨

近年来,医患关系逐渐出现了一些不和谐的现象,医患关系日渐趋于紧张,显然,长此以往,这将会不利于我国医疗卫生事业的健康快速发展,并且不利于我国和谐社会的建设,因此缓和并解决医患矛盾,构建和谐医患关系具有战略性意义。本文从医患关系的概念及现状出发,探讨了医患关系紧张的原因,并提出了一些促进构建和谐医患关系的对策建议,以希望能促进我国医疗卫生事业的健康快速发展,促进和谐社会的建设。     

Annual Reporting Mechanisms of National Health Service Trusts

This article investigates the role of the annual report and the annual general meeting (AGM) in the context of NHS trusts. The authors report the results of a questionnaire survey of every NHS trust in the UK. Significant variation in the approach taken within a common framework of accountability was found. In general, there seems to be little public demand for trusts' annual reports and attendance at their AGMs was low. The research indicates possibilities of extending annual reporting in the public sector beyond the annual report and AGM and discloses innovative ways that trusts have attempted to overcome the limited interest of stakeholders produced by the traditional reporting mechanisms.     

Assessing Benefits from Department of Health and National Health Service Research & Development

Public services in the UK are increasingly expected to account for their outputs and performance. This article describes a retrospective evaluation of the benefits from the R&D funded by a regional office of the NHS Executive. The methods adopted enabled the various elements of the region's R&D portfolio to be examined and provided a basis for the development of a plan for regular monitoring. The proposals for implementation are now also feeding into a debate as to how health services R&D might best be monitored nationally in a way that is compatible with the norms and practices of research in other contexts.     

Consumer Response to a National Marketplace for Individual Health Insurance

The objective of this analysis is to simulate the difference between national and state‐specific individual insurance markets on take‐up of individual health insurance. This simulation analysis was completed in three steps. First, we reviewed the literature to characterize the state‐specific individual insurance markets with respect to state regulations and to identify the effect of those regulations on health insurance premiums. Second, we used empirical data to develop premium estimates for the simulation that reflect case‐mix as well as state‐specific differences in health care markets. Third, we used a revised version of the 2005 Medical Expenditure Panel Survey (MEPS) to complete a set of simulations to identify the impact of three different scenarios for national market development. (National market estimates are based on the simulation model with competition among all 50 states and moderate impact assumptions.) We find evidence of a significant opportunity to reduce the number of uninsured under a proposal to allow the purchase of health insurance across state lines. The best scenario to reduce the uninsured, numerically, is competition among all 50 states with one clear winner. The most pragmatic scenario, with a good impact, is one winner in each regional market.     

Phasing Out Market Mechanisms in the Italian National Health Service

The Italian National Health Service introduced quad-markets, regionalization, and managerialism in the 1990s. Under quasi-markets, large providers have been separated from purchasers and funded by ‘activity’—the quantity, mix, and possibly appropriateness of services provided. Under regionalization, each of Italy's 21 regional governments is able to design its own funding arrangements. The regions have generally been trying to mitigate the effects of quasi-markets and are now increasingly ‘governing’ them. The system is producing some desirable results, including a shift from ordinary to same-day hospitalizations and a reduction in length of stay. Hospital admissions increased initially, but only where the regions encouraged this. Financial effects are more controversial.     

Phasing Out Market Mechanisms in the Italian National Health Service

The Italian National Health Service introduced quad-markets, regionalization, and managerialism in the 1990s. Under quasi-markets, large providers have been separated from purchasers and funded by 'activity'—the quantity, mix, and possibly appropriateness of services provided. Under regionalization, each of Italy's 21 regional governments is able to design its own funding arrangements. The regions have generally been trying to mitigate the effects of quasi-markets and are now increasingly 'governing' them. The system is producing some desirable results, including a shift from ordinary to same-day hospitalizations and a reduction in length of stay. Hospital admissions increased initially, but only where the regions encouraged this. Financial effects are more controversial.     

Multiple logics and accounting mutations in the Italian National Health Service

Traditional public administration (PA) relied on cash- or commitment-based budgets, while NPM advocated accruals accounting. Currently, Continental Europe is witnessing the re-emergence of the PA logic, but the relevant accounting implications have been insufficiently investigated. We focus on the Italian National Health Service. Our findings suggest that accruals accounting will not be repealed. However, accounting mutations will be introduced to increase consistency with the PA logic and budgetary accounting. Accruals accounting numbers will be interpreted and used accordingly. Great attention will be paid to nation-wide consolidated statements for the control of public finances, while faithful representation of individual organisations will be overshadowed.     

Asset Revaluations in the Accounts of UK National Health Service Trusts

This paper reports the results of an investigation into the impact of the revaluation of fixed assets on the reported results of NHS ambulance services. It recalculates the accounting rate of return of individual trusts after removing revaluation adjustments and examines the published responses of trusts. The numerical analysis demonstrates that, in general, revaluation has depressed the stated rate of return in an inconsistent manner. Failure to meet the required rate of return may cause a trust to be subjected to additional monitoring and management reorganisation while the trusts respond by explaining deviations in the accounting return measure by referring to revaluations and other technical adjustments. Management decisions made in response to these accounting measures may be sub-optimal in delivering health care but appropriate in achieving the desired accounting outcome.     

我国人均卫生总费用增长的实证分析

本文利用2001-2010年的统计数据,通过SPSS统计软件,构建了人均卫生总费用供需模型,对人均卫生总费用增长进行了实证回归分析.结果发现:卫生费用增长快于国内生产总值增长,但弹性相对较小,仅为1.026;卫生支出主要受到人口调整数、城镇居民人均可支配收入的影响;城镇居民医疗保健价格指数、卫生机构数目则不能稳定地解释卫生费用增长;卫生费用增长问题应在供需相统一的关系中加以讨论.     

中国台湾全民健康保险财务危机论析

台湾全民健康保险从1995年实施至今取得了显著成效,但是,台湾健保也面临着严重的财务问题,目前已经爆发了3次财务危机。虽然采取开源节流、调整保险费率等一系列措施,但收效甚微,健保财务依然入不敷出。健保财务危机屡屡爆发,根源在于健保自身的制度缺陷。要达成健保的财务平衡,应该从健保的制度层面上做一番彻底而有效的改革。     

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label ‘care pathways’, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.