政府干预对市场声誉机制的挤出效应——中国医疗保障制度改革的逻辑

监管和自律是克服医生道德风险的两种主要途径,但是政府对医疗领域的过度干预会挤占市场声誉机制的发展空间,同时也进一步强化了医生的道德风险。改革现行“管办不分”的医疗卫生体制以及医院等级评定和医生职称评定制度,同时放松政府对医疗服务价格的控制,以恢复被扭曲的医疗供方市场声誉机制。     

牡丹江市社会保险制度改革的成效与问题

一、牡丹江市社会保险制度改革的基本情况1．富有成效的医疗保险制度改革牡丹江市医疗保险制度的改革试点于1996年首先在财政全额拨款的机关事业单位进行。在此之前，执行的是公费医疗制度。1992年至1995年，牡丹江市医疗费用每年以30％的速度递增。和全国许多城市一样，医疗费用连年膨胀的情况很难控制。1996年1月1日，《牡丹江市职工医疗保障制度改革实施方案》和《牡丹江市市区机关事业单位职工养老保险实施细则》开始实施。方案确定，牡丹江市将建立职工个人医疗帐户与社会医疗统筹基金相结合的医疗保障制度。细则规定，医疗保险基金用…     

谈职工基本医疗保险管理

<正> 加快医疗保险制度改革,保障职工基本医疗,是建立社会主义市场经济体制的客观要求和重要保障。在认真总结近几年改革试点经验的基础上,国家从1999年推行了城镇职工基本医疗保险制度改革,其出发点是,根据财政、企业和个人的承受能力,建立保障职工基本医疗需求的社会主义医疗保险制度。基本医疗保险的水平要与社会主义初级阶段生产力发展水平相适应;城镇所有用人单位及其职工都要参加医疗保险,实行属地管理,其保险费用由用     

职工补充医疗保险管理及实操对比

<正>作为提升职工福利水平的一项重要制度,国有企业补充医疗保险不仅有利于实现多层次的医疗保险体系,更能够减轻职工医疗费用支出。因此,如何发挥补充医疗保险的最大作用,使之切实成为基本医疗保险的延伸,已经成为国有企业必须思考的重要课题。补充医疗保险是企业在国家统一制订的基本医疗保险之外,根据自身的经济实力,在履行了缴纳基本医疗保险费义务之后,专门为本企业职工建立的附加保险。补充医疗保险是基本医疗保险的补充形式,对基本医疗保险制度支付以外由个人负担的医疗费用进行适当补助,以减轻职工和退休人员的医疗费用负担。补充医疗保     

企业医改难点分析及其对策

根据国务院关于开展职工医疗保障制度改革的精神，1996年7月广西壮族自治区劳动厅批复同意我公司(原广西电力工业局)开展医疗保险制度改革试点工作，标志着公司的职工医疗由福利型医疗制度向医疗保险制度的转化，由企业保险制度向社会共济制度的转化，由大小病无所不包的制度向只保障基本医疗需求的基本医疗保险制度的转化。     

构筑职工抵御医疗风险的五道防线

国务院１９９８年１２月印发了《关于建立城镇职工基本医疗保险制度的决定》 ,该制度覆盖包括国有企业、集体企业在内的所有城镇用人单位及其职工的基本医疗保险。按照属地管理原则 ,以地级以上行政区为统筹单位 ,执行统一政策 ,实行基本医疗保险基金的统一筹集、使用和管理。由于电力行业比地方企业效益好 ,医疗待遇高 ,实行属地统筹管理后 ,势必要降低原来已享受到的医疗待遇水平。如何结合电力行业特点 ,构筑职工抵御医疗风险的多重保障 ,四川省电力系统采取的措施是 :一、参加基本医疗保险基本医疗保险制度是职工抵御医疗风险的第一道也…     

稳步推进医疗保险制度改革

稳步推进医疗保险制度改革□刘宗森张振香华北电力集团公司医疗保险制度改革从今年起将步入实际运作阶段。借此机会,谈以下三点认识。一、医疗保险制度改革势在必行（一）在计划经济条件下,我国的医疗制度反映出来的矛盾愈加突出,主要表现在三个方面：其一,医疗费用由...     

大型国企补充医疗保险管理模式探讨

<正>根据国家及地方政府相关政策,紧密结合大型企业自办补充医疗保险实际,本文提出有效管控和规范运作企业补充医疗保险的思路、策略及统筹模式,推荐了多种典型管理模式设计,为大型企业自办补充医疗保险理论创新、机制创新和制度创新提供了参考。一、研究背景企业补充医疗与基本医疗、商业医疗保险共同构成医疗保险"三支柱",是国家推进多层次医疗保障体系建设的重要组成部分,与广大职工及退休人员的切身     

城乡医疗救助制度的现状、主要问题与建设重点

城乡医疗救助制度通过对困难家庭成员的直接救助与资助参加社会医疗保险, 对缓解困难家庭医疗支出负担起到了积极作用。 城乡医疗救助制度目前主要存在的直接救助水平过低、 财政投入非制度化以及审批手续繁琐、 病种限制过严等问题, 可以从提高直接救助水平、 扩大救助病种目录、 借鉴相关社保制度、 开展多样化救助, 以及加强基层医疗卫生建设、 对城乡困难家庭成员开展健康教育与继续提高医疗保险的保障水平等方面重点加强建设, 另外也应重视城乡医疗救助的信息化建设。     

江苏完善覆盖全民医保制度问题研究

随着2007年7月24日《国务院关于开展城镇居民基本医疗保险试点的指导意见》的出台,江苏率先在全省建立了以城镇职工医疗保险制度、新型农村合作医疗保险制度、城镇居民医疗保险制度为主的三种基本医疗制度共存的局面,旨在人人享有基本医疗保险。新的医保体系经过半年多的运行,出现了许多新情况、新问题。如何从实现社会公平和提高公共管理效率出发,整合多种医疗保障制度,建立覆盖城乡全体居民的多层次全民医疗保险制度已成为大势所趋。     

Corruption in PPPs,incentives and contract incompleteness

We analyze risk allocation and contractual choices when public procurement is plagued with moral hazard, private information on exogenous shocks, and threat of corruption. Complete contracts entail state-contingent clauses that compensate the contractor for shocks unrelated to his own effort. By improving insurance, those contracts reduce the agency cost of moral hazard. When the contractor has private information on revenues shocks, verifying messages on shocks realizations is costly. Incomplete contracts do not specify state-contingent clauses, thereby saving on verifiability costs. This makes incomplete contracts attractive even though they entail greater agency costs. Because of private information on contracting costs, a public official may have discretion to choose whether to procure under a complete or an incomplete contract. When the public official is corrupt, such delegation results in incomplete contracts being chosen too often. Empirical predictions on the use of incomplete contracts and policy implications on the benefits of standardized contracts are discussed.     

One pool to insure them all? Age,risk and the price(s) of medical insurance

Asymmetric information can lead to adverse selection and market failure. In a dynamic setting, asymmetric information also limits reclassification risk. This certainty offsets the costs of adverse selection. Using a dynamic model of endogenous insurance choice and price calibrated to the U.S. medical insurance market, I find that asymmetric information is Pareto improving when information is fully asymmetric. However, when insurers can discriminate by age group, but not within age groups, the young benefit by paying less for insurance. The insurance market for the near elderly collapses because it is no longer implicitly subsidized by the participation of the young.     

Winning us with trifles: Adverse selection in the use of philanthropy as insurance

Research Summary: We study the use of corporate philanthropy as a form of reputation insurance, developing a formal model of such insurance to examine how the terms of insurance in equilibrium change under different assumptions about the firm and its stakeholders. We then test the predictions from this model in the U.S. petroleum industry and find that philanthropic donations offer insurance‐like benefits, but are also positively associated with subsequent oil spills—firms that give more, spill more—with this association being stronger for spills that are under firms’ control and in states with low civic capacity. These results are consistent with an adverse selection/moral hazard equilibrium and suggest that the use of philanthropy as reputation insurance may benefit firms at the cost of society. Managerial Summary: Firms that donate to social causes develop a reputation for being socially responsible, and are often given the benefit of doubt when negative information about them comes to light. But are philanthropic firms truly more responsible? We argue that firms that donate more may be more likely to do harm—those that expect to do harm later are likely to give more now, and those that know their reputation protects them may become less careful. Evidence from the U.S. petroleum industry is consistent with this argument, with firms that give more having more subsequent oil spills, but only the type of spills that are under the firm's control, and only in states where the firm faces weaker scrutiny.     

Moral Hazard in Home Equity Conversion

Home equity conversion as presently constituted or proposed usually does not deal well with the problem of moral hazard. Once homeowners know that the risk of poor market performance of their homes is borne by investors, they have an incentive to neglect to take steps to maintain the homes values. They may thus create serious future losses for the investors. A calibrated model for assessing this moral-hazard risk is presented that is suitable for a number of home equity conversion forms: (1) reverse mortgages, (2) home equity insurance, (3) shared-appreciation mortgages, (4) housing partnerships, (5) shared-equity mortgages and (6) sale of remainder interest. Modifications of these forms involving real estate price indexes are proposed that might deal better with the problem of moral hazard.     

Estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance

Insurance induces a tradeoff between the welfare gains from risk protection and the welfare losses from moral hazard. Empirical work traditionally estimates each side of the tradeoff separately, potentially yielding mutually inconsistent results. I develop a nonlinear budget set model of health insurance that allows for both simultaneously. Nonlinearities in the budget set arise from deductibles, coinsurance rates, and stoplosses that alter moral hazard as well as risk protection. I illustrate the properties of my model by estimating it using data on employer sponsored health insurance from a large firm.     

"第三方购买":医疗服务市场化改革的路径选择及其经济学分析

我国医疗改革的“失败”原因不在于改革的市场化取向,而在于市场化的路径与方式选择.医疗服务产品的基本特点是其异质性、不可逆转性,以及服务过程中的严重信息不对称性.以普通商品的市场化方式推动医疗服务市场化是导致目前医疗改革中一系列问题的本质原因,而引入“第三方购买”,可以很大程度上解决信息不对称问题,并通过改变博弈局中人而改变博弈均衡.为此,要提高医疗保障覆盖率,创新医疗费用结算方式,提高医疗服务信息的透明度.     

诘问与正名：对董事责任保险合同功能之责难与回应

有学者认为董事责任保险合同可能会诱发董事和高级职员的道德风险并对董事责任的惩罚功能和预防功能造成一定的冲击，因此对董事责任保险合同的合理性提出了质疑。事实上，董事责任保险合同对道德风险的引发以及董事责任功能的冲击并不是绝对的，可以利用相关的法律规范和技术手段来降低和减少其所产生的影响。     

新生儿未参保之谜:基本事实、成因及其影响

中国已基本实现全民医疗保险覆盖,基本医疗保险参保率多年维持在95%以上,剩下的未参保人群成为真正实现全民医疗保险的“最后一公里”。精准识别未参保人群对于完善当前医疗保障制度具有重要意义。本文基于中国家庭追踪调查数据(CFPS),描述了大量新生儿未参加基本医疗保险的事实,并实证分析了参保率较低的原因及其对医疗服务利用的影响。描述性统计结果显示,新生儿参保率不足1/2,大大低于其他年龄阶段人群的参保率。进一步实证分析发现,父母不了解新生儿参保政策信息、基层组织缺乏向新生儿家庭宣传参保政策的激励是新生儿参保率低的主要原因。最后,考察未参保对新生儿医疗服务利用产生的影响,发现未参保状态显著降低了新生儿的医疗服务利用率。为了提高新生儿基本医疗保险参保率,政府一方面应针对性地加强新生儿医疗保险政策宣传,降低新生儿参保的信息障碍;另一方面应积极推动新生儿自动纳入基本医疗保障范围,甚至应考虑制定专门针对新生儿的医疗保健计划。     

Agricultural credit problems and policies during the transition to a market economy in Central and Eastern Europe

This paper assesses the problems of financing Central and Eastern European agriculture during the present transitionary period and the role of government in this process. Initially the paper looks at why credit markets work imperfectly, even in well developed market economies, focusing on problems related to asymmetric information, adverse selection, moral hazard, credit rationing, optimal debt instrument choice and initial wealth. It shows why these and related problems may cause transaction costs to be so high that credit rationing and high interest rates are rational and efficient responses by lenders to the imperfect information problems of the agricultural sector. A series of specific, transition-related issues are then discussed which have worsened these problems within the Central and Eastern European agricultural sector. The potential roles of governments in solving these issues and actual observed interventions by Central and Eastern Europe governments through credit subsidies, loan guarantees and specialised agricultural lending institutions are analysed. Finally, the paper discusses how financial market innovations have solved some of the credit market problems and derives the implications for government policies.