中国农村医疗保障制度：一项基于异质性个体决策行为的理论研究

2003年初新型农村医疗保障制度在全国范围内试点。本文研究以下三个问题：这个自愿型的医疗保障体系的参与率有多高？保障体系自身是否可能实现收支平衡？人头税形式的缴费方式是否会使穷人受损而富人获利？为此，我们构建了一个异质性个体的消费一医疗支出决策模型，在拟合农村消费一医疗支出行为的基础上计算了农村医疗保障制度的福利效应。结果表明，在一定条件下，现行制度可以实现收支平衡，参与率可以在90％以上，健康状态较差的穷人是最大的受益者。     

我国农村医疗保障管理与监督机制问题探讨

我国农村医疗保障的管理模式为卫生管理部门,应合理划分中央政府与地方政府在农村医疗保障中的责任。农村医疗保障基金的筹集由中央财政、地方财政和农民个人合理分摊,主要用于补偿大病医疗费用、门诊费用和无疾病支出返还。应通过建立农村医疗保障制度中的需方(农民)费用支出及供方(医疗机构)卫生服务费用的控制制度,财务公开制度,监督制度等制度来控制农村医疗保障基金的费用支出。     

美国管理式医疗保障对新农合制度的启示

如何权衡医疗费用成本与医疗服务质量之间的博弈是摆在各国面前的难题。美国的管理式医疗保障制度在控制医疗服务成本、保证医疗服务质量方面可谓独树一帜,成为国家医疗保障领域的典型代表模式。目前我国也同样面临着医疗费用迅速增长、医疗保障效率不高等问题。尤其是新型农村合作医疗制度在农村的推广实施,对农村医疗服务提出了新的要求;新农合的按服务项目收费的支付方式又极大地促进了医疗费用的增长。运用美国管理式医疗保障的成功经验来调节和深化新农合制度的推广,在降低农村医疗卫生支出,提高农村医疗服务质量方面将发挥积极的作用。     

基于面板数据的医疗社保投资与居民消费相关性实证研究

当前转变经济增长模式,以拉动居民消费来促进经济增长的改革势在必行。改革、完善我国医疗保障制度,合理增加医保支出,势必能消除广大居民的消费顾虑,带动民间消费增长,既帮助中国经济从下行中走出来,又促进经济增长模式的转变。通过整理我国31个省（市、自治区）2008～2011年四年间相关数据,进行面板数据的实证分析,研究了医疗保障支出与居民消费的相关关系。实证结果显示：医疗保障支出对城镇居民的消费水平有着很强的推动作用,但医疗保障支出与我国国内生产总值的相关性不显著,加快农村地区的医疗保障制度的建设,以及扩大医疗保障制度的覆盖范围才能有效增加居民消费水平,进一步有效地促进整个社会的经济增长。     

农村医疗保障体制模式的选择与创新

2009年的新一轮医疗改革,政府倡导将基本医疗卫生制度作为公共产品向全民提供,建立覆盖全民的基本医疗保障制度,这对于农村医疗保障制度的建设和完善来说,是难得的机遇,充实新型农村合作医疗制度,确立适合我国国情的农村医疗保障体制模式,实现农村医疗制度的跨越性发展,是众望所归。     

浅议我国医疗保险支付方式的改革

近些年来,随着覆盖城乡的基本医疗保障制度的建立,我国居民基本医疗保险覆盖率已超过90％。在政府不断的增加对居民医疗保险补贴的同时,城乡居民医疗消费支出不断扩大,医疗费用也在不断增长。引起医疗费用上涨和居民实际医疗的支出增加的原因之一就是第三方付费支付制度的不完善。本文认为,在我国目前情况下,医疗保险支付方式的改革,是解决医疗费用增长过快,提高医疗保险制度效率的比较有效的措施。     

新型农村合作医疗与费用控制:基于医疗供给方的角度分析

我国新型农村合作医疗制度的成功可能主要取决于农村是否有一个廉价的医疗服务系统。基于医疗供给方的角度分析新型农村合作医疗制度应如何控制医疗费用。分析表明,我国医疗供给方失去有效的监管,医疗服务价格存在不断上涨的趋势,而目前我国新型农村合作医疗可能促进了农村医疗费用的上涨;通过比较国外发达国家医疗保障制度中医疗供给方的控制方法,提出了我国加强医疗供给方控制的政策建议。     

综合性农村医疗保障构架的制度分析

农村医疗保障,作为农村社会保障的主要组成部分,必然面临卫生防疫、健康保健、疾病诊治等多方面需求。综观我国农村合作医疗制度的演进以及国外农村医疗保障制度构建的成功经验不难发现,以病症诊治为主体,以预防保健、医疗救助、医疗保险、社区医疗等为补充的综合性农村医疗保障制度体系,有着层次分明、功能完备、适应性与可持续性强等特点,理应成为我国农村医疗保障制度构建的目标和典范。     

农村劳动力流动与缓解贫困——基于甘肃省贫困地区的实证分析

农村劳动力流动对农户家庭收入、消费、农业生产投入和农村生态产生了积极影响,改善了劳动者本人的人力资本水平,提高了其自我发展的能力。当前教育和医疗成为致贫的主要原因,这对建立适应农村的教育体制和农村医疗保障制度提出了迫切要求。     

农村社会保障对农村消费需求的拉动分析

要实现我国经济平稳较快发展,关键是要努力扩大以农村为重点的国内消费需求,确保农村居民消费欲望的实现。从目前我国经济形势看,固然有许多因素制约农村消费需求,但关键在于建立健全农村社会保障制度。因此,建立和健全农村社会医疗保障、养老保障和社会保险等制度,对于树立农村居民消费信心、扩大消费需求,促进消费水平的提高有着十分重要的意义。     

中国农村医疗保障制度:一项基于异质性个体决策行为的理论研究

This paper is aimed to provide some responses to the following three hotly debated issues regarding China’s new rural cooperative medical system (NCMS), which was launched at the beginning of 2003. Firstly, how many people would join the system voluntarily? Secondly, can the system be self-balanced? And thirdly, would the lump-sum tax benefit the rich more than the poor? We build a decision model with heterogeneous agents and we compute the implications of NCMS and find under certain conditions, the balanced-system can be sustained and the rate of participation could be higher than 90%. Moreover, it is the unhealthy poor that benefit more from NCMS.     

On the Differential Effects of European Patents

Since the invention of the European Patent System, national patent systems have continued to co-exist, although they did lose appeal. How have the different national systems been affected in view of their characteristics? In order to answer this question a constant-market-share (CMS) analysis is carried out. While on a theoretical level, the different elements adding to the appeal of each patent system are discussed, the CMS-analysis reveals the importance of country size in that the national systems of smaller countries lose.     

新型农村合作医疗绩效评价研究

绩效评价是新型农村合作医疗管理的重要内容之一。本文根据前期的试行情况，分析了新型农村合作医疗绩效评价在空间界定、期间设定和方法选择等方面的特殊性。在此基础上，提出了合作医疗绩效评价中定性分析的资料来源、取得途径和内容设计的基本构想，并建立了定量分析的评价指标体系。     

Constant-market-shares analysis and index number theory

This paper examines the constant market-shares (CMS) analysis of a country's export growth within the context of index number theory and is aimed at finding a satisfactory solution to the problems encountered by the traditional CMS decomposition procedures. The last ones perform the task of disentangling the variations of each accounting factor only partially, because they are based on linear approximations to non-linear functions. The residual “interaction” term left out in the current CMS analyses does not appear if a more flexible CMS decomposition based on the so-called superlative index numbers is used. Moreover, the discussion of the basic identities has clarified the difference in meaning and levels of the accounting components between the alternative versions of CMS analysis.     

Lessons from the Canadian health care system

In a recent poll, 89% of Americans stated that the U.S. health care system needs fundamental changes; 61% said they would prefer a system like Canada's to the system currently in place. How does the Canadian system work? How well has it served Canadian's health needs?     

The Hospital-Acquired Conditions (HAC) reduction program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties

Objective: The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals’ HAC scores and likelihood of avoiding the Medicare-reimbursement penalty.

Methods: A simulation model is developed and implemented using public data from the CMS’ Hospital Compare website to determine how hospitals’ unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals’ HAC scores.

Results: Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction.

Limitations: The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter patients would be able to consume cranberry in either juice or capsule form, but this may not be true in 100% of cases.

Conclusion: Most hospitals can improve their HAC scores and many can avoid Medicare reimbursement reductions if they are able to attain a percentage reduction in CAUTI comparable to that documented for cranberry-treatment regimes in the existing literature.     

DOES CHINA'S RURAL COOPERATIVE MEDICAL SYSTEM ACHIEVE ITS GOALS? EVIDENCE FROM THE CHINA HEALTH SURVEILLANCE BASELINE SURVEY IN 2001

The Chinese government is in the process of providing health insurance to the uninsured rural population by expanding the rural Cooperative Medical System (CMS) to every rural county. Using the China Health Surveillance Baseline Survey in 2001, we conducted a case study on two CMS pilot programs and investigated whether or not enrolling in these CMS pilot programs has led to an increase in health care utilization and a decrease in the likelihood of catastrophic health spending for rural residents. Matched data sets are produced using propensity score and the instrumental variable (IV) method is used. We have found that the CMS pilot programs have had a significant and positive effect on the probability of seeking medical care and the number of visits. However, the CMS programs did not seem to have had a significant impact on households' out‐of‐pocket health expenditure and on reducing catastrophic spending. The findings generated from the matched data are consistent with those obtained from the full set of data and those obtained from the IV method. (JEL I18)     

The Invisible Hand of James Madison

Scholars have disagreed about how to interpret James Madison's Federalist essays 10 and 51, in which he explains and justifies the underlying principles of the new Constitution. Was Madison the architect of a structure of counterpoise, which would force individuals, interests, and institutions to obstruct one another so as to avoid tyranny, or was he a republican statesman, designing a system that would recruit virtuous citizens to public office? I argue that these clashing interpretations can be reconciled by viewing Madison as a theorist who was applying Adam Smith's economic concepts to political phenomena By putting into practice Smith's insight that competition among self-interested actors can achieve the public interest, Madison incorporated both umpired strife and virtuous citizenship into the meta-principles of the Constitution.     

商业保险在“新农合”中的运营模式及发展前景——以浙江省为例

本文通过对商业保险介入新型农村合作医疗基金在浙江的运营实践,总结了现已存在的两种基本运营模式,探讨了商业保险在新型农村合作医疗基金运行中的实际效果,并对商业保险介入新型农村合作医疗基金运行的预期发展和运行中需注意的环节进行了讨论。     

Price Discrimination in Public Healthcare

Could a public healthcare system use price discrimination—paying medical service providers different fees, depending on the service provider's quality—lead to improvements in social welfare? We show that differentiating medical fees by quality increases social welfare relative to uniform pricing (i.e. quality‐invariant fee schedules) whenever hospitals and doctors have private information about their own ability. We also show that by moving from uniform to differentiated medical fees, the public healthcare system can effectively incentivise good doctors and hospitals (i.e. low‐cost‐types) to provide even higher levels of quality than they would under complete information. In the socially optimal quality‐differentiated medical fee system, low‐cost‐type medical‐service providers enjoy a rent due to their informational advantage. Informational rent is socially beneficial because it gives service providers a strong incentive to invest in the extra training required to deliver high‐quality services at low cost, providing yet another efficiency gain from quality‐differentiated medical fees.