Does consumption buy happiness? Evidence from the United States

We examine the association between various components of consumption expenditure and happiness in the Health and Retirement Study (HRS), a nationally representative sample of older Americans. We find that only one component of consumption is positively related to happiness—leisure consumption. In contrast, consumption of durables, charity, personal care, food, health care, vehicles, and housing are not significantly associated with happiness. Second, we find that leisure consumption is associated with higher levels of happiness partially through its effect on social connectedness, as indexed by measures of loneliness and embeddedness in social networks. On one hand, these results counter the conventional wisdom that “material goods can’t buy happiness.” One the other hand, they underscore the importance of social goods and social connectedness in the production of happiness.     

心理健康视角下的大学生失业群体问题研究

在职业危机面前,大学生失业群体面临巨大的心理应激,表现在心理健康方面主要为孤独感、焦虑、抑郁、低自尊、偏激、攻击行为和非理性情绪宣泄等方面,他们在承受生活窘困、身心痛苦的同时也可能对社会产生一些负面影响。因此,对失业大学生应该进行心理辅导,建立社会支持体系、注重预防的工作机制。     

Assessment of regional productive performance of European health systems under a metatechnology framework

Within last seventy years, healthcare spending in Europe has grown faster than national income. However, this does not always translate into good health indicators, suggesting a problem of efficiency in different European health systems. This paper analyzes the efficiency of such systems for 185 European regions in 17 countries by grouping them into three clusters according to their institutional setting: regulation, funding and service provision. We investigate their productive performance by adopting a metafrontier framework for exploring the role of technological spillovers. Our findings suggest that the three European health systems show similar efficiency performance; the best performers are regions that have adopted social healthcare insurance; kernel analysis indicates that there is convergence toward a single club in each frontier. Finally, we find a dramatic change in the convergence process after the nancial crisis, with European regions converging toward different groups with different levels of efficiency.     

医疗健康大数据资产价值实现路径分析——基于信息生态系统理论

医疗健康大数据是我国重要的基础战略资源,它对我国社会和经济发展、推动“健康中国”等方面都有着十分重要的作用。如何准确地识别出影响数据资产价值的关键要素,是提高我国医疗健康大数据管理能力、构建高效数据治理机制的关键。本研究从信息生态系统的视角,以数据生产者、数据中介者、数据开发者和数据消费者为信息主体,提出“数据产生-资产形成-价值实现-数据再生”的价值实现路径,并考虑法律、经济、技术和社会等环境因素,构建医疗健康大数据资产价值实现模型。同时,在梳理出医疗健康大数据资产价值实现的影响因素及其关联关系后,基于Vensim PLE的仿真结果模拟价值实现路径。从仿真结果看,在不同社会保障机制情况下,法律完善程度对医疗健康大数据资产价值实现量的影响最显著。同时,技术水平、医疗健康数据共享程度和医疗健康相关资金投入力度对资产价值实现量也有较大的影响。本文从推进技术水平提高、完善法律政策和促进市场需求等角度提出推进医疗健康大数据资产价值最大化的途径。     

Losing children and mental well-being: evidence from China

This article explores the impact of losing a child, especially losing all children (including losing the only child), on the mental health, happiness and loneliness of parents. The Chinese government has implemented strict restrictions on the number of births for each family since the 1970s, resulting in the creation of millions of only-child families. Using the 2011 baseline data from the China Health and Retirement Longitudinal Study, we find that the bereavement of a child is associated with lower levels of mental health and happiness and higher levels of loneliness for the parents, even after we adjust for demographic and socioeconomic characteristics. The effects are significantly stronger for losing all the children. Results have strong implications for the population-control, elderly-care and mental-care policies especially in China and developing countries, where the social security system is not yet sound.     

财政分权下地方政府卫生支出的竞争行为研究

分权体制框架下地级市政府在制定医疗卫生支出决策时往往会受到相邻城市相关策略的影响,从而引发城市间政府卫生支出的策略互动行为.文章选取了2007?2013年中国283个城市面板数据,运用动态空间面板模型检验了分权体制下地市级政府卫生支出的策略互动行为,并揭示出财政分权及其城市间空间策略互动对政府卫生支出的影响.研究发现,地市级政府在政府卫生支出上存在显著的互补型策略互动,这种效应在地理距离相近的同省区城市间更为显著.进一步分析发现,财政分权促进了政府卫生服务供给;而无论是短期还是长期,地市级政府间财政分权的策略互动对政府卫生支出产生明显的抑制作用,从而较好地解释了政府卫生支出比重徘徊不前的原因.由此,积极利用竞争、激励机制以及实现财政体制安排的优化变革来引导政府的卫生服务供给将是重要的政策选择.     

医疗卫生产业化改革研究综述

看病难、看病贵在全国范围内是一个普遍存在的问题,深化医疗卫生体制改革是解决该问题的重要途径之一。然而,医改是世界难题。2005年,国务院作出了中国医改基本不成功的结论。学术界和实业界有关人士把前一阶段医改的失败归因于＂过度市场化＂,新医改方案也特别强调政府的作用。而由于一直以来,理论界对于＂市场化＂和＂产业化＂均没有形成统一的概念和认识,二者经常被混淆,因此目前医疗卫生产业化的提法显得相当谨慎。该研究系统分析了市场与产业的区别,在此基础上明确市场化与产业化的本质差别;对医疗卫生产业化的内涵进行了综述和界定,对医疗卫生是否应该产业化的正反两方观点进行总结和评析,提出在当前国情下,医疗卫生应该继续走产业化改革和发展之路,并着重讨论了医疗卫生产业化发展的背景和意义、遇到的困难障碍及应对思路。     

The healthy development of economies: A strategic framework for competitiveness in the health industry

Applying a strategic decision-making perspective on the economics of business, we suggest that a competitive locality in the health industry is one that, relative to other localities, is effective in: (1) providing the healthcare that enables everyone to participate fully in the democratic development of the locality; (2) providing the healthcare that is democratically identified as a direct objective of this development; (3) contributing through the health industry to any other democratically determined objectives of the locality's development. The paper hypothesizes that strategic decision-making in organizations is an especially significant determinant of the impacts of the health industry. We conclude that: (i) a locality that suffers concentration in the power to determine the objectives of its health industry could not be strictly competitive in that industry; (ii) the first best way to achieve competitiveness in the health industry would be to democratize its strategic decision-making. What this would entail in practice is discussed in some detail.     

Canadian Health Reform: A Gender Analysis

We analyze the gender impact of the current Canadian system of first-dollar health insurance by examining the use of physicians' services and acute-care hospital services in the Canadian province of Manitoba from April 1, 1997, to March 31, 1999. First, we describe the use by age and sex of healthcare resources offered with universal access at no cost to individuals. Second, we argue that women have a particular interest in maintaining single-payer insurance, because women are moderately high users of healthcare resources, while men tend to be low or catastrophic users who would be shielded from the full force of market-oriented reforms. Third, we attempt to refocus the debate about the gender implications of market-oriented health reform by noting that medicare transfers resources to women of reproductive age from the rest of society, a form of social wage paid as in-kind compensation to women for nonpaid reproductive labor.     

健康物联网技术应用伦理难题研究

健康物联网（H-IoT）技术进步带来医疗健康等领域的革命性变化,并为医疗、保健、护理和科学研究带来新机遇。由于互联网设备的固有风险、健康数据的敏感性以及医疗保健服务形式的转变,H-IoT技术应用将带来一系列伦理难题,具体包括：加剧个人信息泄露风险、H-IoT数据所有权与有效性的冲突、数据主体自主权与数据共享的冲突,以及由H-IoT介导护理产生的用户社会孤立化、医疗去情景化以及护理非专业化等。以国际代表性研究成果的理论框架为参考,从设备、数据协议、实践等层面分析未来需重点解决的H-IoT技术进步与应用伦理难题。     

欧盟《患者跨境医疗权利指令》实施及其借鉴

提升欧盟成员国卫生体系的协同效应,解决共同面临的健康挑战,是欧盟卫生体系一体化发展的重要目标。2013年10月,欧盟所有成员国通过了《患者跨境医疗权利指令》的法律,并在全欧盟范围内正式生效并实施。该指令针对患者的权利做了一些调整,扩大了医疗服务范围,提出了报销原则、成员国职责和创新性措施,如,建立国家联系点,改善各国电子医疗系统,促进各国卫生技术评估,促进各国医疗产品使用和处方的互认,以及促进开发和建立欧洲参考网络等。该指令旨在通过促进成员国合作组织和提供医疗服务,为欧盟公民提供安全、高质的跨境医疗服务。中国与欧盟社会管理体系虽然不同,但该法令在立法过程、实施原则和具体措施等方面,对我国正在实施的医药卫生体制改革有所借鉴。     

The political sustainability of a basic income scheme and social health insurance

This paper studies within a two‐stage framework the political economy of a basic income (BI) and social health insurance (SHI) scheme. At the constitutional stage, individuals decide whether these schemes are implemented behind a veil of ignorance about their future income and risk type. This decision is made in anticipation of the outcome at the second stage in which individuals vote on the payroll tax to finance a BI and the contribution rate of a SHI scheme provided these schemes have been implemented. Depending on the amount of healthcare expenditure and the inequalities in income and risk, only a social health insurance scheme is implemented at the constitutional stage.     

Socio-economic impact of the mHealth adoption in managing diabetes

The increasing prevalence of prediabetes and diabetes has become a serious problem in Korea. This study aims to compare the effects of various policy options for mHealth proliferation for managing and preventing diabetes. To this end, we simulate the plausible possibility of mHealth using system dynamics modelling. There are several important findings of this study that are helpful to policy makers’ decisions. First, innovative healthcare delivery through mHealth has a positive influence on health to significantly reduce prediabetes and diabetes. Moreover, the gap between the healthcare system with and without mHealth increases over time. Second, the effectiveness of mHealth adoption depends on the timing of implementation of institutional reforms. Finally, mHealth adoption can stimulate national economic growth as the demand for a new healthcare system rises.     

Subsidizing healthcare in the presence of market distortions

The paper develops a three-sector full-employment general equilibrium model for a small open developing economy with exogenous labour market imperfection and a non-traded sector providing healthcare services, the consumption of which generates positive externalities. Our main objective is to show that the optimal consumption subsidy to healthcare, if solely judged from the standpoint of economic growth, is strictly positive (zero) when the production technology of the healthcare sector is of the variable (fixed) coefficient type. However, in the variable coefficient case, the optimal per capita expenditure on healthcare crucially hinges on the degree of labour market imperfection and the quality of services provided by the healthcare sector. The latter result can possibly be considered as a theoretical justification why the magnitude of per capita public spending on healthcare services is significantly lower in the developing countries compared to that in the developed nations. Besides, using the Sen's (1974) index of social welfare that takes into consideration both the growth and income inequality aspects, we have proved that the optimal health subsidy is positive irrespective of the nature of production technology of the healthcare sector. Furthermore, most of these results are found to be valid even in the presence of Harris-Todaro type unemployment. Finally, the results lead to a few important policy implications in the context of the developing countries.     

Risk adjustment and prevention

Abstract Widespread integration of market‐based incentives into healthcare systems calls for – and has elicited – increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among regions or insurers according to current population health status, it does not reward – indeed, it penalizes – preventive efforts that improve population health. This prevention penalty of risk adjustment represents a hidden cost of unclear magnitude, undermining provider incentives for health promotion. We develop a theoretical model of selection and prevention demonstrating this problem with conventional risk adjustment and suggesting a simple alternative: risk adjustment should be linked to pay‐for‐performance for prevention.     

Determinants of healthcare spending: a state level analysis

Within the high and rising level of healthcare spending for the US as a whole is substantial variation in spending across states. Yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures, and therefore little empirical evidence exists at the state level to guide policymakers. Using data for all 50 states for the year 1998, we estimate an empirical model that includes structural and reduced-form healthcare spending equations and a health production function to assess the significance, size and relative importance of factors that prior research indicates, may play an important role in explaining interstate variation in medical care expenditures, and the main pathways through which they operate. Our results indicate higher levels of healthcare spending for state populations with higher income, less education, fewer uninsured residents, less healthy lifestyles, larger proportion of elderly residents, greater availability of medical care providers and less urbanization. Our findings suggest that the most effective cost containment measures may be those that increase education and promote healthy lifestyles. Not only do these actions lead to reductions in healthcare spending, they also improve the health status of the population, and may help to achieve other important social policy goals.     

Using the stochastic health state function to forecast healthcare demand and healthcare financing: Evidence from Singapore

Typically, healthcare financing for an ageing population requires projections on healthcare demand and cost. However, projecting healthcare demand based on projected elderly does not consider changes in population health state over time. This paper proposes a new approach to forecast health variables using a stochastic health state function and the well‐established Lee–Carter stochastic mortality model. With the estimated health state at each age over time, we project the hospitalization rate, healthcare demand, and financing cost for Singapore using historical life tables and hospital admission data. Our findings show that while hospital insurance claims increase owing to an aging population, improving health state could save costs from hospital insurance claims. This has policy implications: more attention should be given to preventive healthcare such as health screening to improve the overall health state of the population.     

Information Asymmetries and Risk Management in Healthcare Markets: The U.S. Affordable Care Act in Retrospect

This article critically examines the pertinent issues in ex ante and ex post moral hazard in healthcare markets, with the U.S. Affordable Care Act (ACA) as its focal point of inquiry. First, it compares the various types of information asymmetries resulting from the production, allocation, and utilization of health insurance. Second, it reviews the literature on adverse selection, moral hazard, and risk mitigation against which salient ACA reforms are analyzed. In contrasting conventional moral hazard from an alternative theory of welfare maximization, it suggests that healthcare (over)utilization cannot necessarily be considered wasteful, even if it ends up costing insurers more on a short-term basis. Costs and savings attributable to healthcare spending under the ACA will vary between the consumer, insurer, and regulator-subsidizer. Despite the ambiguities surrounding definitions of “health,” the challenge of containing inefficient moral hazard, and encouraging its desirable counterpart, lies in the tradeoffs that arise between consumer access to affordable and quality healthcare and the market competitiveness of health insurers. The new Trump administration will have to address these tradeoffs in repealing and replacing the ACA, particularly in light of escalating insurance premiums and deductibles, narrower provider networks, and technical implementation issues.     

Income Disparity, Inequity Aversion and the Design of the Healthcare System

An ex post social welfare function is used to evaluate alternative healthcare systems. If a society is averse to inequality and there is some income disparity, social welfare under private healthcare insurance is sometimes higher and sometimes lower than social welfare under public healthcare. However, a third system—public healthcare with the option to purchase supplemental healthcare insurance—is always socially preferred to private healthcare insurance. Moreover, it is either socially preferred to public healthcare or equivalent to it.     

Converging trends in national health services and social health insurance systems

Despite the difficulties in comparing the problems and solutions in the European healthcare system reforms, this paper will emphasise that there are signs of convergence among them given the way that they respond to similar challenges. By observing recent developments in national health services and social health insurance systems the focus will be on common trends. They both appear to favour models of (i) greater decentralisation of responsibilities in managing insurance coverage, (ii) population-based mechanisms to finance providers and (iii) more extensive consumer choice and additional private finance.