浅议国有公立医院引入社会资本的风险及对策

近年来,国家和各地方政府出台多项政策鼓励社会资本以多种方式参与包括国有企业所办医院在内的公立医院改制,促进公立医院合理布局,形成多元化办医格局。截至2017年为止,全国已有多家公立医院试水与社会资本进行多种方式的合作,尤其是原国有企业下属的职工医院参与的居多。但在具体实践阶段,双方合作并非一帆风顺,这是由于公立医院的公益性与社会资本的营利性这一根本矛盾引起的。那么,公立医院在引入社会资本的合作过程中是否存在一定的风险,以及为化解风险有哪些对策,如何使公立医院实现优化配置,使百姓得实惠、医院得发展、政府得民心、投资得回报能够落实,是现阶段公立医院改革中必须处理好的问题。     

引进社会资本办院，公立医院财务管理探讨

近年来,随着我国医疗卫生体制改革的不断深入,原有的政府办医的单一模式缺乏竞争,效率低下,越来越无法满足社会的需求,通过不断提高医疗市场的开放度,引进社会资本办院已明确成为下一步医改的发展方向。随着社会资本的引进,公立医院财务管理亟待改革。本文通过阐述目前公立医院财务管理存在的问题,分析了社会资本的引进对公立医院的影响,并对改善公立医院财务管理措施进行了探讨。     

全球性公立医院的法人治理模式变革--探寻国家监管与市场效率之间的平衡

公立医院在许多国家的医疗服务体系中都存在。不管是否具有主导性,传统的公立医院作为庞大科层体系中的预算单位,程度不等地存在着效率低下和质量低劣的问题。公立医院的治理变革乃是全球性公共管理大变革的一个组成部分,而其大趋势就是引入竞争、引入市场机制、引入基于市场的新型监管体制。具体而言,公立医院的改革有三大模式,即自主化、公司化和民营化。不论采取何种模式,最为重要的是实质性地改变医院与政府的关系。所有改革均涉及到以新型的契约关系来取代原有体制下政府与医院之间的行政关系。     

政府和社会资本合作(PPP)模式下风险分配探析

财政部《政府和社会资本合作模式操作指南(试行)的通知》(财金[2014]113号)第十一条指出:"按照风险分配优化、风险收益对等和风险可控等原则,综合考虑政府风险管理能力、项目回报机制和市场风险管理能力等要素,在政府和社会资本间合理分配项目风险。"文章就政府和社会资本合作(PPP)模式下,风险分配的原则、机制、类别以及风险承担的主体进行了探讨,并提出了四点实际操作建议。     

以PPP模式推动“一带一路”建设的思考北大核心SSCI

“一带一路”沿线发展中国家大多基础设施建设落后。严重制约了其经济发展。“一带一路”倡议将设施联通作为合作重点之一,为社会资本参与沿线国家基础设施建设提供了诸多机遇。PPP模式将社会资本引入基建领域,既可以弥补资金缺口,又可以为发展中国家带去先进的技术和管理经验,是值得推广的合作模式。本文总结了沿线发展中国家PPP模式的发展现状和特点,分析了在沿线发展中国家开展PPP模式面临的主要风险,并从政府层面、行业层面、企业层面对中国企业在沿线发展中国家开展PPP模式提出政策建议。     

我国文化产业PPP项目运营模式选择

我国PPP模式应用于文化产业领域的时间较晚,且资本合作方式单一,其中传统的BOT模式制约了社会资本与政府部门的深入合作.本文根据文化产业项目的类型选择给出恰当的项目运营模式选择,从而有利于社会创意的发挥和政府部门的管理.     

财政补偿体制演变与公立医院去行政化改革

本文首先梳理了建国以来公立医院财政补偿模式的演变过程,并分析了其特征。时至今日,公立医院收入主要来自于社会医保支付,财政直接投入占公立医院收入比例已经很低,其投入目的并非为了维持公立医院的公益性目标,而是在维持财政养人的旧体制。然后本文简要综述了近三十年以来英国、德国和中国台湾地区公立医院财政补偿模式的变革路径,由预算拨款转变为签约购买服务,是这一变革的核心内容,目的在于创造有效的激励机制和问责机制,一方面鼓励公立医院运用其自主权提高绩效,另一方面通过引入竞争实现优胜劣汰。在这些分析的基础上,从改革财政补偿模式的角度,本文分析了中国公立医院去行政化改革的政策选择。     

PPP模式在我国保障性住房中的应用研究

随着我国在公共产品与服务的供给中,对于社会资本所发挥的作用的日益重视.PPP模式作为一种政府部门与社会资本合作的机制,得到了社会广泛的关注与试点实践.相较于传统的公共产品与服务提供方式,PPP模式通过引入社会资本竞争、建设与运营,具有更高的效率,且能在一定程度上减轻政府财政负担.将PPP模式引入我国保障性住房中,对于增加保障房供给数量,破解资金来源不足,提高运营效率等方面均具有重要的意义.本文阐述了PPP模式与保障性住房的基本概念,对我国公共租赁住房PPP项目的运作模式、操作程序进行了说明并探究了推进我国保障性住房应用PPP模式的四点关键.     

PPP模式下准经营性项目风险识别研究

PPP(Public Private Partnership)模式凭借其引入社会资本与政府合作进行基础设施建设的特点,得到政府的大力推广.由于准经营性基础设施项目存在收益甚微、需要政府给予财政补助等特殊性,而在政府财政资源紧张的情况下,引入PPP不失为一种有效对策,因此本文首先通过文献阅读以及案例研究初步确定风险指标体系,其次发放问卷,回收数据,并采用熵权法问卷数据进行处理,从而对PPP模式下准经营性基础设施项目中存在的风险进行识别研究.     

加强PPP监管体系建设构建良性生态圈

政府和社会资本合作(PPP)模式是政府与社会资本之间的合作博弈,既需保障公共利益,又要兼顾社会资本的合理收益,对现有的监管体系提出了不小的挑战.本文指出,当前我国PPP监管体系存在统一顶层设计有待完善、统筹协调管理机制有待健全、公众监管的作用有待发挥等问题,并就加强我国PPP监管体系建设提出了建议.     

Forecasting the price of gold

This article seeks to evaluate the appropriateness of a variety of existing forecasting techniques (17 methods) at providing accurate and statistically significant forecasts for gold price. We report the results from the nine most competitive techniques. Special consideration is given to the ability of these techniques to provide forecasts which outperforms the random walk (RW) as we noticed that certain multivariate models (which included prices of silver, platinum, palladium and rhodium, besides gold) were also unable to outperform the RW in this case. Interestingly, the results show that none of the forecasting techniques are able to outperform the RW at horizons of 1 and 9 steps ahead, and on average, the exponential smoothing model is seen providing the best forecasts in terms of the lowest root mean squared error over the 24-month forecasting horizons. Moreover, we find that the univariate models used in this article are able to outperform the Bayesian autoregression and Bayesian vector autoregressive models, with exponential smoothing reporting statistically significant results in comparison with the former models, and classical autoregressive and the vector autoregressive models in most cases.     

Planned adaptation in risk regulation: An initial survey of US environmental, health, and safety regulation

In principle, we want regulatory programs to be based on current realities, as reflected for example in the best knowledge of relevant experts. That would imply that old rules now on the books should be consistent with today's knowledge base, not just what was known when a rule or standard was originally set. This paper reports on a survey of US programs, examining how often existing rules are actually updated in light of better knowledge, and identifies five programs that attempt to make policy routinely adaptive. These programs exhibit what we term Planned Adaptation: they both revise rules when relevant new knowledge appears, and take steps to produce such improved knowledge. While Planned Adaptation is rare, it is used in several nationally prominent programs, including air pollution, airplane safety, and drug safety. Planned Adaptation is a policy tool that deserves more attention.     

Pleasure and belief in Hume's Decision Process

Abstract

The purpose of this paper is to introduce explicitly pleasure and belief in what aims at being a Humean theory of decision, like the one developed in Diaye and Lapidus (2005a). Although we support the idea that Hume was in some way a hedonist – evidently different from Bentham's or Jevons' way – we lay emphasis less on continuity than on the specific kind of hedonism encountered in Hume's writings (chiefly the Treatise, the second Enquiry, the Dissertation, or some of his Essays). Such hedonism clearly contrasts to its standard modern inheritance, expressed by the relation between preferences and utility.

The reason for such a difference with the usual approach lies in the mental process that Hume puts to the fore in order to explain the way pleasure determines desires and volition. Whereas pleasure is primarily, in Hume's words, an impression of sensation, it takes place in the birth of passions as reflecting an idea of pleasure, whose “force and vivacity” is precisely a “belief”, transferred to the direct passions of desire or volition that come immediately before action. As a result, from a Humean point of view, “belief” deals with decision under risk or uncertainty, as well as with intertemporal decision and indiscrimination problems.

The latter are explored within a formal framework, and it is shown that the relation of pleasure is transformed by belief into a non-empty class of relations of desire, among which at least one is a preorder.     

The greenhouse effect: Damages,costs and abatement

The buildup of so-called greenhouse gases in the atmosphere — CO₂ in particular-appears to be having an adverse impact on the global climate. This paper briefly reviews current expectations with regard to physical and biological effects, their potential costs to society, and likely costs of abatement. For a worst case scenario it is impossible to assess, in economic terms, the full range of possible non-linear synergistic effects. In the most favorable (although not necessarily likely) case (of slow-paced climate change), however, it seems likely that the impacts are within the affordable range, at least in the industrialized countries of the world. In the third world the notion of affordability is of doubtful relevance, making the problem of quantitative evaluation almost impossible. We tentatively assess the lower limit of quantifiable climate-induced damages at $30 to $35 per ton of CO₂ equivalent, worldwide, with the major damages being concentrated in regions most adversely affected by sea-level rise. The non-quantifiable environmental damages are also significant and should by no means be disregarded.The costs and benefits of (1) reducing CFC use and (2) reducing fossil fuel consumption, as a means of abatement, are considered in some detail. This strategy has remarkably high indirect benefits in terms of reduced air pollution damage and even direct cost savings to consumers. The indirect benefits of reduced air pollution and its associated health and environmental effects from fossil-fuel combustion in the industrialized countries range from $20 to $60 per ton of CO₂ eliminated. In addition, there is good evidence that modest (e.g. 25%) reductions in CO₂ emissions may be achievable by the U.S. (and, by implication, for other countries) by a combination of increased energy efficiency and restructuring that would permit simultaneous direct economic benefits (savings) to energy consumers of the order of $50 per ton of CO₂ saved. A higher level of overall emissions reduction — possibly approaching 50% — could probably be achieved, at little or not net cost, by taking advantage of these savings.We suggest the use of taxes on fossil fuel extraction (or a carbon tax) as a reasonable way of inducing the structural changes that would be required to achieve significant reduction in energy use and CO₂ emissions. To minimize the economic burden (and create a political constituency in support of the approach) we suggest the substitution of resource-based taxes in general for other types of taxes (on labor, income, real estate, or trade) that are now the main sources of government revenue. While it is conceded that it would be difficult to calculate the optimal tax on extractive resources, we do not think this is a necessary prerequisite to policy-making. In fact, we note that the existing tax system has never been optimized according to theoretical principles, and is far from optimal by any reasonable criteria.During the academic year 1989–90 Dr. Ayres was at the International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria.During the summer of 1989 Mr. Walter was a member of the Young Scientists' Summer Program at IIASA.     

Globalization,Neoliberalism and the attack on social security

Neoliberal political movements advocate privatization of public pension systems. Globalization imposes pressure on nations to conform to neoliberal policy views with respect to the design and structure of social insurance, including public pension systems. The paper begins with an investigation of the economic, ethical and ideological dimensions of the privatization debates in the U.S.; it argues that privatization advocates may be largely moved by ideology, since the other reasons advanced appear weak or unfounded. The second part discusses the history of Social Security, the purposes for its creation, and some of its economic effects. Differences between public and private pension systems are considered. A brief international comparison of some aspects of public pension system finance and benefit structures is presented. The final section considers the ethical, macroeconomic and distributional implications of privatization, prefunding and payroll tax funding, and argues for a pay as you go system financed with income taxes. In order to promote equity, economic security, community, and social cohesion, public pension systems should be universal in coverage. In order to reduce the inequality, income insecurity, and aged poverty generated by market economies, public pension systems ought to be progressive: benefit/contribution ratios should be inversely proportional to income, and progressive income taxes should finance the system. To promote economic growth, the systems should be financed on a pay-as-you-go basis, and should not be prefunded except for an emergency reserve. The fiscal policy recommendations partially depend upon the theory developed by Abba Lerner in the 1940s, and recently advanced by Wynne Godley and Randy Wray: Lerner's “principle of functional finance.”     

SCIENCE AND INDUSTRY: TRACING THE FLOW OF BASIC RESEARCH THROUGH MANUFACTURING AND TRADE

This paper describes flows of basic research through the US economy during the late 20th century. In addition, the paper studies the effect of the flows on scientific papers in industries and fields. This article differs from others in its use of measures of science rather than technology. Together, its results present a picture of the structure of basic research flows in a modern, science-intensive economy. Basic research flows are large within petrochemicals and drugs, and within software and communications. Flows of chemistry, physics, and engineering are common throughout all industries – biology and medicine are almost confined to petrochemicals and drugs; and computer science is nearly as restricted to software and communications. In general, basic research flows are more concentrated within scientific fields than within industries. Our findings concerning the production of scientific papers indicate that the effect of a 1% change in academic R&D spillovers significantly exceeds that of industrial spillovers. In addition, within-field effects exceed effects between-fields, while within- and between-industry effects are roughly equal. It follows that scientific fields limit basic research flows more than industries do, perhaps because large firms implicitly span a range of industries.     

Valuing Mangrove-Fishery Linkages – A Case Study of Campeche, Mexico

This paper explores the value of mangrove systems as a breeding and nursery habitat for off-shore fisheries, focusing on mangrove-shrimp production linkages in Campeche State, Mexico. We develop an open access fishery model to account explicitly for the effect of mangrove area on carrying capacity and thus production. From the long-run equilibrium conditions of the model we are able to establish the key parameters determining the comparative static effects of a change in mangrove area on this equilibrium. We then estimate empirically the effects of changes in mangrove area in the Laguna de Terminos on the production and value of shrimp harvests in Campeche over 1980–90. Our findings suggest that mangroves are an important and essential input into the Campeche shrimp fishery, but that the low levels of deforestation between 1980 and 1990 mean that the resulting losses to the shrimp fishery are still comparatively small. Over-exploitation of the fishery due to open access conditions remains the more pervasive threat, and without better management any long-run benefits of protecting mangrove habitat are likely to be dissipated.     

Interest on reserves and inflation

The payment of interest on reserves has been a common practice in inflationary economies. This policy may seem paradoxical since it involves returning part of the seigniorage, generated by the inflation process, with the intention to finance the fiscal deficit. This paper argues that the motivation for this policy can be captured by the discretionary regime, where the policymaker pays interest on reserves because he is concerned with the erosion of real liquidity by inflation, which is in part beyond his control. However, this policy is an unlikely outcome in the commitment regime, where the policymaker is in full control of inflation.     

An Economic Analysis and Simulation of Woodfuel Management in the Sahel

This paper presents an economic framework and a computationalmethodology for assessing the evolution of woodfuel supply costsand the spatial distribution of biomass in a Sahelian woodlandsetting. Spatial data on standing stock and the costs oftransport to market are used to construct a supply curve for fuelto a fuel-consuming location. Given an exogenously specifieddemand, the model simulates, period by period, the extraction,regeneration, and transport of wood fuels. The model is appliedto evaluate the benefits and ecological impacts of scenarios forwoodland management around the city of N'Djamena, Chad.