完善制度 强化管理 秦皇岛市积极推进医疗保险制度持续健康发展

2001年1月,秦皇岛市正式启动医疗保险工作,经过7年的探索和实践,初步构建了以基本医疗保险为基础,大额医疗保险、企业补充医疗保险、公务员医疗补助、特困职工医疗补助为补充以及离休干部医药费统筹多层次的医疗保障体系;基本建立了“以收定支、收支平衡、略有节余”的基金良性运行机制,顺利实现了新旧医疗保险制度的平稳过渡。     

日本社会医疗保险基金运作研究及借鉴

社会医疗保险基金的良性运行与收支平衡是实现社会医疗保险制度可持续发展的关键.我国自建立多层次多体系的社会医疗保险体系以来,取得了巨大成就,但是在医疗保险基金的运作方面仍存在很多问题.本文通过对日本的社会医疗保险基金运作的介绍与分析,提出我国可以学习与借鉴的地方,以期进一步完善我国的社会医疗保险制度.     

商业医疗保险亟待创新

在社会医疗保险制度的改革过程中 ,商业医疗保险受到了前所未有的关注 ,合理开发商业医疗保险将成为保险公司一个新的经济增长点。然而商业医疗保险却并未像人们预期的那样迅速发展。只有创新才能开创商业医疗保险的新局面 ,才能实现消费者与保险公司的双赢。     

全民社会医疗保险探索

本文深入剖析了我国医疗保险的现存问题，提出由政府组建专业性保险公司作为保险申介人，通过管理式医疗模式将保险中介人、医疗服务提供者、投保人三方组织起来，共同构建适合我国国情的全民社会医疗保险模式。     

对市医疗保险特殊病种门诊管理的调研

特殊病种门诊的“特”是相对普通门诊而言的，与普通门诊相比，特殊病种门诊医疗的费用是参照住院费用进行核算的，普通门诊的医疗费用只能由个人帐户或现金100％承担，特殊病种门诊医疗的费用，可由统筹基金承担70％-80％，治疗费用同时可与住院费用累计进入大额补充医疗保险支付范畴。     

上海铁路局补充医疗保险风险管理的分析与思考

风险管理对铁路企业补充医疗保险非常重要.通过有效的风险管理使补充医疗保险健康地发展,成为我们补充医疗保险管理者需要研究的课题.上海铁路局统一职工补充医疗保险待遇后,基金支出逐年上升,我们在分析增长的各种外部和内部等风险因素后必须加以应对,把风险控制在可控的范围内,使上海铁路局补充医疗保险平衡有序地发展,服务于铁路改革的大局.     

医疗保险市场道德风险防范初探

商业医疗保险的市场潜力巨大，但发展缓慢。医疗保险的风险控制能力，特别是对医疗保险市场上道德风险的控制，决定了保险公司发展商业医疗保险的意愿，是医疗保险的核心问题。我国医疗保险市场上的道德风险既有普遍性，又有特殊性，其后果是医疗费用的膨胀和保险公司经营困难。保险企业应该对来自投保人和医疗机构的道德风险采取不同的措施进行控制，以发展我国的医疗保险事业。     

我国补充医疗保险制度研究

补充医疗保险作为我国医疗保障体系中的重要组成部分,其产生和发展是我国医疗保障制度深化改革的必然要求,也是满足公众多层次医疗需求的必然结果。因此,分析了我国补充医疗保险制度的发展概况,探讨了我国补充医疗保险制度完善的要点,以及补充医疗保险背景、内容、保障金管理模式及便捷的报销程序,补充医疗保险的对我国保险发展的影响,以为完善我国补充医疗保险制度提供参考依据。     

日本社会医疗保险基金运作研究及借鉴

社会医疗保险基金的良性运行与收支平衡是实现社会医疗保险制度可持续发展的关键。我国自建立多层次多体系的社会医疗保险体系以来,取得了巨大成就,但是在医疗保险基金的运作方面仍存在很多问题。本文通过对日本的社会医疗保险基金运作的介绍与分析,提出我国可以学〉-7与借鉴的地方,以期进一步完善我国的社会医疗保险制度。     

职工补充医疗保险需求及其解决方案

目前正在推行的城镇职工基本医疗保险制度规定有一定的支付范围和支付限额,支付范围以外和支付限额以上的医疗费用只能靠补充医疗保险来解决。本以四川省为例,通过对职工医疗费用特别是高额医疗费用支出情况的分析,揭示各类单位和职工对补充医疗保险的需求模式及特点,并在此基础上提出了解决上述问题的具体方案。     

Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

INSURANCE‐INDUCED MORAL HAZARD: A DYNAMIC MODEL OF WITHIN‐YEAR MEDICAL CARE DECISION MAKING UNDER UNCERTAINTY

This study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within‐year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost‐sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision‐making models commonly found in the literature.     

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

政府责任视角商业保险参与新农合的前世今生——我国农村合作医疗保险制度变迁的视角

基于我国农村医疗保障制度的变迁,对我国新型农村医疗保险最终选择以政府责任为主导的商业化运作模式,从农村医疗保障＂公共品视角＂、农村合作医疗制度变迁路径依赖、商业保险参与新农合运行缺陷,以及国际上现有医疗保障模式比较等方面进行释疑。同时,指出新农合的商业化运作模式发展过程中,政府责任应包括制订相关政策法规、确保管理费的足额到位、加强对农民的宣传教育以及合理的制度设计,明确各方权利义务。     

中国城镇社会医疗保障改革的理论探索

With its transition to a market-oriented economy, China has gone through significant changes in health care delivery and financing systems in the last three decades. Since 1998, a new public health insurance program for urban employees, called Basic Medical Insurance Program (BMI), has been established. One theme of this reform was to control medical service over-consumption with new cost containment methods. This paper attempts to evaluate the effects of the reformed public health insurance on health care utilization, with in-depth theoretical investigation. We formulate a health care demand model based on the structure of health care delivery and health insurance systems in China. It is assumed in the model that physicians have pure monopoly power in determining patients’ health care utilization. The major inference is that the insurance co-payment mechanism cannot reduce medical service over-utilization effectively without any efforts to control physicians’ behavior. Meanwhile, we use the calibrated simulation to demonstrate our hypothesis in the theoretical model. The main implication is that physicians’ incentive to over utilize medical services for their own benefits is significant and severe in China.      

A dynamic analysis of the demand for health insurance and health care

We find that asymmetric information is important for the uptake of supplementary private health insurance and health care utilization. We use dynamic panel data models to investigate the sources of asymmetric information and distinguish short-run selection effects into insurance from long-run selection effects. Short-run selection effects (i.e. responses to shocks) are adverse, but small in size. Also long-run effects driven by differences in, for example, preferences and risk aversion, are small. But we find some evidence for multidimensional asymmetric information. For example, mental health causes advantageous selection. Estimates of health care utilization models suggest that moral hazard is not important.     

非理性就医对医保费用管理的挑战及应对策略

目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。     

城镇居民基本医疗保险适度缴费率分析

城镇居民基本医疗保险缴费率是指把城镇居民纳入基本医疗保险体系后,从社会平均水平看,在一定时期内(通常为一个月)各参与主体为城镇居民所缴纳的基本医疗保险费占工资的比重。通过构建城镇居民基本医疗保险适度缴费率模型,根据模型对城镇居民基本医疗保险适度缴费率进行测算,对现行城镇居民基本医疗保险实际缴费率的适度状况进行了判断,并提出相应的策略选择。     

目标替代率下的企业年金缴费率——基于税收优惠视角分析

企业年金作为我国养老保险体系中的第二支柱,因缺乏税收优惠政策而发展滞后,难以形成对基本养老保险的有力补充。通过将税收优惠政策和企业年金缴费率联系在一起进行考察,建立年金基金平衡模型,计算出为实现企业年金的目标替代率政府应实行多大程度的税收优惠政策。并运用成本——收益理论对这一税收优惠政策进行可行性评价,最终得到企业年金税收优惠政策能够以较小成本换来企业年金较大发展,并能够较大程度地提高整个社会福利水平的结论。     

国外产学研合作模式比较研究及启示

以何种模式进行合作是产学研合作过程中的一个重要问题,各国在产学研合作的实践过程中都形成了不同的模式。本文介绍了6个典型国家的产学研合作模式,并作了对比分析,分析结论对我国高校产学研合作创新提供了一些启示：高校应摆脱传统科研体制的观念束缚,消除产学研合作的传统边界,加快产学研合作的开放性与国际化;充分整合高校的各种社会资源,探索全方位、多元化、深层次的产学研合作模式;改革新形势下产学研合作的制度环境,变被动合作为主动合作。