Das Hamburger Beihilfemodell – Ein Vergleich der internen Renditen von GKV und PKV

At the beginning of their career civil servants in Germany can choose between the social health insurance system and a private plan combined with a direct reimbursement of the government up to 80%. Most civil servants chose the latter, also because they have to cover all contribution payments to the social system themselves, while normal employees get nearly 50% from their employers. The state of Hamburg decided to change the system by paying a share of the contributions if civil servants choose the social plan. Using a comparison of internal rates of return in both schemes, we show that this celebrated reform will not change the decision calculus for the average civil servant household and will probably thereby increase the adverse selection of high risk cases towards the social health insurance.     

公务员养老金制度并轨改革的设计思路与精算评估

我国公务员与企业职工的退休待遇存在巨大差距,养老保险制度的公平性备受质疑,由制度差异带来的阻碍人才流动等弊端日益凸显,已成为近年来社会关注的焦点问题,本文在分析公务员的职业特点及其养老保障特殊性的基础上,借鉴国际经验,并基于融入全国统一的养老金体系和保护公务员既得权益的考虑,给出了公务员养老金改革应采取“基本养老金＋职业年金”的设计思路和具体方案,测算分析了改革方案对个人和财政支出的影响以及在实施上的可行性。     

ECONOMIC ANALYSIS FOR HEALTH PROJECTS

This paper applies to the health sector a method of projectanalysis advocated recently by Devarajan, Squire, and Suthiwart-Narueput.A health project evaluation should establish a firm justificationfor public involvement; establish the counterfactual—whatwould happen with and without the project; and determine thefiscal effect of the project and the appropriate levels of feesin conjunction with project evaluation. The evaluation shouldalso acknowledge the fungibility of project resources and examinethe incentives both for high-level public servants to shiftgovernment resources away from project-funded activities tothose that have not been evaluated and for lower-level contractorsand civil servants to provide good or bad service. Market failuresin health services and insurance markets should serve as a startingpoint for economic analysis, not as a reason to ignore economicsin health projects. Project outputs should be predicted aftertaking into account the reaction of consumers and providersin the private sector as well as market structures of supply,demand, and equilibrium for health services.      

The Spillover effect of compulsory insurance

The assumption usually made in the insurance literature that risks are always insurable at the desired level does not hold in the real world: some risks are not—or are only partially—insurable, while others, such as civil liability or health and workers' injuries, must be fully insured or at least covered for a specific amount. We examine in this paper conditions under which a reduction in the constrained level of insurance for one risk increases the demand of insurance for another independent risk. We show that it is necessary to sign the fourth derivative of the utility function to obtain an unambiguous spillover effect. Three different sufficient conditions are derived if the expected value of the exogenous risk is zero. The first condition is that risk aversion be standard—that is, that absolute risk aversion and absolute prudence be decreasing. The second condition is that absolute risk aversion be decreasing and convex. The third condition is that both the third and the fourth derivatives of the utility function be negative. If the expected value of the exogenous risk is positive, a wealth effect is added to the picture, which goes in the opposite direction if absolute risk aversion is decreasing.     

Consumer Response to a National Marketplace for Individual Health Insurance

The objective of this analysis is to simulate the difference between national and state‐specific individual insurance markets on take‐up of individual health insurance. This simulation analysis was completed in three steps. First, we reviewed the literature to characterize the state‐specific individual insurance markets with respect to state regulations and to identify the effect of those regulations on health insurance premiums. Second, we used empirical data to develop premium estimates for the simulation that reflect case‐mix as well as state‐specific differences in health care markets. Third, we used a revised version of the 2005 Medical Expenditure Panel Survey (MEPS) to complete a set of simulations to identify the impact of three different scenarios for national market development. (National market estimates are based on the simulation model with competition among all 50 states and moderate impact assumptions.) We find evidence of a significant opportunity to reduce the number of uninsured under a proposal to allow the purchase of health insurance across state lines. The best scenario to reduce the uninsured, numerically, is competition among all 50 states with one clear winner. The most pragmatic scenario, with a good impact, is one winner in each regional market.     

Nachhaltigkeit und Erschwinglichkeit gemeindegetragener Krankenversicherungen in Afrika — Eine Fallstudie aus Nouna Distrikt,Burkina Faso

Many African countries developed national health insurance schemes after independence. However, merely public servants were eligible to subscribe. The majority of the population resides in rural areas where health care services of hospitals and dispensaries were free of charge. The economic crisis of these countries has changed this situation. Currently, almost all health services charge direct user fees so that a severe disease leads to a threat for the entire family of the diseased. Consequently, first community-based health insurances were introduced ten years ago.This paper analyses the effect of these insurance schemes on the service provision for the rural poor with the example of the proposed community-based health insurance in Nouna, Burkina Faso. The insurance can only be sustained if the premium is so high that about 50% of the population cannot afford it. Therefore, this insurance will neither benefit them nor will their situation improve. We have to ask whether a programme that betters the state of the well-off while leaving the condition of the poor unchanged is fair and just. For this purpose different aspects of equity are discussed. The author concludes that the premium-induced exclusion of 50% of the population from the insurance is only acceptable if the privileged use this benefit for economic growth which will finally benefit the poor.     

The Effects of Uncertainty on the Demand for Health Insurance

This article analyzes the effects of uncertainty and increases in risk aversion on the demand for health insurance using a theoretical model that highlights the interdependence between insurance and health care demand decisions. Two types of uncertainty faced by the individuals are examined. The first one is the uncertainty in the consumer's pretreatment health and the second is the uncertainty surrounding the productivity of health care. Comparative statics results are reported indicating the impact on the demand for insurance of shifts in the distributions of pretreatment health and productivity of health care in the form of first‐order stochastic dominance, Rothschild–Stiglitz mean‐preserving spreads, and second‐order stochastic dominance. The demand for insurance increases in response to a Rothschild–Stiglitz increase in risk in the distribution of the pretreatment health provided that the health production function is in a special class and the price elasticity of health care is nondecreasing in the pretreatment health. Provided also that the demand for health care is own‐price inelastic, the same conclusion is obtained when the uncertainty is about the productivity of health care.     

我国寿险公司效率评价及其影响因素分析——基于修正的两阶段数据包络分析方法

弥补国内已有研究对有效率寿险公司无法进行比较的不足,以及两阶段数据包络分析方法中第一阶段和第二阶段假设逻辑不一致的缺陷,本文采用2005年～2007年我国23家寿险公司的数据,引入数据包络分析的超效率模型分析23家寿险公司的效率状况,并分别采用截断Tobit回归模型和对称截断最小二乘模型寻找影响我国寿险公司效率的环境因素。研究表明,对称截断最小二乘模型下的参数估计比较稳健。成立年数和市场份额对寿险公司效率的影响相对显著,市场份额的扩大有助于寿险公司效率的提高,而公司规模和所有权形式对寿险公司效率的影响并不显著,仅靠产权改革不能提高寿险公司的效率。     

A Special Breed?– A Longitudinal and Cross‐Sectional Study of Norwegian Budgeting and Financial Civil Servants

Abstract: This paper focuses on civil servants in the central Norwegian civil service whose main tasks are budgeting, supervision and accounting. The main research questions are: (a) What is their typical demographic profile? (b) How has their demographic profile changed over time? (c) What are the effects of having budgeting, supervising and accounting as a main task on civil servants’ attitudes and behaviour? The main findings are that they have a specific profile. There are significant differences between ministries and central agencies as well as changes over time and also marked differences with other civil servants regarding their attitudes and behavior.     

论我国社会养老保险制度的整合

产生于不同历史条件下的我国各类社会养老保险制度,呈现出明显的城乡二元结构和"碎片化试点"等特征。建立健全政府补贴和个人缴费相结合形式的社会养老保险制度是我国社会养老保险制度的发展方向。我国社会养老保险制度整合路径和实现步骤主要包括:将国家政府机关、事业单位人员养老金制度由现收现付模式改革为"社会统筹+个人账户"相结合模式;将城镇职工基本养老保险制度、有固定工作农民工养老保险制度整合为城乡职工社会养老保险制度;进一步加大新农保、城居保制度的整合力度,实现城乡居民社会养老保险制度的实际运作;在此基础上,将城乡居民社会养老保险制度、城乡职工养老保险制度、公务员社会养老保险制度整合为国民养老金制度,建立多层次的社会养老保险制度。     

Health and Wealth: How do They Affect Individual Preferences?

There is no consensus among health economists about the specification of individual preferences that best fits observed behaviors. One crucial point of disagreement concerns the sign of the interaction between health and wealth in individual utility functions. We propose here a simple, static, model where individuals have only one decision to make concerning their future health (say to get a flu shot). We derive very simple testable implications that allow to discriminate between three specifications that are commonly used in theoretical models: additive separability between health and consumption, multiplicative separability, and existence of a monetary equivalent of health. We also derive several implications on the pattern of the demand for health insurance.     

‘It’s every breath we take here’: Political astuteness and ethics in civil service leadership development

ABSTRACT

This paper uses survey and interview research with senior civil servants to argue that leadership with political astuteness is a specific contextual requirement for public servants who work closely with politicians. Also important are technical skills, judgement and a sharp sense of ethics and integrity. The fine balance of political astuteness and other capabilities is shown in a framework about leading in an ethical way. Implications for the development of civil servants are considered.     

Anforderungen an die Abbildung von Versicherungsunternehmen im Rahmen mathematisch-ökonomischer Modelle in der Unternehmenspraxis

The article analyses the requirements which are to be fulfilled when modelling the insurance business from an economic perspective by means of mathematical models. The goal of the discussion is to define what the management needs to draw meaningful conclusions for steering of an insurance company. The authors emphasise the importance of the objective of the analysis, the different views which are important when analysing an insurer (book value versus market value perspective) as well as the importance of the timeline in models. The inclusion of time and the resulting options serve as a reference for the classification of models as being dynamic or static. A discussion of the validity of the model results, in the context of the basic assumptions of the model used, is given at the end of the article.     

医疗保障对居民消费水平的影响——基于省级面板数据的实证研究

近年来,我国居民消费持续走低,在GDP中所占的比重持续下降,消费需求不足已经成为制约我国经济发展的重要因素之一。本文立足于保险学和消费者理论的基础,使用我国31个省、自治区、直辖市的面板数据,系统研究医疗保障体系对居民消费的影响,发现基本医疗保险和商业健康保险对于居民消费均具有明显促进作用,其中城镇居民基本医保对消费的刺激作用大于新农合医保,商业健康保险的促进作用要大于城镇职工基本医保。在此基础上,提出了相应的政策建议。     

Adapting not Adopting: 1958 - 74. Accounting and Managerial 'Reform' in the Early NHS

This paper examines accounting and managerial reform in the public sector National Health Service (NHS) hospitals in the UK from 1958-74. This period is often regarded as one of 'consolidation' (Klein, 1995; Webster, 1998) after the 'turmoil' of the early years of the NHS, though there were a number of attempts to improve 'efficiency' through initiatives largely rooted in commercial practice. There was a deeply embedded respect for local self governance rather than central 'command and control' (Harrison, 1988; Klein, 1995) and more ambitious reforms were avoided. Accounting practitioners and senior civil servants appeared to be content to adjust existing accounting processes rather than embrace major change. The paper concludes with a review of possible factors mitigating against more radical accounting innovation.     

Modeling the Impact of Genetics on Insurance

The role of probabilistic models in the debate over genetics and insurance is discussed. A Markov model is used to show that, under quite extreme assumptions, adverse selection in life insurance ought to be controllable. The statistical problems of estimating small differences in mortality are discussed; these might limit the use of many genetic disorders as rating factors. The influence of the insurance industry on policy-making, especially through its support of research, is discussed. It is suggested that participating contracts are suitable and simple vehicles to carry the genetic risks in life insurance.     

医疗保险、健康异质性与精准脱贫——基于贫困脆弱性的分析

医疗保险能否有效减少贫困,尚未达成共识。本文利用CHARLS全国调查数据,基于资产度量个体的贫困脆弱性(即陷贫概率),实证分析医疗保险参保行为及其保障水平对贫困脆弱性的影响。研究表明,参与医疗保险和提高医疗保险保障水平的减贫效果都存在健康异质性,对健康状况差的群体有显著的减贫效果,而对健康状况好的群体减贫效果不显著。此外,本文证实了改善劳动供给是医疗保险减贫的重要中介渠道之一。     

The Production of Goods in Excess of Demand: A Generalization of Self-Protection

We consider a risk-averse firm producing a limited number of goods that can be defective. The firm must determine its level of production before knowing which goods will be defective. Such is the case, for example, for a producer of telecommunications satellites. The problem under scrutiny can be interpreted as a generalization of self-protection for more than two states of nature. In our model, the firm determines jointly its level of production and its demand for insurance. It is shown that, under reasonable assumptions, the two strategies are complements.     

New Ways of Working: Political–Official Relations in the National Assembly for Wales

The National Assembly for Wales is a novel and unusual institutional design. Unlike Westminster style parliaments, it brings ministers and civil servants into close contact. This article considers how the relationships between the two have developed over the first year and a half of the National Assembly for Wales's life.     

Creating a profession ‘out of nothing’? The case of the Belgian auditing profession

This paper presents the results of a study on the emergence and development of an auditing profession in Belgium in the late 1940s and 1950s. Recent research on Anglo-Saxon professions stresses the role of the state in their development. In continental European contexts, the state played an even more significant role, and civil servants in public administration often served as a model for professional organization and behaviour. The main parties that were involved in the creation of the Belgian auditing profession were the state, the employers and the unions. The state maintained a separation between the Belgian profession of independent auditors, the reviseurs d'entreprises, and the associations of accounting professionals, the experts comptables, who tried first to prevent the creation of an auditing profession and then to obtain control over it. This paper demonstrates that the parties in the debate supported different professional models, depending on what they considered the main role of the auditors to be. The debates preceding and following the introduction of the profession focused on the autonomy and structure of the profession, the services to be provided by the auditors, and access to the profession.