我国责任保险市场发展问题研究

本文系统研究中国责任保险市场发展基本状况,分别从我国责任保险的保费情况、市场份额、保险深度和密度等角度,分析责任保险市场发展现状及存在的问题,指出违法成本低、法律外部环境不健全、国家与保险公司重视程度不够是当前责任保险发展不足的主要原因。随后本文总结了发达国家责任保险的发展经验,并结合国内实际,提出了扩大责任保险的有效供给、增加责任保险的有效需求、因地制宜发展责任保险、完善与责任保险相关的法律法规以及部分责任保险需强制实施等在内的五条建议。     

Cancer survivors in the labor market: Evidence from recent US micro-panel data

Rising cancer survival rates and retiring at older ages improve the probability of labor market presence for cancer survivors. Yet, insufficient evidence exists on the labor market effects of male- and female- specific cancers. Therefore, using a theoretical construct of labor supply and health capital, this study exploits a nationally representative dataset, the 2008–2015 Medical Expenditure Panel Survey (MEPS), for estimating the correlated random effects (CRE) and over-dispersion empirical models to capture the job market effects for cancer survivors. After addressing the potential endogeneity of cancer and controlling for the number of years after cancer diagnoses, the estimated CRE model detect substantial male-female differences in the labor market outcomes for the survivors. Male and female cancer types adversely affect short- and long- run employment prospects, and male-specific cancers increase weekly hours of work and decrease short- and long- run annual labor incomes. Moreover, gender-specific cancers increasingly limit long run family incomes and raise total health expenditures in the short- and intermediate- runs but not in the long-run. Additionally, while the cancers increase the likelihood of missing a work day for both genders in the short-run the effect is larger for females. Finally, the total annual cost of workplace absenteeism for the employed male- and female- cancer survivors range from $0.58bn to $3.1 bn.     

加强医德医风建设促进医疗卫生制度改革

随着我国经济体制改革的不断深入，对医疗卫生制度改革的要求越来越高，医德医风建设日益重要。加强医德医风建设必须认清医德医风建设的意义，抓好医德医风建设工作的重点，并要有组织保证，促使医患关系缓和，构建和谐的医患关系，促进医疗卫生改革，推动医疗卫生事业的发展，是社会主义精神文明建设的迫切需要，为构建社会主义和谐社会作出贡献。     

Lessons learned from the national household food acquisition and purchase survey in the United States

The National Household Food Acquisition and Purchase Survey conducted in 2012 (FoodAPS-1) was an ambitious survey of Americans’ food acquisitions sponsored by the U.S. Department of Agriculture (USDA). The survey was challenging due to its goals of collecting comprehensive acquisition information and including data from extant sources to broaden the survey’s research capabilities. Some challenges were foreseen, and efforts were taken to overcome them through survey design features. Other challenges came as a surprise. This paper shares the experiences of the authors and others at USDA with survey design, survey implementation, and post-survey processing of data to ensure the availability of high-quality data to the research community. Lessons from FoodAPS-1 can inform similar future data collections both in the U.S. and abroad.     

Connecting with prospective medical tourists online: A cross-sectional analysis of private hospital websites promoting medical tourism in India,Malaysia and Thailand

Websites of private hospitals promoting medical tourism are important marketing channels for showcasing and promoting destinations' medical facilities and their array of staff expertise, services, treatments and equipment to domestic and foreign patient-consumers alike. This study examines the websites of private hospitals promoting medical tourism in three competing Asian countries (India, Malaysia and Thailand) in order to look at how these hospitals present themselves online and seek to appeal to the perceived needs of (prospective) medical tourists. The content and format of 51 hospitals are analyzed across five dimensions: hospital information and facilities, admission and medical services, interactive online services, external activities, and technical items. Results show differences between Indian, Malaysian and Thai hospital websites, pointing to the need for hospital managers to improve their hospitals’ online presence and interactivity.     

Empirical research on smart city construction and public health under information and communications technology

Big data and the internet of things in smart cities play an increasingly important role in the health of urban residents. However, few studies have collected empirical evidence to determine whether the implementation of smart cities can have a positive impact on healthcare. Using three years of panel data from the CHARLS national baseline survey, we examined whether and how smart city construction affects the health status of residents. The results show that the construction of smart cities improves residents’ health status. This relationship is achieved by reducing the use of outpatient services and increasing the utilization of inpatient services. Furthermore, compared with urban residents, rural residents show more significant behavioural changes in their use of medical services under the influence of smart city construction.     

Cost and mortality impact of an algorithm-driven sepsis prediction system

Aims: To compute the financial and mortality impact of InSight, an algorithm-driven biomarker, which forecasts the onset of sepsis with minimal use of electronic health record data.

Methods: This study compares InSight with existing sepsis screening tools and computes the differential life and cost savings associated with its use in the inpatient setting. To do so, mortality reduction is obtained from an increase in the number of sepsis cases correctly identified by InSight. Early sepsis detection by InSight is also associated with a reduction in length-of-stay, from which cost savings are directly computed.

Results: InSight identifies more true positive cases of severe sepsis, with fewer false alarms, than comparable methods. For an individual ICU with 50 beds, for example, it is determined that InSight annually saves 75 additional lives and reduces sepsis-related costs by $560,000.

Limitations: InSight performance results are derived from analysis of a single-center cohort. Mortality reduction results rely on a simplified use case, which fixes prediction times at 0, 1, and 2?h before sepsis onset, likely leading to under-estimates of lives saved. The corresponding cost reduction numbers are based on national averages for daily patient length-of-stay cost.

Conclusions: InSight has the potential to reduce sepsis-related deaths and to lead to substantial cost savings for healthcare facilities.     

Evolving provider payment models and patient access to innovative medical technology

Objective:

To investigate the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology.

Methods:

Structured interviews with leading private payers representing over 110 million commercially-insured lives exploring current and planned use of P4P provider payment models, evidence requirements for technology assessment and new technology coverage, and the evolving relationship between the two topics.

Results:

Respondents reported rapid increases in the use of P4P and risk-sharing programs, with roughly half of commercial lives affected 3 years ago, just under two-thirds today, and an expected three-quarters in 3 years. All reported well-established systems for evaluating new technology coverage. Five of nine reported becoming more selective in the past 3 years in approving new technologies; four anticipated that in the next 3 years there will be a higher evidence requirement for new technology access. Similarly, four expected it will become more difficult for clinically appropriate but costly technologies to gain coverage. All reported planning to rely more on these types of provider payment incentives to control costs, but didn’t see them as a substitute for payer technology reviews and coverage limitations; they each have a role to play.

Limitations:

Interviews limited to nine leading payers with models in place; self-reported data.

Conclusion:

Likely implications include a more uncertain payment environment for providers, and indirectly for innovative medical technology and future investment, greater reliance on quality and financial metrics, and increased evidence requirements for favorable coverage and utilization decisions. Increasing provider financial risk may challenge the traditional technology adoption paradigm, where payers assumed a ‘gatekeeping’ role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an additional hurdle to the adoption of new technology, rather than substitution of provider- for payer-based gatekeeping.     

新型农村合作医疗的减贫、增收和再分配效果研究

本文使用2003~2006年覆盖全国30个省区的微观面板数据,对新型农村合作医疗的减贫、增收和再分配效果进行了评估。结果表明:新农合的减贫效果明显,不仅能在农户层面上显著降低贫困发生概率,而且能在省区层面上显著降低贫困率;新农合能显著促进低收入和中等收入农民增收,但需要有利的外部经济环境作为支持条件;新农合能显著降低村庄内部的收入分配不均等程度,但对省区范围内的农民收入分配状况没有产生显著影响。