普惠型医疗保险发展:实践困境与优化方向

近年来,普惠型医疗保险成为多层次医疗保障体系发展的一大热点。文章首先介绍了中国普惠型医疗保险的发展现状及主要特点,其次通过对国内部分保险公司线上及线下调研,发现当前普惠型医疗保险发展面临配套法律法规有待健全、市场认可度普遍偏低、可持续经营能力不强、保险效果低水平重复、相关主体联动不足等困境。进一步分析美国、英国、德国、新加坡相关经验,提出具体的优化路径:以优化顶层设计为立足点,提高保险规制水平;以强化市场环境建设为切入点,提升市场认可度;以优化运行模式为突破点,激发保险生命力;以设计差异化产品为关键点,强化保险增补性;以建立联通机制为动力点,提高相关主体协同度。     

Mortality,Human Capital and Persistent Inequality

Available evidence suggests high intergenerational correlation of economic status and persistent disparities in health status between the rich and the poor. This paper proposes a mechanism linking the two. We introduce health capital into a two-period overlapping generations model. Private health investment improves the probability of surviving from the first period of life to the next and, along with education, enhances an individual’s labor productivity. Poorer parents are of poor health, unable to invest much in reducing mortality risk and improving their human capital. Consequently, they leave less for their progeny. Despite convex preferences and technologies, initial differences in economic and health status may perpetuate across generations when annuities markets are imperfect.Additional support was provided by the National Science Foundation. Additional support was provided by the National Science Foundation.     

Altruism and the Economic Values of Environmental and Social Policies

Altruism is a type of non-use value which can have different definitions depending on the type of goods entering the utility function of the altruists and their expectations about the contributions of others. The purpose of this paper is to measure the trade-offs between different types of altruist values originating from social and environmental policies. Environmental policies are concerned with reducing health effects from a power plant while social policies involve both the attainment of public facilities for education and leisure and an increase in the income of the affected population. The empirical application utilizes a choice experiment technique which allows for valuation of multiple goods. Health effects are decomposed into the values of the risk of becoming ill, the duration of the episodes and the limitations imposed by illness. Altruist values are elicited from a population that is not affected by pollution. Results show that altruism is significant for policies directed to reducing health effects and improving the income level of the affected population, whereas there is egoism for a policy aimed at improving public facilities in the polluted suburb. The value of altruism is significantly influenced by the expectations of net benefits to be received by the affected population.     

Carbon Trading with Imperfectly Observable Emissions

The Kyoto Protocol foresees emission trading but does not yet specify verification of (uncertain) emissions. This paper analyses a setting in which parties can meet their emission targets by reducing emissions, by investing in monitoring (reducing uncertainty of emissions) or by (bilaterally) trading permits. We derive the optimality conditions and carry out various numerical simulations. Our applications suggest that including uncertainty could increase compliance costs for the USA, Japan and the European Union. Central Europe and the Former Soviet Union might be able to gain from trading due to higher permit prices. Emissions trading could also lower aggregate uncertainty on emissions.     

Double Moral Hazard,Monitoring, and the Nature of Contracts

generalized double-sided moral-hazard model, with risk-averse parties who mutually monitor each other (to get a reasonable idea of outcome/effort). The model considers trade-off between monitoring costs and moral hazard costs, which are endogenously determined by the extent of monitoring. Using this model, we formally prove a generalized version of Coase's conjecture – that the optimal contract minimizes the agency and risk costs. We then show how varying assumptions about the feasibility or cost of monitoring of the outcome or the worker's effort lead to different contracts being optimal. The analysis is then used to explain the nature of contracts observed in practice under many different situations. We will give an explanation as to why industrial workers typically work under wage contracts, while share contracts are common in agriculture and will explain why profit sharing is more common for senior managers than for the production workers. Received September 19, 2000; revised version received October 30, 1997     

我国农业生态系统营养循环链的断裂与重建

完整的营养循环是农业生态系统健康、可持续发展的重要保障。我国传统农业属于环境友好型生态农业。农业生态系统的营养循环结构完整，持续健康、繁荣。但是，随着工业化、城市化、市场经济的发展以及农业耕作方式的转变，农业生态系统营养循环的结构遭到严重破坏，导致一系列资源、环境、经济与社会问题。通过秸秆还田以及城市生活废弃物（排泄物、厨房垃圾等）向农业生态系统的返还，重建农业生态系统完整的营养循环，是我国农业生态系统持续健康发展的必由之路。     

Health Damage of Air Pollution: An Estimate of a Dose–Response Relationship for the Netherlands

This paper estimates the dose-response relationship between air pollution and the number of work loss days for the Netherlands. The study is based on illness data (work loss days) for the Dutch labour population and average year concentrations of air pollution in 29 districts. The dose-response relationship has been estimated by means of two different techniques: the ordinary least squares method (OLS) and the one-way fixed-effects method (OWFEM), which we consider to be more adequate. In general health effects are much smaller when OWFEM is applied than if OLS is used. With OWFEM a significant relationship is found between sulphate aerosol (SO₄), ammonia (NH₃) and the number of work loss days (WLDs). Particulates (TSP), O₃ and SO₂ have no significant effect on the number of WLDs. These results differ from those obtained in studies in the United States, which indicate that particulates (TSP) and other small particles, ozone (O₃) and to a lesser extent SO₄ and SO₂ significantly influence the number of WLDs.     

2017年北京社区卫生服务中心处方集中点评结果

目的汇总分析北京市16个区县近100家社区卫生服务中心处方抽样点评的结果,比较各区之间的差异,细化点评结果,促进全市合理用药。方法抽取2017年6月第2周,全门诊不包括草药处方,共计50189张处方,进行精细化集中点评。结果2017年北京16个区县社区卫生服务中心平均处方金额为160.07元,注射剂使用率为5.56%,全部基本药物占比为68.29%,处方的不合理率为8.8%。结论对于北京市社区卫生服务中心门诊处方集中点评最应改进的为统一点评标准,其次还应完善处方管理,强化药剂师自身的业务学习.     

A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Definitions and progress of ecosystem health and ecological security

1. Introduction Development of human industrial civilization and predatory exploitation of natural resources have in- duced tremendous changes of ecological environment. In recent years, territorial and global environmental problems have increased, such as greenhouse effect, depletion of ozone, global warming, water scarcity, water pollution, acid rain, decrease of biodiversity, soil erosion desertification etc. These changes seriously intimidate the health and security of ecosystems, and dist…