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.      

中国社会医疗保障制度改革构想

2002年肆虐的SARS疫情和当前面临的“高致病性禽流感”突显了我国医疗保障制度中存在的制度缺陷。计划经济时期曾经相当完备的社会医疗保障体系已无法适应新的形势，但其以政府为主导的制度精神仍可作为当前社会医疗保障制度改革的借鉴：应结合转轨时期的社会条件，创立一种以政府制度为主导、调动社会各方面积极因素的新型的社会医疗保障的制度体系。     

中国社会医疗保障制度改革构想

1.扩大基本医疗保险的覆盖面。这主要是针对我国目前医疗保险制度覆盖面窄的现象提出的。在这项制度改革中,政府应当将职工基本医疗保险范围扩大到城镇所有各类企业(包括私营企业)的各类职工和个体劳动者。在基本医疗范围以外,效益好的企业,还可以通过建立补充     

中国城镇贫困的福利经济学思考

文章概述了我国城镇贫困的特征,同时从福利经济学的角度界定城镇贫困和分析其成因,认为城镇贫困是社会收入差距过大,市场自由竞争机制不够健全,并在此基础上提出了治理贫困的若干对策.     

中国城镇养老保险制度改革的收入分配效应

在公共养老保险制度下,可以通过调整养老保险的缴费率或养老金计发办法来影响参保人一生中的养老金纯受益,从而实现代际间和代际内的收入再分配。本文利用中国国家统计局2002年的城市住户调查数据,分别估计城镇参保职工在1997年养老保险制度和2005年最新养老保险制度下的终生养老金纯受益,并以此从代际间和代际内的角度对中国养老保险制度改革的收入分配效应进行定量分析。分析表明:在1997年的改革方案下改革前的养老保险制度中存在的逆向收入转移效果得到改善;但在2005年改革方案下,2002年时40岁以上的群体中存在较明显的逆向收入转移倾向。另一方面,从代际分配来看,1997年改革方案的代际不平衡大于2005年改革方案;在2005年改革方案下各代人的养老金纯受益都有所提高,但这是以养老保险制度的缴费率和养老金计发办法不变,养老财政收支能维持平衡以及参保人在整个工作期间按规定缴费为前提的。     

中国增值税改革的政策效应研究——以中部六省改革为例

2007年7月1日,河南、山西、湖南、湖北、江西、安徽等中部六省的26个城市开始实施扩大增值税抵扣范围政策。这一做法是我国增值税由生产型向消费型的转型试点政策。文章运用拉弗曲线和IS-LM模型及一个增值税抵扣案例,从政策效应和经济效应两个方面阐述了中部六省扩大增值税抵扣范围的政策可以在长期内促进税收收入的增加和宏观经济的可持续发展,并结合制度规定和具体操作中已经发现或可能存在的问题,提出政策建议。     

我国城镇社会医疗保障面临的困境与模式选择

目前我国已在城镇基本建立了初级的医疗保障体系,在保障人民群众身体健康方面取得了显著成效。但社会医疗保障仍存在着医疗保障覆盖面窄,医疗保障体系不健全,医疗卫生体制改革、药品流通体制改革与医疗保险制度改革不配套、不同步等问题。突破这些困境,从而保障我国居民基本医疗需求,关键在于改革基本医疗保险制度,并建立社会医疗救助制度。也就是说,我国社会医疗保障的发展模式应该是“基本医疗保险”加“社会医疗救助”,一方面充分发挥社会医疗保险统筹互济的作用,另一方面,对于缺乏基本医疗保障的困难群体,各级政府必须尽快弥补医疗救助缺位。     

浅论老龄化社会医疗保障制度的改革

我国已进入老龄化社会,老人医疗需求和老年照料需求急剧上升,但是未富先老的社会现状使得供给小于需求,它将给社会发展带来不利。文章对此问题进行了探讨,并提出了适合我国国情的医疗保险改革的相关对策。     

合作制:中国城镇小企业改革的方向

<正> 我国城镇小企业的问题,表面看来是多数企业效益不高,原材料供应短缺,电力不足,销售困难,“婆婆”太多,税后利润七折八扣,劳动者所得偏少,等等。但深层次的问题则是所有制问题。在我看来,城镇小企业的出路在于用本企业职工平等持股的合作制来重建企业的经营机制。     

间接庇古税的福利效应分析——以交通污染控制为例

经济学认为当机动车污染排放产生负外部性时最优政策工具就是根据外部性的大小征收相应的庇古税,使外部成本内部化。然而由于每一辆机动车的污染排放水平不一,根据污染排放量直接征收庇古税很难实施,在这种情况下,替代性的政策是对与机动车污染排放息息相关的燃油消费进行征税。文章在Diamond模型的基础上,构建了最优间接庇古税模型,分析了间接庇古税的福利效应。研究发现:一是由于机动车使用年限、消费者收入水平、汽车排量选择偏好等影响燃油消费的异质性因素存在,最优间接庇古税只能是次优的;二是最优间接庇古税作为治理机动车污染外部性这种市场失灵的政策工具所起的作用十分有限,对提高整体社会福利水平效率较低。     

The relationship between the markets for health insurance and medical malpractice insurance

This article evaluates the interdependence of medical malpractice insurance markets and health insurance markets. Prior research has addressed the performance of these markets, individually, without specifically quantifying the extent to which they are linked. Increasing levels of health insurance losses could increase the scale of potential malpractice claims, boosting medical malpractice losses, or could embody an improvement in medical care quality, which will reduce malpractice losses. Our results for a state panel data set from 2002 to 2009 demonstrate that health insurance losses are negatively related to medical malpractice insurance losses. An additional dollar of health insurance losses is associated with a $0.01–$0.05 reduction in medical malpractice losses. These findings have potentially important implications for assessments of the net cost of health insurance policies.     

中国城镇养老保险制度改革的收入分配效应——基于2002年城镇住户调查数据的定量分析

Using the micro data of Urban Household Survey made by the National Bureau of Statistics of China(NBS) in 2002, this paper studies quantitatively the distributional effects of Public Pension Reform in urban China, from intragenerational and intergenerational perspectives, by measuring lifetime net benefits that urban employees obtain under the public pension system in 1997 and the newest one announced in December 2005, respectively. The results indicate that the regressive income transfer existing before implementation of the reform is improved as a consequence of the 1997 reform. However, the Act of 2005 Reform generates the obvious inclination of the regressive income transfer among people who exceed 40 years old in 2002. On the other hand, from the viewpoint of intergenerational distribution, the intergenerational inequality resulted from 1997 reform is greater than that from 2005 reform. Moreover, all generations would receive higher lifetime net benefits under the Act of 2005 Reform, but it must be based on sustainable pension system and participants’ full pension contribution during their duration of employment. __________ Translated from Jingji yanjiu 经济研究(Economic Research Journal), 2007, (3): 70–80, 91     

农民工城镇医疗保险与新型农村合作医疗的衔接

现阶段我国正加强社会保障的制度建设.在城镇,今后社会保障的一个重要内容是将农民工纳入社会保险,首先保障其大病(住院)医疗和工伤;在农村,正试点新型农村合作医疗,主要通过大病统筹的方式解决农民的医疗风险.农民工是一特殊群体,他们多数流动于城市和农村之间.他们是只参加城镇的社会医疗保险体系或新型农村合作医疗?抑或可以两者同时参加?本文作者根据大量的调查和我国社会保障制度的设计,提出了自己的观点:鉴于两者的保障程度有限,近期不宜作出硬性规定,两者的结合可以提高农民工医疗保障的程度.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

The association between smoking cessation outpatient visits and total medical costs: a retrospective,observational analysis of Japanese employee-based public health insurance data

Aims: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs.

Materials and methods: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005–December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs.

Results: In Index Year ?1, PPPY medical costs for male smokers were ～USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n?=?5,608) vs the non-SCOV (n?=?81,721) group; however, by Year 6 the costs were similar. From Year 4–6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively.

Limitations: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed.

Conclusions: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.     

Welfare costs of reclassification risk in the health insurance market

We assess the quantitative importance of reclassification risk in the US health insurance market. Reclassification risk arises because the health conditions of individuals evolve over time, while a typical health insurance contract only lasts for one year. Thus, a change in the health status can lead to a significant change in the health insurance premium. We measure welfare gains from introducing explicit insurance against this risk in the form of guaranteed renewable health insurance contracts. We find that in the current institutional environment individuals are well-sheltered against reclassification risk and they only moderately gain from having access to these contracts. More specifically, we show that employer-sponsored health insurance and public means-tested transfers play an important role in providing implicit insurance against reclassification risk. If these institutions are removed, the average welfare gains from having access to guaranteed renewable contracts exceed 4% of the annual consumption.     

Human development and decentralization: The importance of public health expenditure

In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well-being of citizens, by allocating more resources to healthcare through the different administrative levels.     

Two separated effects of employer-provided health insurance on job mobility

We estimate the effect of employer-provided health insurance (EPHI) on job mobility via a dynamic model of joint employment and health insurance decision in the presence of uncertainty about wage rate and health status transitions. The model is based on a Markov decision process in which a hedonic wage approach provides an economic rationale for the different choices and health insurance serves as an input to the health production process. Including health transitions in the model helps us to understand how the availability of EPHI (positive job characteristic) and holding EPHI (the wage-health insurance trade-off) enter into the individuals’ decisions. The model is estimated using the 1999–2000 Medical Expenditure Panel Survey panel 4, and the results show that the ‘pure’ effects of holding EPHI are negligible, the ‘full’ effects of EPHI are significant and the degrees of the inefficiency vary between 14% and 25% across different states.     

The effect of telehealth insurance mandates on health-care utilization and outcomes

This paper uses panel data techniques to investigate the impact of state mandates to cover telehealth services on private insurance premiums and enrollment, health-care utilization, and health outcomes. There is evidence that telehealth insurance mandates are associated with an increase in primary care, but no significant changes in overall health outcomes. However, there is evidence of a reduction of secondary care and improvement in health outcomes in non-metropolitan areas. The results provide useful information regarding the potential of telehealth to reduce health-care costs as well as to reduce disparities in access to health care and in health outcomes.