新农合、灾难性医疗支出与贫困脆弱性

新农合制度在不同贫困标准下都能有效缓解农村居民贫困脆弱性,发生灾难性医疗支出时,该缓解作用随着贫困标准的提高而增强.新农合对不同收入居民的影响都很显著,灾难性医疗支出冲击下新农合对较高收入居民的影响系数大于低收入居民,存在逆向再分配.因此,我国应继续拓展新农合等医疗保障制度的可及性,减轻农村居民贫困脆弱性;加强医保对农...     

赋予第三者直接请求权与责任保险的风险管控

新《保险法》明确了责任保险中第三者对保险人的直接请求权,受限于中国保险业的发展现状及法律普及程度,第三者直接请求权的赋予将导致责任保险实务中出现新的纠纷,给保险公司带来未知的经营风险。为保证保险公司的稳定经营,有必要加强对诉讼风险的防范,扩大强制责任保险的承保面,加强与新闻媒体及公众的沟通等,以确立对保险公司的利益保护,并以之作为责任保险稳定经营的制度基础。     

新型农村合作医疗保险补偿制度的调查分析——以嘉兴市为例

本文是在对嘉兴市新型农村合作医疗保险补偿方式进行充分调研的基础上,概括总结了嘉兴市新农舍的发展状况,分析了在现行新农合补偿制度下农民的就医比例、对医院的选择偏好、医疗费负担状况,最后对完善新农合的补偿模式提出了相关政策建议.     

Medical claims review in an emerging market

Traditionally, insurance medicine has made significant contributions to sound underwriting and to the rise of insurer's margin of risk ratio. However, it is may be less effective in emerging markets, because emerging markets have few clinical follow-up studies, and there is a lack of medicoactuarial research. Making a medical expert's opinion to insurance claim administration is called a medical claims review. It is subdivided into medical verification and advice for claims staff. In addition to medical risk selection, it is a new field of insurance medicine in emerging insurance markets, which are often characterized by assertive insurance consumers. Medical contributions at the stage of claims adjudication compare the coverage provided in the product, with the information provided in the claims, based on medical records and the agreement between them. This is called medical verification. The insurance doctors can also use their medical knowledge to help the claim staff with informing claimants about the medical basis of claim decisions.     

保险业渠道整合“进行曲”

2012年中国保监会主席项俊波在全国保险监管工作会议上指出,保险业力抓服务,抓服务体现监管为民的思想。借助创新,不断拓宽服务渠道,优化服务流程,创新服务手段。在保险业提升服务水平与服务能力的大环境下,各家保险公司力求通过借助IT以及多渠道、跨平台的整合来提升客服水平。     

Officers’ fiduciary duties and acquisition outcomes

Using a Delaware case law that recognized officers’ distinct fiduciary duties for the first time in 2009, I examine the effect of officers' fiduciary duties (OFDs) on corporate acquisitions. I find that firms with entrenched officers prior to 2009 experienced increased announcement-period abnormal stock returns, mainly because their acquisitions created more synergies and reduced officers’ incentives to preserve control. These firms increased liability insurance premium expenditures, but reduced value-decreasing acquisition frequencies. Furthermore, the effect of OFDs is more pronounced in firms where officers are not directors, have wealth risk, face less product market competition, are insulated from the market for corporate control, or are able to avoid board monitoring. Overall, OFDs are a critical corporate governance mechanism that works in tandem with other disciplinary mechanisms.     

董事责任保险的法律考察

董事责任保险是为公司董事或高级管理人员职业责任提供的一种补偿性保险。对我国上市公司而言,董事责任保险既是对董事及高管人员利益的保障,也可帮助股东监督经营者的行为,对完善上市公司治理结构亦具有积极意义。然而,根据我国目前的董事民事责任制度、证券民事赔偿制度以及诉讼费用制度,董事责任保险并无大多发展空间。为充分发挥董事责任保险的价值,我国在引入董事责任保险制度时,有必要同步完善证券民事诉讼机制,合理设计董事责任承保范围,规定董事适度支付保险费用,并采取期内索赔式保险。     

政府购买医疗保障服务政策下商业健康保险的盈利模式

新医改提出政府向商业健康保险公司购买医疗保障管理服务的思路,为私营医疗保险市场的进一步发展提供了政策支持。但医改方案公布后,除人保健康进入这一市场外,其他公司仍举旗观望,提供该类服务的公司寥寥无几。这一困境出现的原因是保险机构对政府购买经办服务政策下,相关产品组合的盈利模式缺乏认识。对可得的有限数据进行分析,期望总结中...     

The sales force as an information transfer mechanism for new service development in the Thai insurance industry

New service development (NSD) is becoming increasingly important as the insurance industry in many countries opens up and becomes more competitive. This paper examines how customer views are integrated into the NSD process in the Thai insurance industry. The qualitative research was conducted using in-depth interviews with top officers, sales managers, senior vice-presidents of marketing and actuary managers in a number of leading life insurance and non-life insurance companies. The interviews investigated how NSD works in the Thai industry, focusing on how customer views enter the process. The results showed that the NSD process in Thailand is not oriented towards developing truly innovative products, but there is much NSD for adaptation of products from other markets. Sales agents act as a main information transfer mechanism, bringing in customer views through the sales managers, who play a role in NSD. Lack of cross-functional teamwork can cause failure in developing new products and services.     

Produktinnovationen und Produktmodifikationen in der Versicherungswirtschaft: Rolle und Bedeutung nach der Deregulierung

One consequence of the deregulation of the insurance industry in 1994 is a considerably improved scope for insurance companies to design products. Therefore, the question should be raised if there is an observable effect on the insurer’s behaviour with regard to the development of new products. This paper embodies results of an empirical study that collected data of 650 products that were launched in the German insurance industry between 1996 and 2005 and that could be categorised as product innovations or as product modifications. On the basis of the study, it was possible for the first time to provide quantitative evidence that in the whole industry the amount of product innovations (in average 2,4 per year) as well as of product modifications (in average 63 per year) stayed on a modest level after the deregulation and that the evaluated impact of the deregulation on the development of new products is relatively small. This is also demonstrated by the fact that 27% of all German insurers developed only one new product in ten years. In addition, it became evident that there is no significant change in the extent of the (small) impact in the last ten years. Thus, the deregulation itself only sent limited impulses for renewing products in the German insurance industry. Apparently, the theoretical considerations are supported that while considering a high entrepreneurial risk and the absence of a monopoly rent at the same time the Value Based Management imposes a high hurdle for the insurance industry to develop new products. The role of renewing products is therefore determined by their value contribution to companies and customers, whereas the deregulation itself marginally changed this role.     

Critical Illness Insurances: Challenges and Opportunities for Insurers

Since the first introduction of critical illness insurance in 1983 in South Africa, the product has successfully spread to some insurance markets, especially in Asian and Anglophone countries, but market penetration remains low in other countries. For this reason and because of the increasing relevance of dread diseases, the aim of this article is to provide a first comprehensive overview of challenges and opportunities associated with critical illness products for insurers. Toward this end, we first present the various product designs, as well as the developments that have taken place within the market before comparing this form of coverage to alternative insurance products in order to better assess the market potential. Based on these assessments, we thoroughly discuss the major challenges and opportunities within the market from the insurer's perspective.     

大学生医疗保险的现状分析与政策改进——基于内蒙古自治区呼和浩特市6所高校的实证研究

通过对呼和浩特市6所高校的学生访谈和问卷调查，分析得出：将大学生纳入城镇居民基本医疗保险试点范围的政策，初步实现了与公费医疗的制度转换，但还有不少问题，需要进一步的改进和完善。笔者认为，要根据大学生的生理特点、经济承受能力以及对医疗保险的需求意愿，坚持分责制的建制理念，以“重预防、保大病”为重点，建立一种以疾病预防保健为基础，基本医疗保险为核心，大额医疗保险为应急和商业保险为辅助的大学生医疗保障模式。     

无锡新区:跨国公司业务代表谈如何面对WTO

不久前,在无锡新区国际咨询顾问委员会召开的第三届年会上,不少委员(这些委员大都是已在无锡新区投资的跨国公司亚太区或中国区的高级行政管理人员和长期以来始终关注无锡新区发展的国外跨国公司和投资咨询机构的高级管理人员等)就中国加入WTO与无锡新区跨世纪发展等重大问题进行了广泛、深入地讨论与论证。这些意见可供有关部门参考。本刊择其部分发言摘要刊发于后,以飨读者。     

十二五期间中国军人保险制度发展研究

探讨十二五期间中国军人保险制度的发展,首先要明确军人保险制度发展的出发点,在此基础上明确军人保险制度发展的目标和任务,并紧紧围绕完善军人保险制度的目标任务,立足于军人保险现实情况,统筹兼顾,循序渐进,从不同层面、不同角度完善军人保险制度。具体包括：建立大病医疗保险与基本医疗保障相结合的新型军人医疗保险制度,建立军人分类养老保险制度,完善军人伤亡保险制度,建立军人互助保险等。     

Probability Updating and the Market for Directors’ and Officers’ Insurance

Over the past decade, much attention has been given to the topics of corporate governance and corporate risk management. One increasingly important insurance product associated with each of these issues is directors’ and officers’ (D&O) liability insurance. Given the interconnectedness that exists between D&O insurance, corporate risk management, and corporate governance, we exploit industry‐specific D&O data to explain how industries most associated with the corporate scandals of the early 2000s adjusted demand patterns during periods of certainty and uncertainty. The rich data set coupled with dramatic changes in the marketplace allows for the testing of insurance demand patterns and enables us to offer insight into the market's response to a unique type of loss shock. The results of this study suggest evidence in favor of demand‐side probability updating, whereby those industries most associated with the corporate scandals of the early 2000s adjusted the demand for D&O insurance during periods of greater uncertainty.     

商业保险公司参与社会医疗保险管理的模式分析

摘要：建立和完善医疗保险是一个关系国计民生的发展计划,对于促进社会发展有着十分重要的意义。就目前来看,覆盖全民的医疗保险目标已基本实现。商业保险公司参与社会医疗保险管理的模式已经成为下一阶段的发展模式之一。但是由于各种因素的影响,此模式在发展的过程中,也存在一些困境。本文主要分析商业保险公司参与社会医疗保险管理的理论依据,典型地区商业保险公司参与社会医疗保险的管理模式,并提出相应的建议。     

提高医保基金管理效益的财务研究

社会医疗保险是一项巨大的民生工程,经过多年的运行,已经初步达到了预期目的,但尚有许多亟待完善的地方;同时在发展过程中又会面临许多新的问题和挑战,需要用新的举措予以应对,这些问题比较集中地体现在医保基金所涉各方的利益平衡、均衡医疗资源、医保基金城乡统筹、医保基金收支平衡和安全运行、弱势群体就医权益的保护等五个方面。为此,以财务视角的研究方法进行深度分析,从而找出相应的解决措施,推进医保基金管理更加科学化、效益最优化。     

我国社会保障城乡发展状况及对策的实证研究——基于河南省的调查

社会保障城乡分割的格局已经成为我国社会保障制度发展的主要瓶颈.通过对河南省郑州市金水区和新乡市获嘉县的抽样调查,我们对最低生活保障、养老保障、医疗保障制度在城乡的发展状况进行了比较研究.结果显示,低保待遇水平低且城乡差距大、养老保险制度多元分割现象严重、医疗保险报销费用低,是三项基本社会保障制度存在的突出问题.解决上述问题的关键是,加大财政对低保制度的投入力度、加快城乡养老保险制度的优化整合、完善大病保险制度、加快推进社会保障城乡一体化建设.     

积极推进医疗保险体制改革

建国以后,中国机关事业单位实行公费医疗制度,企业实行劳保医疗制度.随着社会主义市场经济体制的确立和国有企业改革的不断深划,与之相配套的社会保障制度建设也在加速进行.作为社会保障制度的重要组成部分,医疗保障制度的弊端愈发明显.它的改革和建设,息息相关的影响和改变着中国人民的生活和权益;它的改革和完善,也将对当前和今后国民经济的发展起到有力的促进作用.本文在总结医疗保险制度的历史与现状的基础上,通过对新、旧医疗保险制度存在的弊端进行了分析,从而提出新时期推进医疗保险体制改革的对策.     

医疗保险谈判机制构建的现状分析及路径探索

建立社会医疗保险谈判机制是我国医疗卫生体制改革深入发展的迫切需要,也是实现医疗保障政策有效性的重要保证。由于医疗保险覆盖面窄,医疗保险经办机构的能力及动力的局限,导致我国医疗保障政策制定中谈判机制的缺失。而社会医疗保险谈判机制缺失正是我国社会医疗保险制度改革中出现的一些政策失误和面临困境的重要原因之一。为使社会医疗保险制度改革顺利发展,应该通过实施科学的制度保证、政府信息公开、谈判主体的角色定位、谈判代表的产生、谈判内容确定、谈判结果公布等制度建设,以及加强监督管理等措施,建立起完善社会医疗保险谈判机制。