加拿大医疗保险中的混合供给制度及其启示

医疗保险服务通常由第三方（政府或保险公司）付费，在社会医疗保险中第三方主要是指政府。针对“第三方付费”问题，加拿大全民医疗保险实行“公共融资、私人提供”的混合供给制度，即公共部门承担起融资的责任，但具体提供的任务则交给私人部门来负责。‘这种混合方案可以较好地解决“第三方付费”问题，对我国具有借鉴意义。     

实行缴税制:社会保险筹资模式的思考

目前世界各国社会保险筹资模式,通常有三种形式:缴税制、缴费制和预筹基金制(强制储蓄)。但在我国,对于社会保险筹资模式到底应该采取税的形式还是费的形式,一直存在着激烈的争论。本文在回顾社会保险筹资模式税费之争的基础上,认为我国社会保险筹资模式应采用缴税制,主要的原因是实行缴税制符合社会保险的公共产品特性,且具有天然的优势。     

我国卫生筹资目标的可行性与筹资能力

在未来几年内,我国在卫生总费用占GDP的百分比继续增长的同时,逐步提高公共筹资的比例,相应地降低居民个人筹资比例是完全可行的,是城乡个人、社会医疗保险和财政卫生筹资能力都能承受的。现阶段农村合作医疗的筹资能力相对较弱,未来财政卫生支出需要重点向农村地区倾斜。     

Computable Stochastic Equilibrium Models and Their Use in Pension- and Ageing Research

This paper surveys recent advances in the field of computable general and partial equilibrium models dealing with pension issues that take into account various aspects of uncertainty. Whereas previous quantitative research with deterministic models solely focussed on efficiency losses due to labor market distortions from pay-as-you-go (paygo) financing, stochastic simulation models highlight the insurance effects of social security systems and allow to quantify the welfare consequences from myopic behavior. The results from these studies challenge the common wisdom about the cost and benefits of social security. While previous studies typically either recommended a move towards a more funded system or proposed a tight tax-benefit linkage, recent results from stochastic models indicate that welfare losses due to reduced insurance coverage compensate the gains due to improved labor market incentives. Consequently, paygo financing and progressive benefit formulas should not be eliminated on pure efficiency grounds. Current research tries to qualify whether this conclusion is robust in models with private insurance institutions and/or macroeconomic risks.     

风险水平、替代性损失融资与企业保险需求——对A股制造业上市公司的经验研究

论文采用Heckman样本选择模型,以2010-2013年间A股制造业上市公司为研究样本,分析企业风险水平和替代性损失融资渠道对制造型企业保险购买可能性和购买数量的影响。研究结果表明,企业风险水平越高,保险购买可能性越大,但与之相联系的高成本制约了企业保险购买数量;企业是否购买保险与现金持有水平存在替代效应,现金持有量充足时企业更倾向于用自有资金进行损失融资,但保险购买数量与之存在依附关系,保费支付受制于现金持有水平;剩余举债能力对企业保险购买具有负面影响,在负债与保险两种损失融资方式之间,企业更倾向于前者。论文利用最新数据构建了企业可保风险水平和替代性损失融资的衡量指标,在微观层面量化研究了我国企业财产保险需求不足问题,并为企业和保险公司提供了相关决策建议。     

Equity in health-care financing in China during the progression toward universal health coverage

Financing equity has become a major policy goal in China's progression toward universal health coverage since the beginning of the 21st century. In this study, we examine the equity characteristics of health-care financing in a province in the middle of China, comparing the equity performance between urban and rural areas at two different points in time. Progressivity and the corresponding Kakwani index were used to assess four health-care financing sources: indirect and direct taxes, public health insurance, and out-of-pocket payments. Two rounds of surveys were conducted in 2008 (5650 individuals in 1800 households) and 2013 (11,250 individuals in 3598 households). Household socioeconomic status, health-care payments, and utilization information were recorded during household interviews. Total health-care financing was near proportional in 2008 and slightly progressive in 2013 in urban areas, whilst it was marginally progressive in both 2008 and 2013 in rural areas. The health-care financing system was more equitable in 2013 than in 2008. Overall, the performance of China's health-care financing has improved over the period 2008–2013. Using flat-rate contributions to fund health care is not equitable to the poor. Key measures to achieve equitable health-care financing distribution include improvements in the benefit packages offered by health-insurance schemes and provision of essential health services.     

Is There Job Lock? Evidence from the Pre-HIPAA Era

We estimate discrete time hazard models of employment duration and standard logarithmic wage equations using the 1987 and 1990 panels of the Survey of Income and Program Participation (SIPP) to examine the phenomenon of job lock. We lest for job lock using differences-in-differences approaches among those with and without employer-provided health insurance and family members with and without health problems. We find no statistically significant evidence of job lock on employment duration or wages using this approach. We do find some evidence of shorter employment spells for those with employer-provided health insurance and spouse-provided health insurance, and longer employment spells for those with employer-provided health insurance and large families. Others have interpreted these findings as evidence of job lock. However, the wage equation results using these measures are not consistent with job lock. Although anecdotal evidence makes it clear that some workers have been locked into less-than-optimal jobs because of the combination of health problems and employer-provided health insurance, our results do not suggest that this phenomenon is pervasive in the U.S. economy.     

Does health insurance decrease health expenditure risk in developing countries? The case of China

This article studies the impact of health insurance on individual out‐of‐pocket health expenditures in China. Using China Health and Nutrition Survey data between 1991 and 2006, we apply two‐part and sample selection models to address issues caused by censored data and selection on unobservables. We find that, although the probability of accessing health care increases with the availability of health insurance, the level of out‐of‐pocket health expenditure decreases. Our results from a selection model with instrumental variables suggest that having health insurance reduces the expected out‐of‐pocket health expenditure of an individual by 29.42% unconditionally. Meanwhile, conditional on being subjected to positive health expenditure, health insurance helps reduce out‐of‐pocket spending by 44.38%. This beneficial effect of health insurance weakens over time, which may be attributable to increases in the coinsurance rates of health insurances in China.     

论保险经纪公司的发展策略

随着我国宏观经济形势的持续向好,我国的保险中介市场获得了迅猛的发展。然而,由于多方面的原因,目前大多数保险经纪公司的发展停滞不前,处于瓶颈状态,甚至有的保险经纪连生存都难以维持。文章试图从一个实操的角度来分析保险经纪在现阶段存在的问题,并为提升保险经纪企业的发展空间提出相应的营销策略、融资策略和人才策略。     

农村养老保险的制度“缺失”与“补位”

公平是社会养老保险的本质属性,以公平为基础构建农村社会养老保险制度,是应对农村人口老龄化、老年人口贫困化的客观需要。现行新农保公平缺失,其主要原因在于:新农保地方各级政府财政责任不明确;新农保的筹资机制不公平;农村社会养老保险建设政策缺位。公平视域下中国农村社会养老保险制度的构建,必须由中央和省级财政共同设立最低养老金,保证底线的公平;同时,建立农村养老保险个人账户,体现机会的平等;合理界定地方各级政府在新农保建设中的责任;加强农村社会养老保险政策建设。     

Medical insurance system evolution in China

Healthcare financing and payment in China are mainly based on medical insurance. This paper examines the key issues of the Chinese medical insurance system, with a particular emphasis on basic social medical insurance, which has the broadest coverage in China. It reviews the evolution of the basic social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system. The paper concludes with a discussion of some suggestions for the future development of the system.     

信贷配给、出口信用保险与中小企业出口融资

中小企业融资难的关键性问题在于信贷市场上的信息不对称造成的信贷配给,而出口贸易融资中的信贷配给既具有对中小企业惜贷的共性,又具有较多使用信用证项下融资产品的特性。出口信用保险融资由于消除了借贷双方对进口商及进口国信息占有上的不对称,从而能够在一定程度上缓解商业银行对中小出口企业的信贷配给,有助于继续发挥贸易金融对稳定外需的积极作用。     

城镇职工医保省级统筹可行性评价体系构建——以广东省为例

在基于认同“广东省城镇职工基本医疗保险现行筹资制度是可行性的”的前提下，文章结合广东省城镇职工基本医疗保险运行现状，建立了城镇职工基本医疗保险筹资经济可行性的评价指标体系。从公平性、效率性、筹资能力、筹资可持续性四方面开展广东省城镇职工基本医疗保险省级统筹的筹资经济可行性评估。为客观、科学地评估广东省城镇职工基本医疗保险省级统筹的筹资经济可行性，进行省级统筹决策提供参考。     

农村“小额信贷+小额保险”模式探析

农村小额信贷是实现农村建设和农户融资的重要手段,它和其他贷款产品一样都存在着风险,如果锁定农民生产经营活动的风险,降低其收入来源的不确定性,适度提高其进入信贷市场的能力,该问题就可以得到缓解,而农业保险可以在此方面发挥积极作用。为此,本文对保险与农村小额信贷相结合的银保结合模式进行了探讨。     

住房反向抵押担保贷款特设机构的风险及其防范

住房反向抵押担保贷款业务对拓宽养老资金筹资渠道,完善养老保险体制,活跃住房市场有重要意义。银行、保险公司作为开展此项业务的特设机构经验不足使风险巨大。本文剖析了特设机构面临的基本风险及其相应的防范措施。     

城市基础设施建设投融资模式创新的基本思路

在国家宏观经济调控的条件下,城市基础设施投融资模式创新显得尤为重要。本文从政府融资平台的视角,对后金融危机时代城市基础设施投融资模式进行探讨,认为通过基础设施融资租赁、产权权益证券化、股权转让来盘活存量基础设施的融资模式;通过土地融资、发行中票和短期融资券、PPP或FPI等运营方式,以及发行产业基金、吸引保险资金等融资模式相结合的策略,对于加快城市基础设施建设具有较强的推动作用。     

Employment-Based Health Insurance and the Effectiveness of Intrafirm Competition between Insurance Providers

This paper examines the effects of competition between insurers for the patronage of a firm's employees. Since for employment-based health insurance the employee choice of health insurance plans is often limited, the availability of competing plans in the market does not necessarily reflect competition within the firm. We utilize data from the 1987 National Medical Expenditures Survey (NMES) to examine the effect of intra firm competition in the employment-based health insurance market. Using switching regression models, we explore the process that sets premiums and the process that sets the net premium/medical cost margins. We find that greater choice results in higher margins and lower premiums. We also find significantly negative health maintenance organization choice effects on both premiums and margins.     

我国中小企业融资困境的对策探讨

我国中小企业融资困难，严重制约发展。文章比较借鉴了成熟市场经济国家中小企业融资方式、政策与法律保障措施等方面的经验，提出了法律法规建设、完善金融服务、建设信用体系、扩展融资渠道等一系列的对策建议。     

社会保险筹资方式的影响因素及国际比较

对社会保险筹资方式的选择不仅仅是一个筹资问题,也关系到社会保险基金的管理、支付方式,甚至决定着整个社会保险制度的运行过程。本文从理论上分析了社会保险筹资方式的类型,探讨了社会保险筹资方式的影响因素,并力图通过负担水平、管理模式、制度公平性、政府责任等方面的比较,实现对社会保险税和社会保险费的理性认识。     

Health system reform in China: What role for private insurance?

The purpose of the present paper is to show that much of the literature on health economics and on the international experience with different forms of health system organization can be interpreted as supporting the idea that reliance on an unregulated market mechanism for organizing the production and financing of health services is likely to result in major problems both with respect to efficiency and equity. However, reliance on a centralized “command-and-control” model managed by government has also been shown to entail problems in practice. For this reason I argue that the best option at China's current state of development may be a compromise model in which competing private providers are given an important role, both for the production of health services and in the provision of health insurance, but in which the government intervenes (through regulation and direct provision) in such a way as to attain both a high degree of equity of access to health care, and to avoid the most significant forms of “market failure” that would arise in an unregulated private system.