SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.     

The utilization of diagnostic tests among the elderly: Evidence from Malaysia

Diagnostic test plays a major role in reducing the prevalence of non-communicable diseases (NCDs). The present study examines the relationships between the utilization of diagnostic tests and socioeconomic, insurance, lifestyle, and health factors among the elderly in Malaysia. Analyses based on the National Health and Morbidity Survey 2011 (NHMS 2011) suggest that high income and having private insurance are associated with a higher likelihood of utilizing diagnostic tests. However, low education levels, being employed and smoking are associated with a lower propensity to utilize. These results provide public health administrators with useful information on policy development. In particular, the proposed policies include providing the poor with nominal price of basic diagnostic tests, introducing various health education programmes to the public, creating health awareness campaigns to encourage elders who do not own private insurance to utilize diagnostic tests, as well as making basic diagnostic tests compulsory for all elders owning government insurance.     

促进医药卫生改革的税收政策研究

我国医药卫生领域现行税收政策与新一轮医药卫生体制改革目标存在一定冲突。现行税收政策不利于医疗行业公益性目标的实现,不利于吸引民营资本进入,不利于营利性民营医疗机构的发展,不利于鼓励商业健康保险的发展。我国应建立和完善能够与医药卫生体制改革目标相适应的税收政策体系,包括医疗服务营业税及税收优惠制度、医疗机构所得税税收优惠制度、药品增值税及税收优惠制度、商业健康保险税收优惠制度等。     

CPI revision provides more accuracy in the medical care services component.

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.     

Homelessness in Dublin: An Irish Urban Disorder

A bstract . Urban homelessness in Dublin has emerged as one of Ireland's most serious socioeconomic problems. Etiological explanations for the estimated 1,200 homeless individuals in the capital range from personal problems to the structure of Irish society. Empirical examination reveals that many Irish are drawn into the homeless network through personal crises such as poor health, alcoholism, economic deprivation , and psychiatric disturbances. However, it is the inequitable social, economic, political , and legislative system which ordinarily entraps them in this deprived state. Thus the causes of Irish homelessness are fundamentally structural. The Irish Government has no policy or program for assisting the urban homeless. Consequently, they have become wards of charitable agencies ill-equipped to care properly for them. Reform legislation seems to be needed. But public apathy and prejudice suggests that it will not be enacted soon.     

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.     

A systems approach to health insurance policy information: a preliminary taxonomy of health insurance issues, program options, problems and solutions.

A methodology is proposed for assisting health insurance policy analysts by developing a systems approach to health insurance information and literature. The general approach is to supply a link between the quantitative and qualitative information available, and the analytic needs of policy analysts. There is a great deal of information available, but traditional cataloging and indexing techniques do not adequately meet the policy researcher's and analyst's information needs. The most important of these once goals and limitations are identified, is knowledge of the interrelationships between program options in terms of expected results (problems, solutions) in a wide range of settings.The key element of the approach used is the concept of an information frame, based on considering health insurance as systems of issues, program options, problems, and solutions with interrelationships explicitly defined. This approach would provide initially qualitative identification of these interrelationships and make them available via a machine readable taxonomy of the components. With substantiating literature references, preliminary work on the building of the taxonomy is based on seven major health insurance issues, and over 70 program options, 325 problems, and 350 solutions so far identified for 170 of the problems. The implementation of this methodology would provide analytically structured information for policy analysts in a format not presently available. The multi-country information to be included would allow consideration of alternatives which might otherwise be neglected. The result would improve an important element of the analytic process, and reduce the lead time required for inquiries by health insurance policy analysts, legislators, health planners and administrators.     

Issues in the Industrial Organization of the Market for Physician Services

What is the nature of the industrial organization of the market for physician services? Is the market “competitive?” Are there pareto-relevant market failures, such that there is room for welfare-improving policies? Economists have devoted a great deal of attention to this market, but it remains relatively poorly understood. The key features of this market are that the product being sold is a professional service, and the pervasive presence of insurance for consumers. A professional service is inherently heterogeneous, nonretradable, and subject to an asymmetry of information between buyers and sellers. These characteristics are what bestow market power on sellers, further strengthened by the fact that consumers face only a small fraction of the price of any service due to insurance. This paper considers the implications of these characteristics for agency relationships between patients and physicians, and insurers (both private and public) and physicians. Agency relationships within physician firms are also considered. Both theoretical and empirical modeling of contracting between insurers and physicians and of the joint agency problems between patient and physician and insurer and physician are recommended as areas for future research. Because failures in this market are seen to derive largely from the structure of information, the potential gains from government intervention may be sharply circumscribed. Nonetheless, careful consideration of the competitive implications of contracting between physicians, insurers, and other health care providers is an important area for antitrust policy.     

A low quality–high cost–low satisfaction trap in public health care: a model and an efficiency-quality-welfare improving stochastic resolution

This paper develops an applied stochastic model of public health care and shows that the public health care sector in Turkey is plagued by a low quality–high cost–low satisfaction trap which has been persistent over time. The values in question are shown to be stochastically stable. We formulate an efficiency-quality-welfare improving stochastic policy rule, which helps the sector to reach a selected target and which stabilizes quality, cost and welfare around that target.     

奥巴马政府面对医疗保健体系的挑战（英文）

美国的医疗保健危机引起了广大美国人民的关注。美国的医疗保健系统是全世界最为昂贵的,六分之一的美国人因此而不能享有医疗保健。为了能有一个广泛的,高质量的,可以为广大民众能够负担的医疗保健系统,美国人民试着发现和改变一系列现存的问题。该文章浅析了美国医疗保障体系中的种种弊端和奥巴马政府在医疗改革中的基本原则。医疗改革能否成功的关键在于是否能够克服财政,特殊利益集团和政党斗争以及民众的质疑等问题。     

发达国家(地区)的老龄人口长期护理体系及其启示

由于人口老龄化,发达国家的长期护理体系正面临着成本攀升、财源短缺、信誉下降等挑战。在广泛研究与分析国内外长期护理文献的基础上,评介了发达国家应对长期护理挑战的措施,并结合中国人口老龄化问题,指出中国应尽快建立符合中国国情的长期护理体系;大力发展商业长期护理保险;采取各种预防措施控制长期护理成本增长,如强化长期护理培训、出台加快相应法律法规等。     

人口老龄化背景下发达国家社会保障事业面临的财政压力

本文用数据详细介绍了人口老龄化给发达国家的社会保障事业带来了巨大压力,政府支出中用于社会保障和医疗保险的比例在以越来越快的速度上升,财政赤字和政府债务不断攀升.虽然老年人抚养比上升是导致这一结果的一个重要因素,但养老金制度和其他相关社会保障制度所导致的老龄人口劳动参与率的下降至少同样重要.这对于正处在建设初期的中国社会保障制度有着既现实又深远的借鉴意义.     

Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution

We investigate whether in a mixed insurance system, people enrolled into voluntary health care insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption without reducing reliance upon public provisions (top up). We specify a joint model for public and private specialist visits counts, allowing for different degrees of endogenous supplementary insurance coverage. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for‐profit VHI. Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.     

Residential facility is "hospital" in group medical policy dispute.

A residential facility that treated preadolescent children suffering from functional nervous disorders was considered to be a "hospital" for purposes of coverage under a group medical insurance policy, despite the fact that it lacked an on-premises surgical facility and did not provide 24-hour nursing services by registered nurses. The insurance company had waived the surgical facility requirement. Additionally, since the policy in question did not contain a definition of "nursing services," there was no requirement that these services be provided 24 hours a day by registered nurses. Thus the insureds were entitled to coverage of the treatment for their son in the residential facility. But a bad faith claim was denied because the insurer's interpretation of its policy was not found to be unreasonable.     

Estimating willingness to pay for medicare using a dynamic life-cycle model of demand for health insurance

Medicare is the largest health insurance program in the US. This paper uses a dynamic random utility model of demand for health insurance in a life-cycle human capital framework with endogenous production of health to calculate the individual willingness to pay (WTP) for Medicare. The model accounts for the feature that the demand for health insurance is derived through the demand for health, which is jointly determined with the production of health over the life-cycle. The WTP measure incorporates the effects of Medicare insurance on aggregate consumption through effects on medical expenditures and mortality, and consumption utility of health. The model is estimated using panel data from the Health and Retirement Study. The average WTP or change in lifetime expected utility resulting from delaying the age of eligibility to 67 is found to be $ 24,947 in 1991 dollars ($ 39,435 in 2008 dollars). However, there is considerable variation in the WTP, e.g., in 1991 dollars the WTP of individuals who have less than a high school education and are white is $ 28,347 ($ 44,810 in 2008 dollars), while the WTP of those with at least a college degree and who are neither white nor black is $ 15,584 ($ 24,635 in 2008 dollars). More generally, the less educated have a higher WTP to avoid a policy change that delays availability of Medicare benefits. Additional model simulations imply that the primary benefits of Medicare are insurance against medical expenditures with relatively smaller benefits in terms of improved health status and longevity. Medicare also leads to large increases in medical utilization due to deferring of medical care prior to eligibility.     

东北地区脑血管病的护理

结合哈医大二院神经内科具体病例的特点和脑血管病的成因,给出了东北地区脑血管病的注意事项和患者的康复护理措施,最后对医疗机构提出建立全民医疗保险的建议。     

我国医疗保险制度存在的问题及对策研究

我国新医改方案推行3年来,用最短的时间编织了世界最大全民医保网,但还存在着社会医疗保障供给与老百姓的医疗保障需求之间差距较大;社会医疗保险的责任范围较小;老百姓的医疗费用负担较重;医疗机构改革滞后等问题。为切实满足人民群众的健康需求,应在建立所有公民都享受全国平均水平的医疗保障体系,有效的实现社会公平和每个公民的健康保障权;本着"最基本的筹资水平、最基本的医疗服务"的理念,建立符合社会主义初级阶段的医疗保险费用筹措制度;在基本医疗的界定和选择上,采用国际上成本效果的评价方法和思想理念;建立行业管理、统筹规划的医疗保险管理体制,促进现代医疗市场的发育和完善;发挥政府、市场两个主体的作用,把商业保险作为对医疗保险的有效补充等方面扎实推进工作。     

Provisioning health care infrastructure in communities: Empirical evidences from West Bengal,India

We developed a framework to reinvigorate communities in terms of public health care infrastructure provisioning for outpatient needs within the neighborhoods. The health care seeking episode is often influenced by the physical and health care infrastructure availability within the neighborhood, need of the health care seeker as well as personal, household, occupational, and latent perception of the users. This empirical study has been developed for two different groups in West Bengal India, firstly based on location and secondly based on the choice of the health care seeker. In case of resident based approach, we focused on the revisit decision of the rural inhabitants who sometime tend to travel to the regional facilities in urban areas. Facility based approach analyzed the people who were at the regional facilities for health care services. We devised scenarios ascertaining improvisation in service delivery, emergency facility and mobility ease at local public facilities might reduce regional tours and instigate higher utilization of the neighborhood health care facility. We develop integrated choice and latent variable models to incorporate latent perception in choice of scenario for instigating revisit decision. Results showed choice of development scenarios have association with the household structure, social network, locational and infrastructural impedance. This framework lead to two distinct outcomes: (1) method to identify programs, those are essential to by initiate_revisit_to the health care facility (2) perception based assessment of the current mobility and health care infrastructure of the region, which could be instrumental in developing the overall health care infrastructural planning policy as a whole.     

Market power among physicians in the U.S., 1983–1991

The growth of health care costs and expenditures recently led to suggestions for innovations that would affect demand for health care. However, supply side issues were largely ignored in the debate despite the fact that the American Medical Association has controlled entry since it was granted that power by legislators early in this century. We consider the supply side of the market for physicians' services over 1983–1991. Our estimated index of market power indicates nontrivial power among physicians. This suggests that conventional policy tools could reduce costs in this market. This, in turn, could effectively lower insurance premiums.