医疗卫生体制改革对我国商业健康保险市场潜力影响分析

2009年,我国新一轮医疗卫生体制改革拉开了序幕,其对商业健康保险发展的影响又将如何?本文分析了医疗卫生体制改革对商业健康保险市场潜力的影响机制,对我国当前商业健康保险潜力进行定量评估,并对此次新一轮医疗卫生体制改革的影响作了预测,最后就我国健康保险监管思路调整给出了建议。     

Health Care Reform: Separating Insurance from Income Redistribution

Most systems of health care financing in EU member states currentlyinclude elements of income redistribution. The paper analyzesthe effects of shifting this kind of redistribution to the taxsystem and argues that this reform could create two types ofefficiency gains. On the expenditure side, it would facilitatethe adoption of more incentive-compatible insurance contracts,for example through the introduction of copayment schemes. Onthe revenue side, income redistribution through the general taxsystem is likely to imply a shadow price of public funds thatis lower than if redistribution is carried out through wage-basedinsurance contributions.     

Health Care Reform,Efficiency of Health Insurers,and Optimal Health Insurance Markets

This research examines the efficiency of the U.S. health insurers. It shows that more insurers are less efficient than in the previous sample year; however, the results suggest that the federal health care reform has no significant effect on the overall efficiency of all insurers as a whole, which is very low but does not change much over time. This research explores how to improve the efficiency of the health insurance market by proposing state, regional, and national efficiency-based goal-oriented market models and an efficiency duplicating system, and it discusses important implications to the health care compacts, the health insurance exchanges or marketplaces, and the national multistate programs. It also analyzes further moves for efficiency enhancement with regard to payment methods and the health care delivery system. One interesting finding is that the Medicaid program is very efficient because it provides support to the offering of Medicaid coverage and further expansion, which enhances the health welfare of society with fewer resources inputs from the perspective of efficiency. This research should provide important insights for state and federal governments, policy makers, regulators, the health insurance industry, and consumers.     

全国车险费率变法--车险市场费率改革一周年回眸

2002年8月15日,北京的王先生一大早就来到了亚运村汽车交易市场.几年的购车愿望就要实现,王先生的嘴角带着一丝不易察觉的笑容.办完购车手续,王先生没有忘记为自己的爱车上了份保险.     

社会医疗保险、自我保护与商业健康保险

基于消费者保险需求理论,采用中国家庭金融调查（CHFS）数据,分析了社会医疗保险、自我保护与商业健康保险之间的关系。结果表明：社会医疗保险抑制了商业健康保险的发展,显著减少了自我保护支出;自我保护促进了商业健康保险的发展。鉴于此,政府应制定合理的封顶线及报销比例以提供适度的基本医疗保险保障水平,商业保险公司应提供差异化的健康保险以补充社会医疗保险,政府及保险公司应鼓励自我保护投资以促进商业健康保险发展。     

The Health Economy and Health Insurance Research in the JRI

College professors typically expend a considerable amount of time, energy, and effort on academic research. But only one study to date has demonstrated the societal benefit of such research by showing that the content of academic research responds to real-world problems. This article adds to this scant literature by investigating empirically if the prevalence of health insurance articles in the Journal of Risk and Insurance ( JRI ) can be explained by the state of the health economy. According to the findings, both the uninsured rate and health care spending share are directly related to the percentage of health insurance articles published in the JRI . Thus, the empirical results suggest that the research decisions of insurance economists are influenced at the margin by real-world problems.     

Tort Reform and Insurance Markets

Proposed tort reforms have focused on punitive damages and noneconomic damages, each of which pose problems for jury decision making. The U.S. Supreme Court decision in State Farm v. Campbell will greatly limit very large punitive damages awards, and will affect smaller punitive awards to a lesser degree. Noneconomic damages caps enacted by state legislatures have greatly enhanced insurance market performance. Insurers operate within the context of a highly imperfect, regulated market in which there is substantial price rigidity induced by regulation. Reform efforts should strive to establish greater predictability and stability in these awards components rather than simply being concerned with imposing specific numerical caps.     

The Public Pension Reform Debate in the United States and International Experience

This article describes the recent debate on Social Security in the United States. To provide some perspectives on the U.S. system, comparisons with public pension systems in other countries are made throughout the article. The article is organized as follows. The first section discusses financing problems in the U.S. Social Security system. Following this, the U.S. Social Security system is described. Options for fixing public pension systems are discussed next. The topic of individual accounts appears in its own section.     

The Determinants of Financial Health of Asian Insurance Companies

Previous studies of financial health of insurance companies are mainly focused on insurers operating in the United States and developed economies. This article focuses on the solvency of general (property‐liability) and life insurance companies in Asia using firm data and macro data separately. It uses different classification methods to classify the financial status of both general and life insurance companies. With the exception of Japan, failures of insurers in Singapore, Malaysia, and Taiwan are nonexistent. We find that, first, the factors that significantly affect general insurers' financial health in Asian economies are firm size, investment performance, liquidity ratio, surplus growth, combined ratio, and operating margin. Second, the factors that significantly affect life insurers' financial health are firm size, change in asset mix, investment performance, and change in product mix, but the last three factors are more applicable to Japan. Third, the financial health of insurance companies in Singapore seems to be significantly weakened by the Asian Financial Crisis. As the insurance industry in different Asian economies is at different stages of development, they require different regulatory guidelines.     

我国财产保险公司经营短期健康保险的效率及其影响因素分析

兼具企业经济效益与社会保障功能的短期健康保险已经成为我国财险公司多元化经营转型的重要部分.本文选取2014～2019年22家经营短期健康保险的财产保险公司相关数据,运用窗口 SBM分析模型测算出各公司经营效率,揭示了财险业健康保险经营的效率趋势与改进路径,并且构建面板Tobit模型对经营效率的影响因素进行回归分析.结果...     

医保制度改革：从城镇保障到城乡统筹——医疗保障“马鞍山模式”研究

安徽省马鞍山市医疗保险制度改革,一直以其创新性和样本性被各级政府、媒体及公众广为关注,被称为“医疗保险马鞍山模式”。本文通过对马鞍山医保制度改革从城镇保障发展到城乡统筹过程的调查,介绍该市医疗保险制度的发展历程,总结、分析统筹城乡医保制度的主要内容、特点及成效,探究存在问题及对策,以期为研究中国当前的医疗保险制度改革提供参考,为广大中西部地区中小型城市的医疗保险工作提供借鉴。     

"贱卖"之争的实质:改革路径之争

国有银行贱卖和国家金融安全的争论声一浪高过一浪，这一场争论已公开蔓延到监管部门高层的层面。而在金融业界和学术界，这场争论早已沸沸扬扬。 前些天某高官回应“贱卖”论答曰：“建行的投资亮点之一就是有国际著名金融机构加盟。战略投资者会改善公司治理，会带来技术支持，会与我们一起来共同面对未来的市场风险，这些都是无形资产性质的收益。所以转让价格而言，也大大高出账面净资产”。     

The Effects of Uncertainty on the Demand for Health Insurance

This article analyzes the effects of uncertainty and increases in risk aversion on the demand for health insurance using a theoretical model that highlights the interdependence between insurance and health care demand decisions. Two types of uncertainty faced by the individuals are examined. The first one is the uncertainty in the consumer's pretreatment health and the second is the uncertainty surrounding the productivity of health care. Comparative statics results are reported indicating the impact on the demand for insurance of shifts in the distributions of pretreatment health and productivity of health care in the form of first‐order stochastic dominance, Rothschild–Stiglitz mean‐preserving spreads, and second‐order stochastic dominance. The demand for insurance increases in response to a Rothschild–Stiglitz increase in risk in the distribution of the pretreatment health provided that the health production function is in a special class and the price elasticity of health care is nondecreasing in the pretreatment health. Provided also that the demand for health care is own‐price inelastic, the same conclusion is obtained when the uncertainty is about the productivity of health care.     

论互助保险公司在法国医疗保险制度中的作用

法国的医疗保险制度较好的保障了法国人民的健康状况和生活质量,在世界上享有良好的声誉。本文在介绍了法国医疗保险的财政支持的基础上,分析了互助保险公司在法国医疗保险制度运行中所发挥的重要作用,并以MGEN（法国最大的互助保险公司）为例,介绍了其建立原则、历史沿革、经济模型、覆盖的医疗服务及其发展的评估,探讨了其完善和促进法国卫生保障事业的功效,同时也缓和了社会不平等现象。基于互助保险公司非盈利、联盟和责任感的价值观,MGEN还在眼科医疗方面提供更多的服务。     

台湾地区“全民健康保险”制度对癌症患者医疗保障的启示

癌症多年来占据疾病死因顺位榜首,不仅严重威胁居民的健康和生命,更让患者面临较大的医疗费用支付压力。本文介绍了我国台湾地区全民健康保险制度在癌症患者医疗保障方面的特点,包括通过免除个人部分负担等措施为癌症患者提供经济协助、为癌症终末期患者提供安宁疗护、实行卫生技术评估、开展全民健康保险信息化建设。台湾地区的经验为改善癌症患者医疗保障带来以下启示:提高现行社会医疗保险对癌症相关医疗费用支付的待遇;推动社区开展癌症的慢性病管理;利用卫生技术评估匹配癌症治疗新药及新技术的医保准入与定价;以信息化建设助力肿瘤诊疗。     

补充医疗保险对居民消费的影响——来自城乡居民大病保险的证据

促进消费对我国稳定经济增长和构建新发展格局至关重要。本文基于中国家庭追踪调查数据(CFPS),利用地级市层面实施城乡居民大病保险的时间差异,运用双重差分法估计了大病医疗保险对居民消费的影响。结果表明,大病保险使家庭人均消费显著增长了约6%。使用了事件分析法、置换检验、改变回归样本和控制变量等一系列检验后,结论仍保持一致,且这一效果在期初住院率高、储蓄率高以及收入较高的家庭中更明显。进一步地,本文检验了大病保险对居民消费的三种可能影响渠道,发现降低家庭对未来医疗支出风险的预期是大病保险促进家庭非医疗消费进而影响家庭总消费的主要渠道,印证了我国居民对高额医疗支出的担忧是影响消费意愿的重要因素。本文研究对于完善多层次医疗保障体系和促进居民消费具有启示意义。     

Member Plan Choice and Migration in Response to Changes in Member Premiums after Massachusetts Health Insurance Reform

In 2006 Massachusetts implemented a substantial reform of its health insurance market that included a new program for uninsured individuals with income between 100% of Federal Poverty (the upper limit for state Medicaid benefits) and 300% of Federal Poverty. Enrollment was compulsory for all citizens because of a mandate. Consumers who enrolled in this program, which offered generous benefits with low copays, received graduated subsidies depending on their income. Five insurers were contracted to underwrite the program, and consumers were able to choose their insurer. Insurers bid annually, and the member contribution was set according to an affordability schedule for the lowest-bidding insurer. Consumers could choose from the range of insurers, but if they chose a plan other than the lowest cost, their contributions reflected the difference. Premiums were changed annually at July 1, and members were eligible to move to a different plan at this date; a number of members migrated each year. This study aims to quantify the effect of this premium-induced switching behavior. Prior studies of member switching behavior have looked at employer plans and estimated the elasticity of response to changes in member contributions. The Massachusetts environment is unique in that there is a mandate (so being uninsured is not an option) and members may choose insurer but not benefit plan. Thus a study of migration in Massachusetts is uniquely able to quantify the effect of price (contribution rates) on member switching behavior. We find elasticity averaging ?0.21 for 2013 (the last year of the study) to be somewhat lower (in absolute value) than previous studies of employer populations. Elasticity has also been significantly increasing with time and appeared to have at least doubled over the studied period (i.e., 2008–2013). Prior studies have estimated higher elasticities in the range ?0.3 to ?0.6. We found that the data contained many outliers in terms of both changes in contributions and percentage of members switching plans. The effect of outliers was moderated by the choice of robust regression models, leading us to question whether other studies may have been affected by outliers, leading to overestimates of the elasticities.     

我国商业健康保险主体地位缺失及对策分析

我国目前的健康保障体系存在着总体结构不合理、商业健康保险所占比例偏低及发挥作用偏小等问题,这与商业健康保险在国家健康保障体系中的主体地位缺失直接相关。本文对商业健康保险主体地位欠缺造成的发展不足进行了详尽分析,并就如何在国家健康保障体系中建立商业健康保险的主体地位提出了相应的对策建议。