医保支付方式改革对医疗行为的影响研究

<正>医疗保障作为国家和社会的重要组成部分,其支付方式的改革将深刻影响医疗机构的经营策略、医生的治疗行为以及患者的就医选择。随着我国医保制度不断完善,医保支付方式的改革已经成为医保制度改革的核心内容,如何确保在新的医保支付制度下,既能控制医疗费用的快速增长,又能确保医疗服务的质量和效率,是我们当前面临的重要课题。     

医保支付方式改革对医院经济的影响研究

随着社会经济的发展和医疗体制的变革,医保支付方式作为医疗服务和医疗保险之间的重要桥梁,影响着医院的经济状况和医疗服务的质量。近年来,医保支付方式的改革通过调整支付机制来控制医疗费用的增长,优化医疗资源配置,提高医疗服务质量,给医院收入结构、成本控制以及医院经济运营带来了深远的影响。因此,本文针对医保支付方式改革对医院经济的影响展开探讨,以期为医院管理者、政策制定者以及相关卫生经济研究者提供理论参考。     

中国医保改革与政策演进：综述与展望

我国的公费劳保医疗保障制度于1998年正式废除,自那时起,经过二十多年的努力,医疗保障基本实现了从初步建立到全覆盖、再从全覆盖到城乡统筹的跨越。虽成绩很大,但医保制度仍未定型。2020年2月25日,中共中央、国务院印发了《关于深化医疗保障制度改革的意见》,启动了对医保体系的全面深化改革,以消除现行医疗保障的制度性缺陷,目标是在2020～2030年间,全面建成高质量的中国特色医保制度。为实现此目标,迫切需要相关研究的引导和推动。为此,本文梳理了过去五年多（2017～2022年）对我国医保事业的改革与发展所进行的大量研究中价值较高的二十余篇文章,并汇集成七个专题进行综述,就是试图展示在若干重要领域的最新研究成果,并挖掘其对实现“十四五”全民医疗保障规划可能发挥的积极作用。     

医保城乡统筹待何时

从医疗保障制度改革的实践来看,目前已经基本形成了“三加一”的医疗保障体系,即城镇职工基本医保、城镇居民基本医保、新农合和社会医疗救助,覆盖城乡的医疗保障制度框架初步建立。但是,这仅仅是搭好了全民医保的制度框架,理论上可以覆盖全体居民,实际上还很不完善。无论是不同制度之间,还是制度内部,都存在许多有悖公平原则的问题,有待于进一步完善。     

新政

“十二五”医改规划出炉近日，国务院印发《“十二五”期间深化医药卫生体制改革规划暨实施方案》。通知要求，充分发挥全民基本医保的基础性作用，重点由扩大范围转向提升质量。通过支付制度改革，加大医保经办机构和医疗机构控制医药费用过快增长的责任。在继续提高基本医保参保率基础上，稳步提高基本医疗保障水平，着力加强管理服务能力，切实解决重特大疾病患者医疗费用保障问题。     

医保谈判机制亟待解决的三大问题

医疗保险谈判机制是控制医保基金支出过决增长、提高医保基金使用效率的一项行之有效的制度。我国新一轮医改也已明确提出，要“积极探索建立医疗保险经办机构与医疗机构、药品供应商的谈判机制，发挥医疗保障对医疗服务和药品费用的制约作用”。新医改实施4年来，不少地区对建立医保谈判机制积极探索，也取得了一些效果，但很有限，远没有形成一种机制。笔者认为，     

医保预付制改革的效果研究——来自中国CHIRA数据的实证检验

推进医保支付方式改革是完善中国特色医疗保障制度的重要内容,对于规范医疗服务行为、引导资源配置、控制医疗费用不合理增长具有重要意义.本文利用中国医疗保险研究会2014～2017 年CHIRA数据库,抽取了16 个城市134522 条住院患者样本,采用处理效应模型对医保预付制改革的效果进行研究.研究结果显示,医保预付制可以...     

商业保险参与城乡医保一体化建设研究

2007年,城镇居民基本医疗保险试点在全国范围内展开,标志着我国以职工基本医疗保险、城镇居民医疗保险与新型农村合作医疗为框架的基本医疗保险制度基本建立,三大医疗保险制度以及贫困人口医疗救助制度组成的社会医疗保障体系已从制度上覆盖城乡全体居民。但是各项医保制度基金分立、体制分割并存的局面引起了各种弊端。     

借鉴管理式医疗保险制度--有效控制医疗费用的快速增长

我国医保改革的实践证明，过快增长的医疗费用已经严重制约了医疗改革全全面深入，因而，在保证医疗质量的前提下抑制医疗费用的快速增长已成为我国医保下一步改革的重中之重，作为世界性难题，各国政府都在为此进行长期的、系统的研究与探索，其中，美国管理式医疗保险制度在控制医疗费用的快速增长方面已初显成效，代表了世界医费风险控制的趋势。文章由此指出，借鉴管理式医疗保险制度，对我国医保改革的的成功至关重要。     

试析医疗卫生事业发展的特殊矛盾和我国医改的路径选择

市场经济条件下医疗卫生事业发展面临五大特殊矛盾。现行医疗卫生体制要解决的首要问题是体制、机制创新问题。公立医院改革和医疗保险体制改革相结合,建立以公益性医院为主题的医疗保险职能和公共医疗服务职能相结合的制度统一、全民覆盖、统筹城乡的新型公共医疗服务保险制度,构建政事分开、管办分开、医保基金管用分开的医疗卫生管理体制,是化解现行医药卫生体制蕴藏的内在矛盾,破解我国医改难题的可行的路径选择。     

Debt and Taxes and Uncertainty

With a graduated personal tax schedule, Miller showed that there could be an equilibrium debt supply for the corporate sector as a whole. In the presence of uncertainty there is also a unique debt/equity ratio for each individual firm, and this ratio is related to the firm's operational risk characteristics. However, if firms merge and spin off in response to tax incentives, the identity of firms is ambiguous and only the corporate sector is a meaningful construct. These arguments are developed in both discrete and continuous models that employ extensions of the arbitrage-free pricing theory.     

教育与资本怎样的前景怎样的现实

来自政府的声音: "动员各种社会资源,发展教育" 此次论坛上财政部长助理张少春的发言是最受关注的发言之一.他的演讲传达出的信息有这样几方面:第一,谈到现实,他认为全社会对教育的巨大需求与我国公共投入不足已成为我国教育事业发展的突出矛盾.近年来,以公共部门投入为主,多渠道筹措教育经费的教育投入机制成为解决这一问题的重要途径,也使得公共部门与私营部门在教育领域的合作日益密切.第二,谈到前景,他认为,1.中国经济持续、快速的增长对高技能人才产生巨大的需求,这为私营部门的参与提供了广阔空间.2.随着公共财政职能的不断完善,财政资金将在各项教育事业中重新进行分配,进一步优化财政支出结构,提高资金的使用效率.在"十一五"期间,我国将把公共支出的重点转移到农村.我们将逐步把全体农村适龄儿童的义务教育全部纳入公共财政体制.     

Director gender and mergers and acquisitions

Does director gender influence CEO empire building? Does it affect the bid premium paid for target firms? Less overconfident female directors less overestimate merger gains. As a result, firms with female directors are less likely to make acquisitions and if they do, pay lower bid premia. Using acquisition bids by S&P 1500 companies during 1997–2009 we find that each additional female director is associated with 7.6% fewer bids, and each additional female director on a bidder board reduces the bid premium paid by 15.4%. Our findings support the notion that female directors help create shareholder value through their influence on acquisition decisions. We also discuss other possible interpretations of our findings.     

Political corruption and mergers and acquisitions

This research examines the relation between political corruption and mergers and acquisitions (M&As). We find that local corruption increases firm acquisitiveness but decreases firm targetiveness. The levels of corruption in acquirer areas relate positively to the bid premiums and negatively to the likelihood of deal completion. Corruption motivates acquiring firms to use excess cash for payment, which mitigates the negative effect of corruption on acquirer shareholder value. The evidence indicates that acquisitions help acquiring firms convert cash into hard-to-extract assets and relocate assets from the high to low corruption areas, thereby shielding their liquid assets from expropriation by local officials.     

Trust and cross-border mergers and acquisitions

A number of studies suggest that social trust matters for investment. Using different measures of trust from World Values Survey, we show that countries where people display higher levels of trust engage in more cross-border M&A activities. When they do, these acquirers pay lower premiums. To the extent that these acquirers also tend to engage in larger acquisitions as well, our findings suggest that a larger selection pool of potential targets and higher value targets enable these acquirers to negotiate for lower premiums. We do not find evidence of the significant effect for target country trust levels. Hence, trust may benefit those acquiring firms in cross-border transactions.     

Tournament-based incentives and mergers and acquisitions

This research examines the relation between tournament-based incentives, which are proxied by the difference between a firm's CEO pay and the median pay of the senior managers, and mergers and acquisitions (M&As). We find that tournament-based incentives are positively related to firm acquisitiveness and acquiring firms' stock and operating performance. Further analysis indicates that positive acquisition performance increases the likelihood of the CEO being promoted from inside the acquiring firm. Our evidence is consistent with the view that tournament-based incentives motivate acquiring firms' managers to make greater efforts and take more risk that result in superior acquisition performance.     

Corporate Innovations and Mergers and Acquisitions

Using a large and unique patent‐merger data set over the period 1984 to 2006, we show that companies with large patent portfolios and low R&D expenses are acquirers, while companies with high R&D expenses and slow growth in patent output are targets. Further, technological overlap between firm pairs has a positive effect on transaction incidence, and this effect is reduced for firm pairs that overlap in product markets. We also show that acquirers with prior technological linkage to their target firms produce more patents afterwards. We conclude that synergies obtained from combining innovation capabilities are important drivers of acquisitions.     

East and west and north and south : A preliminary model

The Brandt report and other proposals for a new North-South world order continue to be the focus of lively debate, yet it is often argued that little concrete has emerged from their recommendations. A major reason for this, the author argues, is that the East-West conflict component is not sufficiently taken into consideration-East-West tensions are a severe constraint on and a determining factor of North-South relations. Using influence diagrams, the author develops a flexible framework for discussion and assessment of N/S-E/W relations.