Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

Public provision of health insurance and aggregate saving in an overlapping generations model with endogenous health risk: The South Korean case

This paper examines the effect of expanding public health insurance in South Korea on medical expenditures and aggregate saving using an overlapping generations model with endogenous health risk. South Korea had a substantial underinsured population, which is aging rapidly. Higher public health insurance benefits reduce individual medical expenditure and health risks but lead to a modest decline in individual and aggregate saving. Even after the expansion, the medical care coverage remains incomplete, and the elderly face a substantial risk of out-of-pocket medical expenditures.     

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

公共财政:概念界说与演变脉络——兼论中国财政改革30年的基本轨迹

本文立足于中国特定的体制转轨背景,在系统考察公共财政问题来龙去脉的基础上,对这一经济范畴的内涵与外延做出了比较清晰的界说。本文的分析表明,跳出纯学术思维的局限而放眼中国财政改革30年的历史进程,可以发现,公共财政本来就是为了解决中国自身问题的需要而提出的一个富有中国特色的概念。鉴于"公共性"是财政与生俱来的本质属性,作为一个有别于计划经济年代的财政制度安排,以覆盖范围不断拓展为集中体现的中国公共财政建设之路,实质是一个让传统中国财政体制机制和传统中国财政学回归"公共性"轨道的过程。站在制度变革的高度,按照公共的理念和规则,深刻把握公共财政制度的基本要求,以此勾画中国财政改革与发展蓝图并改造中国财政学学科体系,是历史赋予我们这一代人的特殊使命。     

公共支出范围:分析与界定

本文建立一个新的理论假设 :政府存在的天然合理性在于防范和化解公共风险 (在不同历史条件下 ,其表现形式不同 ) ,并以此为逻辑起点 ,提出了两个基本观点 :一是公共风险决定公共支出 ;二是公共支出的使命是防范和化解公共风险。在此基础上 ,本文构筑了界定公共支出范围的两种基本方法———风险归宿分析法和反向假设分析法。     

Decision theories and probabilistic insurance: an experimental test

This paper reports the results of an experiment in which probabilistic insurance, as proposed by Kahneman and Tversky (1979), is compared both with full insurance and no insurance. The experimental results conform to the intuitive prediction that risk-averse agents who are indifferent between full insurance and no insurance, will prefer full insurance to probabilistic insurance and probabilistic insurance to no insurance. The first conclusion is incompatible with the predictions of expected utility theory, and the second with Kahneman and Tversky's prospect theory. We also show that Loomes and Sudgen's regret theory can easily accommodate these intuitive results. JEL Classification: C91, D81. We are most grateful to Graham Loomes and two anonymous referees for their very helpful comments. Financial support from the Ministerio de Ciencia y Tecnología, under project BEC2001-0535, and from the Generalitat Valenciana under project GRUPOS03/086, is gratefully acknowledeged.     

国家治理视角下公共政策审计的内容界定与发展规划

随着国家治理免疫论的提出,公共政策审计作为审计服务国家治理的一种新模式日益受到关注,但是系统、完整的相关理论框架尚未形成,真正意义上的公共政策审计实践也是屈指可数。本文在阐释公共政策审计的含义、本质、立项依据、服务国家治理依据和审计机关权力边界的基础上,试图构建出公共政策审计的内容框架,并就我国公共政策审计的三阶段发展规划作出关于阶段审计重点的分析。     

Regulatory and environmental effects on public transit efficiency: a mixed DEA-SFA approach

This paper assesses the impact of regulatory and environmental factors and statistical noise on the efficiency of public transit systems within a DEA-based framework. Using a panel of Italian companies, we implement a DEA-SFA mixed approach based on [H.O. Fried et al. (2002) Journal of Productivity Analysis, 17(1–2), 157–174] to decompose DEA inefficiency measures into three components: exogenous effects, managerial inefficiency and stochastic events. Besides providing evidence on the determinants of input-specific efficiency differentials across companies, the results point out that managerial skills play a minor role, and emphasize the relevance of regulatory policies aimed at replacing cost-plus subsidization with high-powered incentive contracts as well as improving environmental conditions of public transit networks.      

Public capital,deficit financing,and economic growth in a stochastic economy

This paper examines the relationship among deficit-financing fiscal policy, risk and economic growth in a stochastic endogenous growth model with private and public capital. We show that there are positive balanced-growth rate and a debt-to-GDP ratio that depend on deep parameters such as the income tax rate and the standard deviation of the growth rate of private and public capital. Investment and fiscal shocks influence the mean and variance of the growth rate and the debt dependency rate through portfolio changes and capital accumulation. In particular, an increase in the risk of private investment destabilizes the economy and reduces the mean growth rate if the portfolio change is drastic, and this increase in risk increases the debt-to-GDP ratio. In contrast, an increase in the income tax rate stabilizes the economy, increases the mean growth rate, and has a positive or negative effect on the debt-to-GDP ratio according to the ratio of public to private capital if the income tax rate is sufficiently small.     

Unemployment insurance: The role of electoral systems and regional labour markets

Levels of insurance against unemployment vary considerably across countries. Replacement rates, the ratio relating income from unemployment to what people earned when they were employed, are higher in countries with proportional electoral systems than in countries with majoritarian systems. Also, replacement rates are positively correlated with per capita income and negatively correlated with the countries' unemployment rates. I develop an electoral competition model that replicates these stylized facts.     

巨灾压力下的公共财政:国际经验与启示

从保护公共财政的角度看,为了让巨灾保险充分发挥作用,如果政府有充分选择的自由,政府的最优选择应该是回避对巨灾损失承担直接责任,而是让居民和保险人共同承担.但政府可以通过为商业保险人提供再保险、为居民购买巨灾保险提供补助等方式积极承担间接责任.第二,在政府不得不承担直接责任的情况下,政府次优选择应当是位居商业保险之后.而且提供比商业保险更低的保障.总之,政府应当尽可能让商业保险在前面首先承担直接责任,并减少自身的直接经济责任.     

Deposit insurance and bank regulation in a monetary economy: a general equilibrium exposition

Summary. It is commonly argued that poorly designed banking system safety nets are largely to blame for the frequency and severity of modern banking crises. For example, underpriced deposit insurance and/or low reserve requirements are often viewed as factors that encourage risk-taking by banks. In this paper, we study the effects of three policy variables: deposit insurance premia, reserve requirements and the way in which the costs of bank bailouts are financed. We show that when deposit insurance premia are low, the monetization of bank bailout costs may not be more inflationary than financing these costs out of general revenue. This is because, while monetizing the costs increases the inflation tax rate, higher levels of general taxation reduce savings, deposits, bank reserves, and the inflation tax base. Increasing the inflation tax rate obviously raises inflation, but so does an erosion of the inflation tax base. We also find that low deposit insurance premia or low reserve requirements may not be associated with a high rate of bank failure.Received: 2 January 2002, Revised: 1 March 2003JEL Classification Numbers: D5, E5, G1.B. D. Smith: Sadly, our co-author, colleague and dear friend, Bruce D. Smith, died on July 9, 2002.     

Premium subsidies and demand for private health insurance: results from a regression discontinuity design

This article investigates the impact of a private health insurance (PHI) subsidy on the demand for PHI in the context of the Australian health care system. In particular, we focus on the subpopulation of elderly Australians and exploit discontinuous increases to the universal ‘PHI rebate’ that occur when people turn 65 and 70 years. Using a regression discontinuity design, we find the policy has little effect on take-up of PHI and is best interpreted as a wealth transfer to elderly Australians who already have insurance.     

Minimum standards, insurance regulation and adverse selection: evidence from the Medigap market

This paper examines the implications of minimum standards for insurance markets. I study the imposition of binding minimum standards on the market for voluntary private health insurance for the elderly. The central estimates suggest that the introduction of the standards was associated with an 8 percentage point (25%) decrease in the proportion of the population with coverage in the affected market, with no evidence of substitution toward other, unregulated sources of insurance coverage. To explore possible factors contributing to the impact of the minimum standards, I develop comparative static predictions of the impact of imposing minimum standards in an insurance market with adverse selection. The observed changes in market equilibrium associated with the minimum standards are broadly consistent with these predictions, providing evidence of the existence of adverse selection in this insurance market. More importantly, they suggest that the presence of adverse selection—which in principle may provide an economic rationale for minimum standards—in practice may have exacerbated the declines in insurance coverage associated with the minimum standards.     

Determinants of non-life insurance expenditure in developed and developing countries: an empirical investigation

The determinants of non-life insurance expenditure in a panel data set covering 36 developed countries and 31 developing countries for the period 2000–2011 are analysed. Results of our instrumental variable analysis indicate that economic freedom, income, bank development, urbanization, culture and law systems are the key drivers of the non-life insurance expenditure across countries. However, their impacts differ significantly between the groups of developed and developing countries, suggesting that the heterogeneity among countries in terms of the level of development plays an important role. The global financial crisis is also found to influence the direction of those effects, especially in developed countries. The article yields useful policy and economic implications for governments and multinational non-life insurance companies with regard to the development of the non-life insurance sector, an important engine for economic growth and prosperity.     

经济学视域下的公共政策分析:批判与反思

当前主流经济理论对公共政策的分析主要是基于其广泛适用的规则和假设,在进行演绎式分析推理过程中,其所使用的抽象效率标准将公平分析几乎完全排除在外,从而使公共政策在很大程度上失去了其应有的价值判断。现实中,社会性个体基于契约理性追求角色意义上的目标及其协调,因此,公共政策首先应考虑的是目标定位与一致认可,这必然要兼顾公平与效率,并全面考虑人类行为的伦理、经济和法律方面,这是人作为一切社会关系的总和的必然产物和要求。政府公共政策及其引导下的集体行动是对个体角色目标的协调一致的表现和结果,因此公共政策只有能够满足诸多个体实现不同的个人目标,才有被认可并得到执行的可能。由此可见,公共政策首先应当有其价值判断,该价值判断建立在共识判断的基础之上。     

Precautionary motivation and consumption insurance: Empirical analysis of household consumption behavior in rural China

Based on a household survey in rural China, this paper discusses parameters such as precautionary motive, excess sensitivity, consumption insurance, and inter-temporal substitution in the household consumption function in rural China. The conclusions of the paper indicate that there is a significant precautionary motive in household consumption in rural China, but the function of consumption insurance is very limited, and the consumption is also excessively sensitive to the income change. Such parameters are different among consumers within different groups. __________ Translated from Zhongguo Nongcun Jingji 中国农村经济 (Chinese Rural Economy), 2006, (4): 12–19     

The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP

We examine Medicaid enrollment and private coverage loss following expansions of Medicaid eligibility. We attempt to replicate Cutler and Gruber's [Q. J. Econ. 111 (1996) 391.] results using the Survey of Income and Program Participation (SIPP), and find smaller rates of take-up and little evidence of crowding out. We find that some of the difference in results can be attributed to different samples and recall periods in the data sets used. Extending the previous literature, we find that take-up is slightly increased if a child's siblings are eligible and with time spent eligible. Focusing on children whose eligibility status changes during the sample, we estimate smaller take-up effects. We find little evidence of crowding out in any of our extensions.     

公共服务的覆盖面管制：价格与质量的社会权衡

文章讨论了同质单一公共服务覆盖面的管制问题。不同消费者存在异质的偏好，这种差异会影响公共服务的管制方式和目标，此时管制不仅是协调消费者剩余和经营者利润，而且还涉及到服务价格和质量的权衡。本文分析了公共服务最优覆盖面的决定因素，并考察了垄断和不同管制方式对公共服务覆盖面的影响。     

关于公有经济收入差别倒U理论的讨论与验证(上)

在经济发展方式逐步从增长型向分配型、从生产型向消费型、从建设型向民生型转变的过程中,回顾和总结学术界关于居民收入分配差别的讨论显然是必要的。文章从多个方面回顾、分析和考察了"公有经济收入差别倒U理论"这一理论模型提出后的争论焦点及演变过程,包括围绕这一理论所讨论的主要内容,比如有关公有制经济与私有制经济条件的比较分析,有关劳动差别、劳动供求、剩余/生计比以及农村收入差别大于城镇差别等两部门内部各种因素的趋势、二元结构部门转换影响收入差别的讨论,有关国有资本积累及改革引起的民营资本积累、税收政策和体制改革对收入差别变动趋势的影响的讨论,以及这一理论在中国的验证等。分析表明,目前中国居民收入差别还在沿着公有经济收入差别倒U曲线的前半段逐步呈"阶梯形"上升,但上升的势头已经趋缓,并且个别方面比如城市化等因素导致的收入差别已经初现下降趋势。