城镇居民基本医疗保险征缴过程中存在问题及对策

城镇居民基本医疗保险运行过程中,参保人员的费用征缴尤为重要,因为征缴的参保费用直接影响医保基金抗风险能力,参保费用征缴额越大,抗风险能力就越强。笔者对在城镇居民基本医疗保险征缴过程中存在问题进行了归纳,并提出建议。     

城镇居民基本医疗保险基金的管理思路

大庆市是黑龙江省开展城镇居民基本医疗保险的试点城市，按照《黑龙江省城镇居民基本医疗保险试点方案》的精神，对试点城市城镇居民基本医疗保险的参保范围和筹资水平以及基金管理都做了相应规定，本文仅对城镇居民基本医疗保险基金管理进行初步探讨。     

劳动和社会保障部关于促进医疗保险参保人员充分利用社区卫生服务的指导意见

各省、自治区、直辖市劳动和社会保障厅(局):促进医疗保险参保人员充分利用社区卫生服务,对保障参保人员基本医疗,提高医疗保险基金使用效率具有重要意义。医疗保险制度改革以来,各地在大力推进医疗保险制度建设的同时,按照党中央、国务院的统一部署,结合本地实际,通过扩大社区卫生服务机构及基层医疗机构定点范围、将社区卫生服务中的基本医疗服务项目纳入医疗保险支付范围、以及适当降低参保人员医疗费用自付比例等措施,引导参保人员利用社区及基层医疗服务,既方便了参保人员就医购药,减轻了参保人员费用负担,又促进了医疗机构的公平竞争…     

德州市职工医保政策有新调整

德州从9月1日起对现行的城镇职工基本医疗保险制度的有关政策进行调整,降低基本医疗保险统筹基金的支付标准,放开基本医疗保险个人账户和增加特殊医疗门诊病种。此次调整最突出的特点是降低了参保职工住院治疗时进入基本医疗保险统筹基金的"门槛",减轻了个人的自负比例,特别是解决了一些较低住院医疗费用参保职工的"看病"问题,从而扩大了统筹基金支付的范围。首先,降低了基本医疗保险统筹基金的支付标准。按照政策规定,参保职工住院治疗时只有个人拿出一定比例的医疗费用额度后方可进入统筹基金的支付范围,并由统筹金支付主要的医疗费用。这也就是人们通常所说的"起付金"     

城镇职工基本医疗保险参保率低的成因及对策

最近，审计机关通过审计和调查，会同医保经办机构对鄂州市基本医疗保险的发展现状进行了解剖分析。审计分析的结果显示，城镇职工基本医疗保险还处于起步阶段，参保率较低，与《国务院关于建立城镇职工基本医疗保险制度的决定》提出的城镇所有单位及其职工都要参加基本医疗保险的要求相比，存在较大的差距。根据医保经办机构的登记，鄂州市应参保单位650个，实际缴费单位只有475个，占应参保单位的     

采取切实有效措施堵住医保基金漏洞

我市实施《北京市基本医疗保险规定》以来,在给广大参保人员就医带来方便和保障的同时也出现了一些问题,尤其是部分参保人员在医药费报销中存在不规范现象应引起足够重视。 目前我市大部分基本医疗保险人员参加了大额医疗费用的补充医疗保险,《北京市基本医疗保险规定》第四十条规定了参保职工和退休人员在一个年度内门诊、急诊医疗费用在个人负担的基础上,分别累计超过     

解决困难企业退休人员医疗保险问题的建议

城镇职工基本医疗保险制度的实施,保障了职工的基本医疗,对促进企业深化改革和建立健全社会保障体系起到了积极的作用。然而,长期以来,困难、破产企业退休人员的参保问题,一直制约着医疗保险制度改革的顺利进行。鉴于此,本文对困难企业退休人员医疗保险问题进行了探讨。     

关于促进医疗保险参保人员充分利用社区卫生服务的指导意见

各省、自治区、直辖市劳动和社会保障厅(局):促进医疗保险参保人员充分利用社区卫生服务,对保障参保人员基本医疗,提高医疗保险基金使用效率具有重要意义。医疗保险制度改革以来,各地在大力推进医疗保险制度建设的同时,按照党中央、国务院的统一部署,结合本地实际,通过扩大社区     

垦区医保基金管理存在风险分析与对策

垦区现行的基本医疗保险基金收缴筹集办法，是由垦区医疗保险经办机构按国家的有关规定．根据垦区实际向用人单位和个人收缴的，用于保障参保人员基本医疗的专项资金。为了能够平稳运作，抵御风险，以满足垦区职工的基本医疗保障水平．对基本医疗保险进行风险控制势在必行。     

工作传真

四川成都城乡基本医疗保险费实现全域结算2009年12月26日,四川省成都市城乡基本医疗保险费全域结算信息系统测试切换成功,标志着成都市城乡基本医疗保险参保人员就医或购药不再受参保区域限制,定点医疗机构和定点零售药店只需与一家医保经办机构进行费用结算,这是成都市基本医疗保险实现市级统筹、城乡统筹后又一重大举措。     

浅论差异化营销理念在保险经营中的引入和运用

在顾客关系管理理论日益得到广泛应用的今天“,差异化行销”理念在国内保险公司经营中引入和运用已变得十分必要。它能够有效帮助保险公司与保户之间建立起情感连接,塑造具有亲和力和信任感的品牌。它能够使保险公司通过吸收高质量的新保户、关注最有价值的现有保户和动态筛选优劣保户,有力提升自己的经营业绩。     

Are generalized call-spreads efficient?

In order to explain coexistence of a deductible for low values of the loss and an upper limit for high values of the loss in insurance contracts, we consider the exchange of risk between two rank dependent expected utility maximizers. It is shown that if the insurer (insured) takes more into account the lowest outcomes – hence maximal losses – than the insured (insurer), then the optimal contract has an upper limit (includes a deductible for high values of the loss). If furthermore, the insured (insurer) neglects the highest outcomes while the insurer (insured) does not, the optimal contract includes a deductible (full insurance) for low values of the loss.     

The issuer effect on default risk insured municipal bond yields

In this study, an interesting aspect of the secondary market's pricing of the riskiness of insured municipal bonds is examined. Do secondary market investors still consider the underlying intrinsic credit quality of the issuer in pricing insured bonds? Is the pricing of this “issuer effect” treated equally for both revenue and general obligation bonds? We find that, while the market does not differentiate between equally insured revenue and general obligation bonds, the intrinsic credit quality of the issuer is reflected in the bond issue's quality spread. The results suggest that investors are concerned with the default risk protection of insured municipal bonds regardless of whether they are revenue or general obligation bonds. The market does not perceive insurers to be perfect substitutes for issuers in a risk transfer. Further, the results suggest there is justification for obtaining an agency rating according to issuer credit quality even for insured bonds.     

信息不对称下保险信用缺失分析及防范

当前，保险信用缺失已成为制约保险市场进一步发展的瓶颈。文中从投保人、保险人的逆向选择及道德风险三个方面阐述了保险信用缺失的原因，同时提出了健全我国保险信用体系的对策。     

诚实信用原则在铁路货物保价运输中的适用

诚实信用原则为民法中的基本原则。保价运输是铁路货物运输中的一种特殊的运输方式。诚实信用原则在铁路货物保价运输中广泛适用。同时,实践中一些承运人和托运人存在着失信行为。因此,重塑铁路货物保价运输中的诚实信用原则成为了当务之急。     

农地承包经营权资产收益分配与农民社保资金筹集管理研究

随着我国农村社会保障制度的不断完善,农民参保范围日益扩大,参保人数快速增加,社会保障资金需求金额急增,财政负担加重。而一方面,在我国社会主义市场经济体制中,村集体所有的农村土地等公有资产的增值收益,本该属于村民的保障收益,却因为缺乏增值收益再分配管理,从而造成农民社会保障基金资金严重短缺问题。因此,必须加强农村土地等公有资产收益分配的科学管理,确保农民社保基金资金的有效筹集积累。     

Ambiguity on the insurer’s side: The demand for insurance

Empirical evidence suggests that ambiguity is prevalent in insurance pricing and underwriting, and that often insurers tend to exhibit more ambiguity than the insured individuals (e.g., Hogarth and Kunreuther, 1989). Motivated by these findings, we consider a problem of demand for insurance indemnity schedules, where the insurer has ambiguous beliefs about the realizations of the insurable loss, whereas the insured is an expected-utility maximizer. We show that if the ambiguous beliefs of the insurer satisfy a property of compatibility with the non-ambiguous beliefs of the insured, then optimal indemnity schedules exist and are monotonic. By virtue of monotonicity, no ex-post moral hazard issues arise at our solutions (e.g., Huberman et al., 1983). In addition, in the case where the insurer is either ambiguity-seeking or ambiguity-averse, we show that the problem of determining the optimal indemnity schedule reduces to that of solving an auxiliary problem that is simpler than the original one in that it does not involve ambiguity. Finally, under additional assumptions, we give an explicit characterization of the optimal indemnity schedule for the insured, and we show how our results naturally extend the classical result of Arrow (1971) on the optimality of the deductible indemnity schedule.     

保障民生—稳妥推进社会保障卡项目建设

克拉玛依市、新疆油田按照社会保障卡工程的"统一规划整体推进"原则,在认真完成基本数据库核对以及改造各家医院HIS系统的前提下,确定了基本医疗报销目录和对应目录匹配关系,发放社会保障卡14万余张,在七家医院上线试运行,7月份正式投入运行,实现参保人员医疗费用即时结算的目标。     

Safety of nonfederally insured versus federally insured credit unions in the United States

The recent failure of the Rhode Island Share and Deposit Indemnity Corporation has heightened the debate about mandating federal deposit insurance for credit unions. To date, however, opponents of and proponents for required federal deposit insurance for credit unions have relied primarily on anecdotal evidence to support their positions. The objective of this study is to provide empirical evidence concerning differences in the behavior of federally insured versus nonfederally insured credit unions in the United States in 1989. Results suggest that the problems occurring in Rhode Island are not symptomatic of widespread differences in the safety of the two groups of credit unions throughout the country.     

Incorporating a “no claim bonus” in insurance agency contract

A bonus received by an agent from an insurer when the insured does not make a claim is called a “no claim bonus” (NCB). An NCB rewards the agent's risk‐management (RM) effort that reduces the probability that the insured suffers a loss. This paper designs an incentive compatible contract that induces the agent to choose an RM effort. If the agent's RM effort cost is lower than a threshold, feasible ranges of NCB and premium values exist such that the insurer can offer an incentive compatible agency contract with an NCB that is acceptable to the agent.