论民营中小企业医疗保障制度的建设

民营中小企业医疗保障制度是我国社会保障制度的重要内容之一。但由于政策与法律监督的缺位、劳动力市场供大于求、民营中小企业的劣势地位、企业主和职工的短期行为等因素的困扰,民营中小企业医疗保障存在着参保率普遍偏低、企业参保状况参差不齐、保障明显不足等问题。民营中小企业医疗保障制度建设的重点应是建立和完善大病医疗保险制度,同时要加快立法步伐,明确政府职责,加强保险资金的科学管理,夯实医疗保障的微观基础,发展和完善医疗救助制度,为民营中小企业医疗保障制度建设扫除障碍。     

灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

税延政策下不同收入层人群养老保险模式选择——基于累进税制和比例税制的综合实证研究

个税递延型商业养老保险政策的实施将对不同收入层次和不同收入来源人群的养老保险模式选择产生重大影响,而我国现行以累进型为主的个人所得税制度在这一影响发生的过程中发挥着根本性作用.基于这一影响机制,本文重点研究EET模式商业养老保险的受益群体范围,以不同收入水平和不同收入来源的杭州市居民为研究对象,以包含社会养老保险和商业养老保险的动态养老金总替代率期望值为调节目标,构建包含个人所得税的累进税率和比例税率变量的保险精算模型,设计和测算了投保期内的下临界点S1和上临界点S2.在此基础上,从居民购买商业养老保险意愿度和社会公平的角度出发,探讨对两个临界点的进一步调整,分析EET模式商业养老保险受益群体范围以外人群的行为决策,并最终提出政策性建议.     

试析企业年金税收优惠

随着人口老龄化危机的加重,企业年金计划被确立为社会养老保险体系的第二支柱。由于企业动力不足,当前我国年金计划只在少数企业建立,覆盖面还不够广。税收优惠在促使企业建立年金计划方面的激励功能已在发达国家所证实,我国应借鉴国外的经验,推动企业年金的发展。     

关于大学生医疗保险体系完善的研究分析

当前,大学生医疗保险体系存在的主要问题是大学生对医疗保险常识以及各项权利和义务的理解欠缺,高校对大学生的医疗理赔行为缺乏有效的支持与帮助,大学生参保积极性不高、医保使用率较低。完善大学生医疗保险体系,应坚持以社会保险为主,商业保险为辅,构建多层次医疗保险体系,充分发挥高校在大学生医疗保险体系中的作用,各级政府应加大政策力度和经济投入,应该在政策的制定和执行方面加大力度,根据需要适当增加资金投入,积极协调高校、保险公司、定点医院及大学生之间的关系,充分降低高校在大学生医疗保障方面的压力,保证所有大学生都有能力参加社会医疗保险。     

Energy,Insurance, and Health: Viewpoints of a Microeconomist

Abstract

This contribution reviews developments in the microeconomic analysis applied to three fields that are rarely considered in combination – energy, insurance, and health – focusing on four themes. First, it finds that stocks are crucial not only in energy but also motivate (in the guise of assets) demand for insurance coverage, as well as healthcare services designed to maintain one’s stock of health. Second, however, the three fields strongly diverge in terms of their industry structure. While oil and, until recently, electricity are vertically integrated, healthcare has been the leading example of a cottage industry, with private insurance in between. Third, the structure of innovation also differs. In energy and private insurance, process and organizational innovation prevail; in healthcare, it is product innovation, meaning new characteristics at higher cost, facilitated by health insurance. Finally, government regulation impinges on all three industries.     

Genetic Testing and the Demand for Cancer Insurance

There has been an expansion of the availability of disease-specific insurance policies in the United States over the past decade. At the same time, recently developed medical tests are providing consumers with new information regarding their risk of contracting particularly serious diseases. This exploratory study makes use of data from two groups of women to examine the demand for one type of disease-specific policy, cancer insurance. Members of the first group have been tested for a BRCA1 gene mutation that is associated with an 88% risk of contracting breast and/or ovarian cancer by age 70. The other group consists of women from the general population who have not been tested for any BRCA1 gene mutation.The study results indicate that women who have been tested for the BRCA1 gene mutation are more likely than untested respondents to have purchased cancer insurance and to have recently thought about purchasing cancer insurance. The results also indicate that older women and women who have modest household incomes are more likely to have purchased cancer insurance. Women who have minor children, who are more highly educated, who have no health insurance, who have had cancer, or who report that they are in poor health are more likely to have recently contemplated purchasing cancer insurance. Our discussion of the findings highlights several issues that merit further consideration on the part of consumer policy makers working in the area of insurance regulation.     

Dualit?t aus gesetzlicher und privater Krankenversicherung überholt?

The present division between statutory and private health insurance in Germany (GKV and PKV) is hard to justify. If it is the goal to include the whole population in the GKV eventually, one author states that the only legal way is to change its financing from wage-based contributions to a per-capita amount, which would generally reduce incentives to join the PKV. Possible reform alternatives for the financing of health insurance are analysed by another article according to the following principal questions: Are they able to raise sufficient funds and allocate them efficiently? How does that affect employment and distributive justice? These questions can be used to benchmark various insurance models, i.e. citizens insurance, citizens private insurance and premium models. Another article focuses on a non-profit private legal framework, e.g. a co-operative or a limited society.     

Measuring physician contribution to the healthcare safety net

There are an estimated 46 million Americans without health insurance and an even larger number for whom health insurance does not cover all needed medical services. These individuals and families have to rely more and more on government programs and physicians’ willingness to provide uncompensated services, most often described by providers as charity care. Previous studies have shown a downward trend in the percent of physicians willing or able to provide charity care. We extend this research by examining the results of the Medical Group Management Association's Cost Survey of Medical Group Practices for 2005, 2006, and 2007. It is important to examine the uncompensated care reported by medical groups because groups have policies that may govern how much, if any, charity care their physicians provide. This survey data shows that, overall, the number of medical practices providing charity care continues to decline. The results and analysis of the survey data indicate that uncompensated (charity) care is being offered by less than half of medical practices, and at less than 2% of total gross charges. We examined the results by potential explanatory variables: population density, practice size, physician practice specialty, practice ownership structure, payer mix, and practice financial performance. Results were consistent across all categories; charity care is declining. These results have major policy implications for both the federal government and all state governments, especially in light of the current recession and proposed healthcare reform legislation.     

湛江模式的启示:探索社会医疗保险与商业健康保险的合作伙伴关系

在推进全民医保的新探索中,广东省湛江市在推进社会医疗保险与商业健康保险的合作伙伴关系上呈现出独有的特色,引起了政府和社会各界广泛的关注。"湛江模式"的重要启示是,社会医疗保险与商业健康保险建立合作伙伴关系,可以有效促进双方的共同发展以及多层次医疗保障体系的形成与发展。     

Future issues in health economics: one view from Washington

These are comments about how policy issues at the federal level may create a demand for research in several areas of health economics. As background, there is a discussion of the current federal budget situation and the cost-containment pressures this puts on public health programs. The longer-term problem of financing of the Medicare trust fund is also discussed. Four areas where new research may affect future health policy are identified: the market for physician's services, medical technology, competition in health care, and the market for health insurance.     

建立开放型社会医疗保障制度实证研究与理论探讨——京晋两地实例分析

通过对北京和山西两地居民基本社会医疗保险选择意愿的调查分析,对政府卫生支出进行估算,探索经济发展水平不同地区建立城乡统筹的基本社会医疗保险的必要性和可行性。运用2011年的实证调查数据,采用交叉列联表、回归分析等统计方法,分析、对比北京、山西居民对基本医疗保险的选择意愿及其人口学因素,估算统筹城乡医保后两地政府卫生支出的变化。结论是：按照户籍、是否就业划分的医保制度在两地均不能满足所有居民的医保需求;影响两地医保选择的共同人口学变量有户籍、是否有商业保险、家庭人数、家庭年收入;若允许居民自由选择现行三大医保,北京市需多投入119.929亿元,山西省政府可节约109.815亿元。在经济发展水平不同的京、晋两地将现行三种基本社会医疗保险制度转化为统一制度下的三种医保水平并允许居民自由选择,可以取得事半功倍的效果。     

Making Health Care More Affordable Through Health Insurance Finance Reform

The way that we finance health insurance today is both unfair and inefficient. The tax code subsidizes the most expensive employment-based policies while penalizing those who buy insurance on their own or choose more basic policies. By reforming this system, we can both make health care more affordable for millions of people and get higher-value care for the money that we spend. These reforms should be coupled with policies to ensure that basic private insurance is affordable for everyone, including those with chronic health conditions or low income, and to ensure that patients and physicians have the tools that they need to make well-informed decisions. JEL Classification I11     

商业健康保险和农村健康保障

随着农村医疗卫生系统的市场化改革和合作医疗的解体 ,农民失去了最基本的健康保障。多层次的农村健康保障体系亟待建立。商业健康保险是多层次健康保障体系中的重要支柱。目前开发农村地区对于商业健康保险的潜在需求在经济上是可行的。进一步提出了发展农村商业健康保险的建议。     

The Distributional Impact of Health Financing in Europe: A Review

This article summarises, extends and updates previous empirical work on the distributional implications of alternative health care financing arrangements in a selection of European countries and the US. On the one hand, total health care payments are almost proportional to ability to pay in most countries. This is predominantly driven by a high reliance on public financing. On the other hand, private payments – out‐of‐pocket payments as well as private insurance premiums – are highly regressive. More extended reliance on private financing may therefore endanger the equitable nature of financing systems. In addition, private payments put a heavy burden on unfortunate households.     

Health Information Technology and Financing's Next Frontier: The Potential of Medical Banking

Calls to action for widespread adoption of electronic health records have come from a broad spectrum of the private and public sectors. The problem, to date, is not that information does not exist, as much as that the data have not been organized around the patient. An integrated Personal Health Record is a patient- or family-centered technology designed to capture not only the contacts with health care providers, but also personal information on insurance, diet, and personal preferences that a physician's health record will not capture. Medical banking, based on a new technology platform called the Integrated Health Card, is emerging as a solution to the problem of collecting and combining information from the electronic health record with personal health information. It may also be the only way for fledging health savings accounts to enable the price and quality transparency of the medical market that has been called for repeatedly in this decade. In analyzing the political and patient applications of widespread adoption of this new innovation, the positive contributions to social welfare are very likely to outweigh the negative.     

浅谈如何在新形势下做好农民工的医保工作

农民工医保是一项全新的工作,它涉及面广,政策性、专业性强,工作环节多,业务管理繁杂。农民工医疗保障制度的建设是新农村建设的配套工程,它关系到新型农村合作医疗制度的完善,关系到新农村建设的进程,关系到城市的稳定和发展,关系到我国小康社会的进步,解决好农民工的医疗保险工作对于我国和谐社会的建设至关重要。笔者就农民工参保比例较低、用人单位参保行为的影响因素、劳务公司借劳务派遣避责及农民工医保管理工作存在的问题提出了些自己的看法。     

完善我国医疗保障体系的几点思考

完善我国医疗保障体系,要加大政府对医疗服务领域的资金投入,为医疗保障制度的有效运行奠定基础;医保、医疗、医药要"三改联动",创遣医疗保障制度实施的良好环境;引导卫生资源合理配置,发展社区卫生事业,理顺医疗卫生服务体系;加强医疗保险基金的预算管理,用科学的复合式付费方式对定点医疗机构的医疗服务进行合理补偿;加快社会医疗保障的立法步伐,为医疗保障制度的推进提供法律保证;逐步建立多层次的医疗保障体系.     

步长稳心颗粒市场营销策略分析

通过对步长稳心颗粒所进行的SWOT分析显示:其具有知名度高、实力强、产品技术和疗效佳、销售网络与团队强大的优势,且国家政策的支持、市场潜力大、医药市场和医保制度的逐渐完善也为其发展提供了良好的机会;但仍存在销售政策和薪酬激励机制不完善、渠道控制力差、缺乏有力监管以及市场竞争激烈、外资和国内药企业并购重组的冲击、国家监管力度加大等劣势和威胁。步长集团应加快进行客户分类和市场营销组合策略,完善薪酬激励制度,并加强集团道德建设,以进一步提升稳心颗粒的市场竞争力。