The public sector and health care

This paper specifies a model of the determinans of total expenditure on health care. The model shows how this expenditure is divided between the public and private sectors when public expenditures are chosen by majority rule.From the theoretical model I derive two equations determining the private and public expenditures on health care as shares of GDP. The equations are estimated using OECD panel data with two-way fixed effects and with simultaneous correction for heteroeskedasticity and serial correlation. The results include estimates of the price and income elasticities of public and private demands for health care as well as estimates of the crowdingout effects of public on private expenditures.Paper presented at the 51st Congress of the International Institute of Public Finance.     

论商业健康保险在新医疗保障体系中的地位

国务院新公布的《关于深化医药卫生体制改革的意见(征求意见稿)》引发了社会各界的高度关注,方案中明确提出在新的医疗保障制度构建中要积极发展商业健康保险。国际经验表明,要建立一个高效率运行和可持续发展的医疗保障体系,商业健康保险是不可或缺的重要组成部分。本文从经济学理论和医疗保障的实践结果两个角度出发,论述商业健康保险与社会医疗保险合理配合的必要性,以及商业健康保险在医疗保障体系中的优势和特殊作用,并对进一步确保我国商业健康保险发展提出相应的政策建议。     

Information-sharing in health and social care: Lessons from a socio-technical initiative

Advances in information technology have led to new and innovative approaches in data-sharing, analysis, interpretation, and the potential for real-time responses to changes in health and social care status. However, health and social care information is not only complex but often socially and personally sensitive in ways that do not apply in other domains. This requires adoption of a tailored interdisciplinary (social, ethical, legal, technical and data science) and intersectoral (health and social care, academic and commercial institutions and citizens) approach to technology development. The authors present some important lessons to date from ongoing development of an innovative infrastructure for sharing health and social care data.     

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label ‘care pathways’, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.     

全球价值链的发展改变了什么

全球价值链的发展改变了国际贸易的性质,并对收入的形成、竞争力的衡量和贸易政策的制定产生了重要影响。全球价值链创造了财富,但不同国家的财富增长速度是不同的;全球价值链也改变了竞争力的意义,使得竞争力的衡量更加侧重于企业的跨境生产;全球价值链加深了国家之间的依赖,政策合作更加重要。     

After the tide: Commodity currencies and global trade

The decade prior to the Great Recession saw a boom in global trade and rising transportation costs. High-yielding commodity exporters׳ currencies appreciated, boosting carry trade profits. The Global Recession sharply reversed these trends. We interpret these facts with a two-country general equilibrium model that features specialization in production and endogenous fluctuations in trade costs. Slow adjustment in the shipping sector generates boom–bust cycles in freight rates and, as a consequence, in currency risk premia. We validate these predictions using global shipping data. Our calibrated model explains about 57% of the narrowing of interest rate differentials post-crisis.     

Tax-tariff reform with costs of tax administration

As is broadly recognised, the straightforward application of the Diamond–Mirrlees (1971) production efficiency theorem implies that when lump-sum taxation is not available, then it is optimal for the government in a small open economy to rely on taxes on the net demand of households rather than on border taxes to finance its resource requirements. However, the theorem does not hold when taxation is associated with administrative costs. The present paper explores the implications for optimal taxation and for desirable directions of tax-tariff reform of taking into account the costs of tax administration in countries at different levels of economic development. The paper clarifies the reasons for, and lends support to, the criticism by Stiglitz (Presentation to Congress of International Institute of Public Finance, Prague, 2003) of the IMF and the World Bank’s recommendation to developing countries to adopt VAT to replace border taxes.      

The impact of health care reform on older workers, retirees and employers

The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 impacts everyone who uses or pays for the health care system. Among the new law's effects will be changes in older workers' health care choices as they transition from full-time employees to part-time work or other jobs and, ultimately, to retirement, and the retiree health benefit choices facing their employers. This article reviews the major issues surrounding these changes, including those affecting retiree health benefits, benefits for Medicare-eligible retirees and health care options for older Americans not yet eligible for Medicare. The authors conclude that although employers will be reacting in 2010 and 2011 with regard to some issues surrounding FASB ASC 715-60 and the early retiree reinsurance program, employers should consider waiting to make major changes until regulations are issued and the health plans for active employees have been fully vetted.     

Capped hospital budgets,risk-influencing activities and financial consequences

It has long been recognized in the health economics literature that increased financial incentives for better-informed health care providers not only lead to desirable efficiency gains and cost savings but may have unintended consequences. Accounting-based cost containment instruments like capped budgets or prospective payment may induce physicians and hospitals to systematically avoid high-cost patients. Our paper uses an empirical approach backed by theoretical arguments to study a small German hospital’s reactions to a major increase in financial incentives. We first describe essential features of the German hospital sector and developments that led to the introduction of capped budgets for hospital care in 1993. Next, incentives to treat high-cost patients before and after the reform are analyzed in more detail. Using an anesthesia-related patient severity score (ASA score) as a proxy for financial patient risk, we empirically address the question of how the distribution of ASA scores has changed over time at the hospital for the 1989–2002 period. Our analysis of detailed operating room data reveals that the number of high-risk patients (high-ASA score) showed a systematic and significant decrease after the introduction of capped budgets. Using data from the new German DRG-reimbursement system, we also gain some preliminary evidence of the possible financial consequences of such practices.     

Public health care services in the advanced welfare state: Observations from the Swedish futures study care in society

In 1978 the Swedish Secretariat for Future Studies—a government advisory body for long-term issues of broad societal significance—began its project “Care in Society”. The final project report was published in May 1982. The original purpose of the project was to study how conditions in society affect needs for care in different forms and how these needs are met—informally or through formal institutions. More broadly, the study came to be a general assessment of the welfare state and its growing problems. This article examines findings and proposals from the Swedish report.     

Defining the road ahead: thinking strategically in the new era of health care reform

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.     

Envisioning the future for older adults: Autonomy,health, well-being,and social connectedness with technology support

Envisioning the future of older adults of 2050 is a challenging task given the heterogeneity of the older adult population. We consider primarily the domains of home, health, and social participation for individuals over age 65 and the potential role of information, communication, and robotic technology for enhanced independence, maintenance of autonomy, and enriched quality of life. We develop several scenarios to illustrate the diversity of circumstances, health, and living situations for older adults in the future. We discuss possible negative outcomes resulting from the proliferation of technology, including increased social isolation and a widening digital divide. However, we focus primarily on envisioning desired situations wherein older adults have autonomy and independence; are easily able to manage their health and wellness needs; have rich and rewarding opportunities for social connectedness, personal growth, continued life purpose, and overall high quality of life. To attain this future, we must be acting now: designing the technology with involvement by today’s older adults who represent the needs and capabilities of tomorrow’s older adults; developing the necessary infrastructure to support widespread availability and deployment of these technologies; and supporting the integration of technology into people’s lives at younger ages with adaptive functionality to support changing needs and preferences.     

新医改视角下我国商业健康险的发展契机

在新一轮医疗卫生体制改革及其相关配套政策措施的合力推动下,作为覆盖我国城乡居民多层次医疗保障体系有机组成部分的商业健康险,其在整个国家医疗保障体制中的地位必将得到进一步巩固和提升。本文从我国商业健康险的发展现状出发,从外部经营环境和内部管理运营两个角度分析了我国现阶段商业健康险发展过程中存在的主要问题,并结合新一轮医改带给健康险发展的机遇与挑战,提出专业化经营+健康管理是我国商业健康险发展的唯一路径。     

衍生品电子化交易确认及其在银行间市场的应用研究

自全球金融危机以来,国际场外衍生品市场监管逐渐趋于严格和透明,标准化和电子化已成为衍生品市场发展的重要趋势。文章回顾了场外衍生品电子化交易确认业务的产生背景、发展进程与发展经验,介绍了国内银行间衍生品市场应用电子化交易确认业务的实践,及其对于提高市场标准化程度、降低市场风险以及完善衍生品市场基础设施的重要意义。     

论国有商业银行机制改革与管理创新

加快国有商业银行机制改革和管理创新 ,是增强核心竞争力的有效手段。要采取渐进性、整体推进办法 ,按照建立现代企业制度的要求 ,着重进行法人治理结构、产权制度、资源管理等机制改革和管理创新。     

改进国际经济与贸易专业实践性教学的思考

目前,我国地方财经类院校国际经济与贸易专业实践教学环节都比较薄弱,培养出的学生实际操作能力较差,难以达到社会要求,在一定程度上影响了学生的就业。本文就目前国际经济与贸易专业实践性教学存在的问题进行了分析,并提出了改进本专业实践性教学的有效途径以及需要关注的几个问题。     

关于贸易和汇率间相互引导关系的实证分析及启示

针对在我国究竟是贸易引导汇率和资本流动,还是汇率引导贸易和资本流动这一争议,文章采用计量分析的方式进行了实证检验。实证结果显示,在这三个变量中,贸易差额居于至关重要的地位,其变化引导着人民币汇率变动和跨境资本流动。因此,要缓解我国资本流入的压力,保持人民币在合理水平上的基本均衡,必须从根本上加快转变经济发展方式,减少经济发展对“净出口”的依赖,实现进出口贸易的基本平衡,同时加快推进资本项目可兑换,便利企业“走出去”进行全球投资,并加快推进汇率形成机制改革。     

伦敦同业拆借利率操纵事件及其改革动向分析

近期巴克莱等国际主要金融机构卷入伦敦同业拆借利率（Libor）操纵事件,引起了市场广泛关注。文章针对Libor操纵事件进行了专题研究,概括总结了Libor形成机制与主要用途,梳理了Libor操纵事件的主要情况,研究了事件造成的主要影响、形成的原因及改革前景,并提出Libor操纵事件带来的主要启示与相关政策建议。