Health Insurance Choice with Flexible Spending Accounts

I model the interaction of flexible spending accounts (FSAs) and conventional insurance. I show that FSA participation reduces the desired level of insurance coverage. I also show that FSA participation can reduce the total tax cost of health insurance premium and FSA contribution exclusions.     

Flexible Spending Accounts as Insurance

We model flexible spending accounts (FSAs) as a special type of insurance policy. We prove the following results given losses drawn from a continuous distribution: (1) the optimal election amount, F^*, is increasing in the consumer's level of risk aversion; (2) F^* is increasing in the level of the maximum loss; If utility is decreasing in absolute risk aversion (DARA), then F^* is (3) decreasing in income and (4) increasing in the marginal tax rate.     

Asset Revaluations in the Accounts of UK National Health Service Trusts

This paper reports the results of an investigation into the impact of the revaluation of fixed assets on the reported results of NHS ambulance services. It recalculates the accounting rate of return of individual trusts after removing revaluation adjustments and examines the published responses of trusts. The numerical analysis demonstrates that, in general, revaluation has depressed the stated rate of return in an inconsistent manner. Failure to meet the required rate of return may cause a trust to be subjected to additional monitoring and management reorganisation while the trusts respond by explaining deviations in the accounting return measure by referring to revaluations and other technical adjustments. Management decisions made in response to these accounting measures may be sub-optimal in delivering health care but appropriate in achieving the desired accounting outcome.     

Implementing Evidence-Based Practice in Health Care

This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application.     

医保改革面临挑战

当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程,并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例,探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

印度的医疗卫生融资改革

印度公共医疗卫生支出水平较低,且在各邦之间分布不均。中央政府拨款对于各邦政府自身医疗卫生支出具有替代性。本文认为,要推进印度医疗卫生事业改革,必须扩大公共医疗卫生支出,提高政府支出效率,并重新设计转移支付制度。     

医保改革面临挑战

当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程，并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例，探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

Working Across Professional Boundaries: Primary Health Care and Social Care

Effective joint working between health and local authorities, and between health, social services and housing professionals, has long been recognized as vital to the provision of 'seamless' services for the most vulnerable members of society. Unfortunately, the history of formal joint working over the past 20 years has been largely a poor one. In this article the authors outline the findings from a recent study of working alliances across the primary health care/social care boundary. They examine how obstacles are being overcome and how, in some localities, the essential ingredients of inter-professional and inter-organizational trust are leading to the improved integration of services.     

对个体纳税户建账情况的调查

据调查,目前个体纳税户建账工作进展缓慢的主要原因是个体户的非税负担沉重,发票管理使用不规范,个体纳税户税务管理存在许多缺陷,税法宣传不到位.对此,必须采取有效措施,大力推进个体纳税户的建工作.     

Monitoring Targeting Performance When Decentralized Allocations to the Poor Are Unobserved

How can a central government monitor the performance of a decentralizedpoverty program when the incidence of the program's benefitsis unobserved at the local level? This article shows that, usinga poverty map and the corresponding spending allocation acrossgeographic areas, one can identify the latent differences inmean program allocations to the poor and the nonpoor. The nationalmeasure of targeting performance can also be decomposed intosubgroups. An application to an antipoverty program in Argentinais used to assess the program's performance before and afterreforms. Increases in funding and changes in program designbrought large gains to the poor, although performance differedacross provinces.     

人口老龄化对医疗费用的影响研究——基于北京市的实证分析

人口老龄化问题是一项世界性难题,本文利用2008-2014年北京市时间序列数据进行实证分析了老龄化对于我国医疗费用增长的影响。结果发现:老龄化与医疗费用增长之间存在正相关关系,老龄化的人均医疗费用弹性为0.558,在人均医疗费用增长的贡献率为4.9%。其次,医疗技术进步、人均GDP增长等因素对于医疗费用的增长贡献率显著,其影响不容忽视。本文给出的政策建议是合理调整生育政策,发展老龄化产业,实施银色经济发展战略。此外还要有效的规制新技术和新药品的应用,遏制过度医疗等行为,已达到合理控制医疗费用增长的效果。     

Prices and Protocols in Public Health Care

This article addresses the problem of how to determine the optimalallocation of public expenditure in the health sector. The firstpart poses the question: How should the set of services providedin the public health care system and the fees charged for thembe chosen to maximize the health status of the population witha fixed budget? First, the findings show that policy reformshould take into account the response of the private sector.Substituting for a reasonably well-functioning private sectoris not as valuable as providing services the private sectorcannot. Second, the assumptions needed to justify the cost-effectivenessof medical interventions as a criterion for setting prioritiesare so restrictive as to make this method usable in few, ifany, circumstances. Third, prices for any one service shouldbe set to balance the conflicting goals of encouraging its useand of conserving the budget for more effective services. The second part broadens the objective of policy to cover thestandard welfare economics concerns of utility and market failure,that latter being extensive in the health sector. It reexamineswelfare maximization rules to show that only the market failurecomponents of shadow prices are needed to calculate the welfaregains from public investments.     

Accounting, Modernity and Health Care Policy

The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy.     

论资本帐户开放的条件

资本帐户开放条件的不完备，是导致金融风险的主要因素。我国当前在对资本帐户开放条件的认识上还存在着不足，缺乏从动态和系统的角度进行分析。实现资本帐户开放的目标，关键条件是建立健全良好的金融监管体系和高效的机制。     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers.     

医疗卫生保障满意度调查研究——以辽宁省沈阳市为例

目的:对医疗卫生保障满意度进行研究,为构建公平、可持续发展的医疗保障制度提供科学依据。方法:根据调查目的,设计一套完整的问卷,运用计算机辅助电话调查方法(CATI),抽取2300各样本进行医疗卫生满意度调查。结论:有效样本中,34.5%的居民选择满意和比较满意,44.4%的居民选择一般,21.1%的居民选择不太满意和不满意。医疗卫生保障满意度为59.4分。