公共服务设施步行可达性对住宅价格的影响——基于累积机会的可达性度量方法

构建节能环保低碳的“绿色交通体系”是目前解决城市交通及其一系列衍生问题的重要举措。“将生活与服务混在一起”对于提升步行效能、促进步行和降低机动交通需求有重要的现实意义。公共服务设施步行可达性,反映居民获取公共服务设施的难易程度,对住宅价格具有资本化效应。文章以厦门岛1840个普通多/高层住宅为样本,通过累积机会法评价教育、商业、医疗和文体4种公共服务设施的步行可达性,并构建特征价格方程来检验公共品在住宅市场的资本化方向与程度。研究发现,教育、医疗和商业3类公共服务设施的规划布局已资本化入住宅价格：教育和商业服务步行可达性对住宅价格有正向影响,而二/三甲医院步行可达性有负向影响;省示范小学步行可达性对房价的正向影响大于重点中学;市区级文化体育中心对房价的影响不显著;此外,建筑面积、小区内部环境、商业中心距离等因素对房价都有显著的影响。特征价格模型也实证估计了各特征变量对住宅价格的影响程度。     

Are Factor Substitutions in HMO Industry Operations Cost Saving?

Past research on the potentials for cost-saving scale and scope economies in multiproduct HMO operations in the United States are incomplete in their economics of the underlying technology structure. This article exploits the translog cost model estimates of all past studies of HMO production to infer the extent to which pairwise factor substitutions (e.g., administrative services vs. medical care resources, e.g., hospital days, physician services) suggest potential for cost savings in groups and independent practice associations. Given the industry's nonhomothetic production over a 20-year period, the conceptually valid Morishima elasticity measure at constant output reveals limited cost-saving potentials from factor interchange and input demands. These opportunities differ for groups and IPAs across Medicare and non-Medicare products. My findings add a timely and significant dimension to understanding potential cost savings in HMO operations. Policy suggestions and cost implications are rationalized in light of the declining Medicare HMO enrollment and recent changes in factor input prices.     

Market Share and Price in Dutch Home Care: Market Power or Quality?

The paper uses unique data on contracts concluded by providers of home care to evaluate the effect of provider market power on prices of home care services in the Netherlands. Since, at least in some regions, one or two providers dominate the market, there are concerns about the effect of providers’ market power on the pricing of home care services. Using data on contracted prices and quantities for 2004–2006, we find that providers with a larger market share are able to contract at a higher price. The effect remains after controlling for quality.     

The role of for-profit hospitals in medical expenditures: Evidence from aggregate data in China

The health care delivery system in China, which is dominated by state hospitals, is being increasingly challenged by public concerns: it is too expensive and too inaccessible, a complaint commonly phrased as “kai bin nan, kan bin gui” in Chinese. As the penetration of for-profit hospitals has gradually increased, there is a growing need for policy research to assess their impact on medical spending from the patient perspective. Using panel data at the provincial level in China, this paper examines the impact of the penetration of for-profit hospitals on average medical expenditures for both outpatient and inpatient services in public general hospitals. Based on fixed-effect model estimates, the study shows that the penetration of for-profit hospitals has lowered the average medical expenditures for both inpatient and outpatient services across regions, especially for pharmaceuticals. Together with other results, this study finds no evidence that private for-profit hospitals drive up average medical expenditures while serving their profit-maximization objectives. Rather, they help increase the market supply of health care, which in turn better serves the increasing demand.     

DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS1

The research presented in this paper provides an analysis of the delivery of a few health care services by the public sector in Gauteng, South Africa. The data for the study was especially difficult to collect, suggesting the need for hospital level data information systems, as well as staff who are trained to analyze the information collected. The empirical results from the analysis suggest that services provided by small‐scale medical facilities waste fewer resources, while medical centres offering more technical services, such as surgeries, also appear to deliver medical services more efficiently.     

政府采购残障公共服务的现实困境与对策——以长沙市为例

为应对日益增长的残障公共服务的需求,政府购买非营利组织所提供的残障公共服务是必然选择。本文以长沙市作为个案研究,从购买残障公共服务的现状与困境出发,探讨中国政府购买残障公共服务的经验与不足之处,并提出了相应的对策。     

长三角非中心区城市“医养结合”养老服务需求研究——基于安徽省蚌埠市的调研

长三角地区非中心区城市大多属于经济欠发达地区，人口老龄化使得这些地区的社会养老问题凸显。而“医养结合”集中医疗和养老功能的新型养老模式可以作为缓解老年人口养老压力的有效手段。积极推行长三角地区一体化“医养结合”新型养老服务，应进一步明确长三角非中心区城市“医养结合”养老结合保障需求因素。通过对长三角非中心区典型城市安徽省蚌埠市老年人进行问卷调查的方式收集数据，采用Logistic回归模型进行分析，得出结论:老年人健康状况与参加“医养结合”意愿呈负相关；购买过商业健康保险和商业意外保险与参加“医养结合”意愿呈负相关；“医养结合”的服务类型也对“医养结合”意愿有显著影响，并以此提出相关政策建议，以期促进中国养老产业的转型和升级。     

Planification de l’offre de soins et télémédecine

The existence of geographical disparities in the French supply of medical care begs the question of the adjustment between needs and effective access to medical care. This access depends on the sharing out of financial resources, first between regions and second between medical infrastructures in each region. The two priorities of the government in the field of Health, which are equality in medical care access and the control of medical public spending, may obviously be conflicting. The concentration of medical activities in some regions and the agglomeration of specialized hospitals in urban centers can be observed. So the methods used by the government to plan medical supply seem to be inefficient in resolving this geographical imbalance. The use of Information and Communication Technologies (ICT) in the field of Health appears to be an innovative solution. In particular, the development of telemedicine may resolve the problem of medical supply concentration. The first contribution of the paper is to develop a theoretical model in order to explain the French disparities in hospital medical care access between urban and rural areas in the same region. It describes the allocation of public funds to hospitals in a region, which determines the medical care supply in this region. We show that the optimal allocation mechanism leads to large disparities between the two areas in terms of quality of medical care access and of utility. Second, we introduce telemedicine into our model to measure its effect on the inequality in medical care access. We show that telemedicine increases regional utility only if the urban area has a great advantage in terms of medical infrastructures. This result implies that telemedicine has to be considered as an alternative to public policies attempting to re-allocate the funds between the two areas. We then propose some public policy recommendations concerning the development of telemedicine.     

居住安排与社会支持对老年人医疗服务利用的影响研究——以上海为例

文章在对上海市静安区老年人进行随机抽样调查的基础上,采用tobit模型分析了居住安排与社会支持对老年人治疗性医疗服务利用的影响,采用logit模型分析了居住安排与社会支持对老年人预防性医疗服务利用的影响。研究发现,居住安排与社会支持对老年人医疗服务利用具有显著影响,但对不同层次、不同类型的医疗服务利用影响不同,同时,老年人的自理能力水平对这种影响发挥调节作用。在我国已经实现了医疗保险全覆盖的背景下,拓宽社区支持功能,提高老年人医疗服务的可及性并提升基层医疗服务质量应成为医疗政策的重要议题。     

Exchange Rates,Domestic Prices,and Central Bank Actions: Recent U.S. Experience

Central banks that are primarily concerned with the behavior of prices will use monetary policy to try to insulate prices from exchange rate changes. Prices then appear unresponsive to changes in the exchange rate. The observed relationships between prices and the exchange rate will reflect central bank actions instead of the underlying relationship between exchange rates and prices. This paper explicitly recognizes the role that policy plays in determining the observable relationships between exchange rates and prices, and in so doing, it illustrates how the underlying relationships can be unraveled. Using three different empirical approaches, we examine the recent experience of the United States. We find that the prices of various nondurable goods, and even of some services, respond modestly to the exchange rate, and we find that the responses emerge most clearly when the role of monetary policy is explicitly considered. These findings are consistent with the hypothesis that the Federal Reserve acts to mitigate the effects of exchange rate fluctuations on domestic prices.     

Substitutional effect of long-term care to hospital inpatient care?

In China, many of the top- and second-tier hospitals are overcrowded, this is partly due to the fact they are providing services which can provided by other medical facilities such as long-term care. The implementation of the Qingdao Long-term Care Medical Insurance (LTCMI) which began as a pilot in Qingdao in 2012 may alleviate the burden of overcrowding in these hospitals. In this pilot, the Qingdao government shifted patients who did not require hospital inpatient care from top- and second-tier hospitals to lower tier facilities, care homes and home care to i) reduce the expenditure of patients, ii) reduce the burden on the top- and second-tier hospitals and iii) improve delivery (from a time and geographic perspective) of long term care to those that need such attention.The purpose of this paper is to assess the impact of this policy from a burden and cost perspective. Our finding suggests that there is a reduction in costs to all stakeholders. The total cost to the government-subsidized medical insurance decreases by around $7918 RMB per recipient. The cost to the individual decreases by around $2324 RMB per recipient. Thus, netting a decrease of $10,242 RMB in total expenditure. Furthermore, we find that there is a 12% reduction in inpatient service after a recipient participates in the pilot. Given the reduction in costs and admissions, this does indicate some level of success with the program. This paper concludes by examining the policy implications of these results.     

In Data We Trust? An Analysis of Indonesian Socioeconomic Survey Data

What if a popular dataset that has generated a large amount of literature has been misunderstood and has led to misleading inferences? This paper examines household expenditure data from the Indonesian National Socio-economic Survey (Susenas), which started more than 50 years ago. Appropriate use of Susenas data for policy analysis requires an understanding that the survey’s expenditure variable does not measure true out-of-pocket expenses, because it includes subsidies received by households when obtaining goods and services. We also highlight an abrupt change in the survey instrument that occurred in 2015, when the reference period for certain items was extended. For health items, this generated a change in the expenditure series that can be misinterpreted as being the result of a social health insurance reform introduced in 2014 to lower the health care burden on households. Accordingly, we propose a way to account for this artificial expenditure movement in Susenas.     

Pricing rules in a mixed economy: an expanded example

Conclusion The purposes of this paper are two-fold. First, to establish the conditions under which piecemeal welfare policy is still useful. Second, to demonstate a method which can be used to remove the outstanding problem that arises in attempts to apply the General Theory of the Second Best. In both cases, policy-makers can turn to the real-world data on prices, quantities, and incomes.The authors demonstrate how the data can be related back to the form of the utility function. If the underlying utility function is found to have a certain property (in particular, if it is additive), then piecemeal welfare policy is appropriate, and definitive pricing rules for nationalized industries are established. Policy-makers are shown how economic theory and data can be combined to resolve puzzling problems. The general principles developed in this paper can be applied to a wide range of other policy problems.     

Adverse Selection and the Demand for Supplementary Dental Insurance

In 1995 dental services were excluded from the compulsory health insurance package that covers the families of all Dutch employees in the market sector with incomes below a certain threshold. People had to choose between no insurance and supplementary insurance. The exclusion of dental services was unexpected and was accompanied by a generous acceptance policy and almost uniform premiums. Due to these features the exclusion constitutes a natural experiment to investigate whether customers with poorer teeth conditions are more likely to buy insurance. This is a key condition for adverse selection to matter. The empirical results show that adverse selection indeed occurs; individuals with poor teeth condition are more likely to choose insurance. The same holds for customers with more frequent visits in the past. Differences in prices play some role, whereas differences in income do not.     

Measuring Core Inflation in South Africa

Measures of core inflation convey critical information about an economy. They have a direct effect on the policymaking process, particularly in inflation‐targeting countries, and are utilised in forecasting and modelling exercises. In South Africa, the price indices on which inflation is based have been subject to important structural breaks following changes to the underlying basket of goods and the methodology for constructing price indices. This paper seeks to identify a consistent measure of core inflation for South Africa using trimmed means estimates, measures that exclude changes in food and energy prices, dynamic factor models, and wavelet decompositions. After considering the forecasting ability of these measures, which provide an indication of expected second‐round inflationary effects, traditional in‐sample criteria were used for further comparative purposes. The results suggest that wavelet decompositions provide a useful measure of this critical variable.     

Employment,welfare and reserve effects of global protection

Summary In this article it is shown that expenditure-switching policies, like exchange rate protection, tariff protection and export subsidizing, might increase the level of employment and welfare in the short run (when indexation of factor prices is absent). Complete indexation of factor prices, however, makes exchange rate protection senseless. In the case of tariff protection, complete indexation will even worsen employment and welfare (protection becomes impoverishing). Only a policy of export subsidies makes sense if employment is to be improved in an indexed economy. This additional employment, however, is paid for with a deterioration of the terms of trade and the risk of retaliation. Therefore, taking the long run view, expenditure switching policies should be rejected for macro-economic purposes. The author is professor of international economics at Tilburg University. He would like to thank Dr. G. van Roij of the department of economics at Tilburg University and an unknown referee for their remarks, which led to an improvement of this article. The author is professor of international economics at Tilburg University. He would like to thank Dr. G. van Roij of the department of economics at Tilburg University and an unknown referee for their remarks, which led to an improvement of this article.     

社区医养结合的经济评估方法及应用

社区医养结合是一个复杂的系统,其可持续发展受多因素影响,因此对其进行经济评估理应成为政府进一步推广该类项目工作的必要环节。根据不同目的或不同背景,评估者可采用成本-最小化、成本-效益、成本-效果等狭义经济评估方法,也可采用成本-效用、成本-结果、多准则决策等更广泛的经济评估方法。评估实践表明,由于其复杂性特性,经济评估结论分歧较大。因此,社区医养结合经济评估方法的选择应该适合需要支持的决策过程。     

基本医疗卫生服务均等化——基于熵值法对山东省7地市比较分析

基本医疗卫生服务均等化是实现全民健康覆盖、促进社会公平的重要战略。但是由于地区经济发展不平衡、政府财力不均等原因，区域间基本医疗卫生服务还未实现均等化。为了解山东省基本医疗卫生服务均等化现状，选取2010—2019年山东省7个地级市基本医疗卫生服务数据，构建包含3个二级指标、7个三级指标的基本医疗卫生服务均等化指标体系，利用熵值法确定权重进行均等化指数的测度，并结合实际对山东省基本医疗卫生服务均等化进行分析，为政府制定卫生政策提供依据。结果显示，各市均等化程度存在较大差异，各级政府应结合当地实际，从资源配置、财政制度及监督制度等方面采取相应措施来减小地区间的均等化差距。     

苏南现代化建设示范区经济、人口与社会医疗保险——以常熟市居民基本(农村合作)医疗保险为例

经济社会发展、人口老龄化和现代化社会医疗保险制度建设的关系,是当前苏南现代化社会医疗保险制度建设的重大课题。文章基于对常熟市居民基本(农村合作)医疗保险的研究,发现:政策延续与经济发展是以常熟市为代表的苏南现代化建设示范区社会医疗保险制度建设取得改革发展先机的重要因素;持续加深的人口老龄化程度对社会医疗保险基金安全和补偿支出结构的负面冲击已经逐步显现;提高补偿标准和改革支付方式在一定程度上优化了参保居民就诊结构,增强了社会医疗保险的宏观经济保障能力,但长期对提高社会医疗保险制度的宏观经济保障能力的作用非常有限。基于以上研究发现,提出政策建议:通过吸纳外来务工人员以优化参保人群年龄结构是解决人口老龄化挑战的关键;重视疾病预防,特别是慢性病早期预防,加强多部门疾病预防协同合作是应对人口老龄化的重要措施。