Health Care Reform: Separating Insurance from Income Redistribution

Most systems of health care financing in EU member states currentlyinclude elements of income redistribution. The paper analyzesthe effects of shifting this kind of redistribution to the taxsystem and argues that this reform could create two types ofefficiency gains. On the expenditure side, it would facilitatethe adoption of more incentive-compatible insurance contracts,for example through the introduction of copayment schemes. Onthe revenue side, income redistribution through the general taxsystem is likely to imply a shadow price of public funds thatis lower than if redistribution is carried out through wage-basedinsurance contributions.     

美国医疗保险扩面改革之路的里程碑

虽然美国有两大类三大层次的医疗保险体系,但没有实现如其他大多数发达国家那样的全民医保,缺乏一张覆盖全国的社会医疗网络,始终是美国近10年来备受诟病的社会问题.没有医疗保险的问题始终处于社会政策争议的前沿和核心.之前克林顿总统失败的改革方案核心就是实现全民医保,15年后,奥巴马新医改方案又明确将扩大覆盖面作为其改革的重中之重.然而,历经波折得以通过的奥巴马医改法案却依然面临诸多反对和抗议,其中最为核心的是关乎强制参险的条款.2012年6月28日,美国最高法院裁定奥巴马医疗保险改革的大部分条款合乎宪法,最具争议的强制参险也得以保留,这意味着美国在实现全民医保时代的进程中向前迈出了一大步.     

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。     

Evaluation of Efficiency in Primary Health Care Centres: An Application of Data Envelopment Analysis

The aim of this paper is to analyse one of the principal problems in primary health care management: the evaluation of efficiency in primary health care centres. Given the special characteristics of measuring outcome in primary care it is necessary to evaluate the performance of centres from a quality perspective too. The methodology used, DEA (Data Envelopment Analysis), allows us to introduce quantitative and qualitative variables in a sample of primary care centres in a Spanish province. Once the efficiency of the different centres is known, we investigate the sensitivity of the methodology to changes in the definition of outputs used.     

经合组织国家医疗融资结构的收敛：经验与启示

摘要：医疗融资是医疗体制中的一个重要组成部分,具有募集资金、分担与降低风险、购买医疗服务等功能。文章基于17个OECD国家1972—2010年间的医疗融资数据,采用公共融资占医疗总融资的比例和人均公共融资作为收敛检验指标,利用盯收敛和p收敛两种判定收敛的方法,结果显示,总样本中这两项指标均发生了收敛现象,收敛的程度随医疗体制类型和时间段的不同而不同,且并非总是单调的。文章的结论虽只是初步的,但深入研究医疗融资结构收敛及其成因和效果,必将对我国医疗体制改革尤其是医疗融资政策设计具有重要意义。     

The Meaning of Balanced Scorecards in the Health Care Organisation

This study investigates the introduction of balanced scorecards in a health care organisation. It analyses a top-down control system, built on measurement, in a medical professional context, where attempts at implementing systematic performance auditing are expected to meet resistance. The study shows, however, that balanced scorecards, redesigned by medical professionals and used in a dialogue about service activities and finances, are regarded attractive successors to criticised financial control systems. In the light of the markets, hierarchies and clans perspective, developed by Ouchi, this popularity becomes comprehensible. Balanced scorecards are seen to reduce both the ambiguity of performance evaluation and the goal in-congruence between parties in the organisation.     

论人人享有基本卫生保健之改革

本文通过分析"看病贵、看病难"原因而导致的阻碍人人享有初级卫生保健的主要因素,提出必须深化卫生体制改革,发展基层社区卫生服务、建立覆盖全民的基本医疗保障制度以及实行均等化的公共卫生服务和基本药物制度,以实现人人享有初级卫生保健的目标。     

碎片化医保制度设计弊端与农民工医保模式路径选择

我国二元社会保障模式的构建思维一直影响我国保障制度的建设,导致我国医保制度建设呈现碎片化趋势,农民工医保制度也受这一传导机制影响。鉴于碎片化医保制度存在的诸多弊端和单独构建农民工医保模式存在的制度缺陷,农民工医保模式的路径选择应该是纳入现有保障制度框架。当前最关键和最紧迫的问题是提高现有医保制度统筹层级、解决三大医保制度接续以及加强农民工医保制度的配套建设。     

Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit

The Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.     

Audit as Leviathan: Constructing Quality Registers in Swedish Health Care

This paper explores the rise of an audit practice: the national quality registers in Swedish health care. Based on actor‐network theory, the study tells the story of an actor‐network formed by physicians in the 1970s who mobilized themselves around a common object; to develop the knowledge‐base of medical professionals. However, over time more actors became persuaded of the potential of the network and associate themselves with it, resulting in reformed registers. The study shows how the network develops into a macro‐actor, a Leviathan in health care, how this macro‐actor comes to affect health care practices and how it contributes towards maintaining a new governance regime.     

内蒙古医药卫生体制改革惠民效应分析

深化医药卫生体制改革是党中央、国务院推行的一项重大惠民工程,也是内蒙古自治区区委、区政府确定的惠民实事之一.新医改固然千头万绪,但评价和衡量其成效的关键在于百姓得实惠.本文正是抓住这一突破口,来了解内蒙古自治区新医改阶段性进展,初步评估医改所取得的效果,分析和研究改革实施过程中出现的新情况和影响因素,为相关部门完善政策措施提供依据和信息支持.     

Modern Costing Innovations and Legitimation: A Health Care Study

This article is a study of the introduction of a modern costing technology—activity based costing (ABC)—into a health care organization which is undergoing change. The transformation of this organization is of particular interest as it focused on the experience of a service which had always existed by collecting blood, which is given as a free donation (the gift), and which is then converted into a variety of health care products. Typically, accounting innovations in the U.K.'s National Health Service are at the behest of central government: In this case, the adoption of ABC is on the initiative of the health care organization itself. The attractiveness of the specific costing approach from the perspective of the management of this health care organization is as an ingredient in legitimation—the portrayal of this entity as a 'complete organization'.     

我国医疗保险制度对新生儿健康的影响

医疗保险制度作为一项重要公共政策,对提升新生儿健康水平具有重要作用。国外学者关于医疗保险对新生儿健康的影响做了详尽研究。我国医疗保险制度与国外模式不同,但国内却鲜有研究关注此领域。本文采用倾向性评分匹配法,探讨医疗保险制度对新生儿健康的影响。本文的基本判断是:现行的医疗保险制度显著提高了新生儿的健康水平,并且对于流动人口及城职保参保对象等群体的新生儿健康的促进作用更大。这为进一步提高医保覆盖率、完善医疗保险制度提供了理论依据与决策支持。     

A Tale of Two Countries: Comparing the US and Chinese Housing Markets

The Journal of Real Estate Finance and Economics - The recent surge in property values in China has been similar to the surge in the U.S before the crash in 2007. This raises concerns about whether...     

隔代照料对老年人健康状况的影响——基于CHARLS的实证研究

"421"型家庭结构的涌现和人口老龄化进程的加快使隔代照料成为目前我国家庭照料的一种重要形式。但是作为隔代照料提供者的老年人,他们的健康状况却经常被忽视。本文试图通过使用2013年中国健康与养老追踪调查(CHARLS)数据,运用STATA数据分析方法,研究提供隔代照料与不提供隔代照料的老年人在日常活动能力障碍、自评健康状况和心理健康状况三方面的不同。研究结果发现,提供隔代照料对老年人的日常活动能力障碍、自评健康状况、心理健康状况三方面均产生了负面影响。     

Integrating Management Control and Human Resource Management in Public Health Care: Swedish Case Study Evidence

The debate on management reforms in the public health care sector has largely overlooked the role of human resource management (HRM) and its potential interaction with traditional management control (MC) mechanisms. This paper explores which factors associated with the integration between MC and HRM may foster organisational learning in a public health care setting. A case study in a public dental practice is used for examining this issue. Apart from highlighting the influence of various task characteristics, the case study suggests that the vertical as well as horizontal dimensions of integration are important to consider in this context. Implications for further research are discussed.     

Downside beta and the cross section of equity returns: A decade later

This study reexamines the relation between downside beta and equity returns in the United States. First, we replicate the 2006 work of Ang, Chen, and Xing who find a positive relation between downside beta and future equity returns for equal‐weighted portfolios of NYSE stocks. We show that this relation doesn't hold after using value‐weighted returns or controlling for various return determinants. We also extend the original sample, add AMEX/NASDAQ stocks or utilize alternative downside beta measures and still find no downside risk premium. We focus on factor analysis results, persistence of downside beta, and various subsamples to understand the economic reasons behind the findings.     

城乡居民医保逆选择的破解——一个基于不同人口年龄需求的设计

逆选择困扰了我国城乡居民医保事业的可持续发展.在原有的大病和重病保障之外,基于不同人口年龄需求设计一个有条件、有限度和有年龄差别的特殊医保待遇方案,让参保者在没有享受到大病重病医保待遇的情况下,也可获得一些与年龄相称的医保待遇.这一设计除了能增加参保的弹性,让各年龄群体都自愿积极参保,还可增强居民的健康意识,提高居民的健康水平,减少居民和医保的医药开支.此外,它还能促进基层医疗服务业的发展.     

An Empirical Re-Examination of the Cross-Section of Expected Returns: UK Evidence

This paper is a study of the Fama and French (1992) analysis in the UK context. Consistent with their findings, our results do not support a positive relationship between beta and average monthly returns. We find that book-to-market equity and market leverage are consistently significant in explaining UK average returns. Contrary to the Fama-French evidence, size has an insignificant effect on average returns. A puzzling negative beta-returns relationship is found in some monthly regressions,and results based on annual data reveal a reversal of betas for the smallest-size portfolios. Some possible explanations are offered for these findings.     

强制首诊和双向转诊——神木“全民免费医疗”的下一步

在＂强县扩权＂背景下,2009年3月神木县启动＂全民免费医疗＂政策,实现了基本医疗服务的城乡一体化。这一制度与其在教育、就业、养老等方面的新政一样,不断探索着资源型城市实现基本公共服务均等化的新思路。本文通过对神木县＂全民免费医疗＂实施以来的居民满意度及制度运行状况的调研,指出神木医改中存在的主要问题：（1）神木县农村三级卫生服务网络不健全,乡镇卫生院作用发挥有限,医疗资源浪费与短缺并存;（2）为解决过度医疗问题而出台的控制医疗费用的细则在实际运行中效果欠佳。基于此,我们建议实行＂守门人＂制度,引入强制首诊和双向转诊制度,并设计出双向转诊和费用报销的程序及其配套制度,以期为神木医改出现的问题提供解决方案,同时为其它地区实现基本公共卫生服务均等化目标,提供一个有益的借鉴。